In the past year, much has been written about the Triple Aim and its three-pronged approach to effectively stop the proverbial hemorrhaging of resources and skyrocketing costs in our nation’s healthcare system. The approach has been an effective catalyst in the transition from a pay-for-service model to a pay-for-performance one. This change is improving the patient experience and increasing overall outcomes while decreasing costs. As we enter the new year, this trend will continue – and that’s a good thing.
For many healthcare providers, the science of delivering effective care, that is diagnosing, treating ultimately healing people was a means to a heartfelt end: helping people. That propelled them into their respective fields.
The obligation to improve the patient experience, an essential component of the Triple Aim, is easily understood. With recognition of the flaws within our healthcare system, everyone from the patients, the providers or the payers agree improved outcomes is the overall goal.
To that end, we are developing more effective methodologies through advanced platforms, telehealth and integrated systems, among others. However, when it comes to the bottom line of optimizing financial resources and decreasing costs while maintaining a healthy revenue stream, many providers find themselves positioned far outside their comfort zones with more questions than answers.
Let’s examine a few areas promising more positive change in behavioral healthcare.
Complacency is Costly
No provider can afford to be lulled into complacency. While most behavioral healthcare providers are well educated as to how to recognize and work with patients in denial, complacency with regard to revenue streams is nothing more than its own form of denial. Any provider who sits on the sidelines this coming year will be left behind and succeed only in positioning their facility for a future of declining revenue.
The Demand for Predictability
With so much emphasis placed on the Triple Aim, more resources and attention is being placed on behavioral healthcare providers. Payers have begun to demand predictability in the treatments and services in which they are paying and expectations for empirical data will soon be a requirement providers must meet.
In most other segments of healthcare, this demand has been met by way of outcomes data based on biological markers, predictive assessments and other standardized measures. For behavioral healthcare providers, embracing telehealth and tracking the rates of success in post-treatments will enable them to collect, analyze and demonstrate their outcomes. When payers request predictability, providers can respond with data.
The good news is, as the transition from pay-for-service to pay-for-performance continues, providers have a wealth of information, resources and answers at their disposal. Revenue cycle management need not to be a source of concern for any provider, rather it is an opportunity to make informed decisions as to how to maximize deliverables while maintaining a healthy revenue stream. Maximizing reimbursements will require a specific focus on these three areas:
1. Integrate your revenue cycle management with your entire organization
The sound of silos being dismantled across the fields of healthcare will continue to reverberate throughout 2017. We know that there is a wide range of PM systems in place in many different facilities and organizations, however data aggregation in vendor-neutral applications will continue to make it easier to improve communication and collaboration.
2. Embrace data collection and predictive analytics
Data collection is no longer a new concept in behavioral health. Nearly every aspect of healthcare has some form of data collection and measurement component. Empirical outcomes data empowers providers with the ability to demonstrate their effectiveness, to personalize and extend their services, which ultimately reduces the need for readmissions and helps to contain costs. Treating the whole person through a population health management approach will be the future of every behavioral healthcare provider.
3. Proactive prevention rather than reactive management
Receiving feedback that a claim has been denied can lead to delays, backlogs and a clogged revenue stream. Denials ultimately cost time in appeals and have a negative effect on the fluency of any providers’ ability to submit claims and optimize reimbursement. Providers must be proactive in their approaches to claims and take a position of preventing potential denials before they happen.
The Good News
There are indeed certain pain points every provider will experience as the transition to pay-for-performance takes hold. However, by taking an informed, proactive position and arming themselves with forward-thinking revenue cycle management resources, providers will have no interest in costly complacency. There is a great deal of opportunity for every provider to fully optimize their revenue streams and now, more than ever, is the time to step into the future of realizing the Triple Aim and benefitting from it.
Karen Pilley is the chief operations officer at MAP Health Management, LLC., located in Austin, TX. Mrs. Pilley has more than 30 years of experience in areas of healthcare billing and collection, revenue cycle management, government and managed care payer regulation and compliance. MAP specializes in behavioral health population management and provides services to nationally recognized addiction treatment and behavioral healthcare providers. MAP Revenue Cycle Solutions is a wholly owned subsidiary of MAP, specializing in revenue cycle management.