Today, RCM company leaders all over the world have realized the importance of embracing and leveraging, the capabilities of information technology, to improve business outcomes for themselves and their clients. The level of accuracy and precision that can result from integrating Robotic Process Automation, Machine Learning, and Artificial Intelligence into RCM is extraordinary and if done first and done right will be revolutionary. This is the real-world truth and you cannot delay accepting it and acknowledging that this is going to be the future of RCM and your business. If you think otherwise, I advise you to start updating your CV today.
The biggest challenge with integrating technology into RCM is the lack of Subject Matter Experts (SMEs) who understand the technology and the lack of Technology Experts (Techies) who under the Subject Matter. And as a result, you guessed it, there is constant tension. The tension between the two teams that result in poorly developed solutions that replace a current problem with a new one. What a shame.
Did you know that the USA contributed to 37% of the world’s healthcare expenditure in 2017 but had only 4% of the world’s population? Something is seriously backward about this country’s healthcare system. Anyways, let’s come back to RCM. The USA spent approx. 8% – 12% of that expense towards the cost of collections, which includes RCM Services, Software, collections agency fees, and related administrative costs and overheads. As RCM leaders, we can do something about that, something significant enough to change the lives of millions of people seeking affordable and safe healthcare. (Now if the word ‘Affordable’ got you thinking about ‘Value’ based healthcare, trust me, you have more time to deal with that. So stay with me on implementing ‘Technology’)
Your current staff needs reassurance (repeatedly and consistently) that their jobs are not at stake as a result of supporting the development and deployment of intelligent IT solutions. Otherwise, they are never going to contribute their wealth of knowledge and expertise towards building IT products that truly deliver the desired outcomes. I strongly believe that it is not a fabricated story you tell your staff. It is a fact. There is so much growth and opportunity to increase your client base through competitive pricing and demoing your robust solutions. Your staff can be reassigned to grow into a higher level of thinking and contribution as your business grows.
Think through this again, your staff is sure to lose their jobs eventually if they don’t contribute towards this transformation today. That does not mean you use fear to drive the change, this fact is just for you to find your motivation to ensure the longevity of your employee’s jobs. Now if that does not motivate you, I really don’t know what else to say (facepalm).
2. Selecting the Right People for the job
Your transformation team should contain the right balance of attitude, knowledge, and skill. Attitude tops it all. Here is why. It is far easier to train a Techy on RCM than it is to train an RCM expert on IT solutions. You need to find an IT lead who understands the importance of learning RCM and even going to the extent of doing some of the RCM functions for a short time to gain a decent sense of the subject. Give your tech lead examples of contrasting specialties, systems, and denials so that it gets his/her thinking more and more in line with what the solution should entail.
3. Balance 'Short Term Gains' with 'Long Term Sustainability'
Your tech team will be eager to use off-the-shelf bots to eliminate small portions of manual labor. Everyone is motivated to show quick wins, even the boss likes quick results and faster ROI. Today there are off-the-shelf attended and unattended bots that can take away manual processing of ERAs, Extract Claim Status from web portals and even update large sets of data on multiple systems. It is easy to purchase these bots and take away the obvious direct tasks, but don’t lose focus on the ultimate goal of why you started down this path. Sustainable solutions are critical to longevity than short-term patches. My advice, reinvest every saving from the quick wins back into building a platform (foundation) that can over time exponentiate your unique value proposition. What I mean by the platform is creating a larger pool of talent that foresees the future of RCM and architects a foundation on which you can build more solutions. This will over time replace your quick win bots (patches) and build a sustainable flow of information, intelligence, and rules.
4. Start today
Do not waste time pondering upon whether you must invest in technology. The opportunity cost is immense. Make the move. Start by asking your team to look at what the competition is doing and how you can be competitive 5 years from now. When they come to you with their findings (which will have technology on the top of their list), it will be easier for you to get them on board with the mission
5. Enjoy the Change
Keep your Eye on the Price and keep your teams focused on the enormity of benefits. The promise of a technology-enabled RCM is badly needed for the Healthcare industry. Think of all the resources you will have freed up and the savings you can use to invest in growth and sustainability.