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Adventist Health System

Partnering for Change: Addressing Revenue Cycle with Interim Management

Overview

Adventist Health System set out to change the way it delivered and managed healthcare, which included deploying cutting edge technology, efficient work flows and processes, and transparency throughout operations.

Case Study Adventist Health System Web Graphics 1

the challenge

Specifically, Adventist Health System leadership engaged in a mission to become a top-quartile performer nationwide for all competencies including quality, safety, patient experience, employee engagement, and employed physician practice operations by the year 2020. Leadership titled this mission Vision 2020, and the first step in the journey was to create a consistent medical record and billing platform across the physician enterprise. With that said, leadership was operating under an extremely aggressive timeline requiring deployment throughout seven states (organized within seven regions) and 13 medical groups in just over one year. This task demanded not only careful coordination pre-go-live, but also sustained support to ensure organizational goals were met and managed effectively. Complicating implementation requirements further, Adventist Health System leveraged the transition to athenaNet as an opportunity and catalyst to transform operational capabilities throughout the physician enterprise by instituting standardized work flows, policies, and procedures. These responsibilities were previously managed in a decentralized manner, therefore a revised governance philosophy and structure would be required to successfully implement and enforce revised standards. Moreover, the transition represented a significant shift in operating model, where the technology vendor became responsible for executing key components of the back office revenue cycle responsibilities. Simply stated, the transition presented an incredible opportunity for Adventist Health System, but also put the organization at tremendous risk to collections, system adoption, and organizational stability.

the process

To manage both the organizational changes and offer additional management capabilities, ECG partnered with Adventist Health System to develop a leadership position responsible for managing revenue cycle operational performance for each of Adventist Health System's employed physician groups ECG was responsible for developing a capability that could be replicated and adopted in each physician enterprise region, as well as support local practices to ensure that revenue cycle support, training, and best practices were deployed and enforced effectively.

To mitigate transformation risks successfully and ensure each region received the support required to meet collections and operating expectations, ECG collaborated with managers and stakeholders within each of the regions to develop adequate management support infrastructure.

Specifically, ECG partnered with Adventist Health System to develop processes and competencies to:

  • Monitor daily operations, inclusive of charge gathering, charge reconciliation, charge validation, data entry, billing, and collections.
  • Understand claim defects, cash flow, denials, and other key trends to manage daily operations effectively.
  • Manage regional relationships effectively through operating transparency and responding to inquiries quickly.
  • Enforce corporate policies and procedures through communication and education.
  • Collaborate with other regions to proactively update training and best practice materials and tools.
  • Standardize reports, tools, and processes to efficiently

ECG accomplished the objectives by:

  • Immediately inserting revenue cycle expertise into two underperforming regions to rapidly reinforce standards, improve financial performance, and secure support by demonstrating performance improvement.
  • Performing denials and charge error analysis to identify and prioritize opportunities, designed to reduce A/R, to decrease charge entry lag, and to increase cash flows.
  • Instituting a culture of continuous improvement and self-sufficiency by enforcing standards and educating teams on athenaNet functionality and best practice work flows.
  • Developing a more robust reporting and communication structure between practices, senior leadership, and physicians to provide increased visibility and confidence into daily operations.

While working to stabilize the regions, ECG also:

  • Developed a methodology detailing the global expectations for the new support role within the organization to drive performance within the regions.
  • Established standardized reporting tools and developed education to ensure information is interpreted as intended.
  • Constructed new or enhanced existing communication channels between centralized coding, A/R, and regional practices to enable increased collaboration between business units.
  • Identified common challenges across regions and developed education materials designed to further front- and back-office staff’s utilization of the best practices deployed.

the outcome

Over the course of eight months, ECG supported Adventist Health System's goals in the regions by developing a guide detailing the clear responsibilities of the newly designed support role. Equally important, revenue cycle performance improved substantially once the regional revenue cycle support role was implemented, including the following at the two regions managed by ECG:

  • An average reduction of over three days of A/R.
  • A 29% decrease in charge entry lag.
  • An average reduction of 39% in practice-specific claim errors.
  • A 10% increase in patient full-registration rate.

The role has been an integral part of Adventist Health System's transformation success and contributed to the financial improvements achieved to date. Without the regional support role, implementing and enforcing revised standards, controls, work flows, and policies would have been difficult to manage and oversee effectively, ultimately harming both system adoption and operating performance. The role provided the stability Adventist Health System required to succeed in its journey toward Vision 2020.

Case Study Adventist Health System Web Graphics 2