AGS Health is working on health equity, and helping hospitals do more | ViVE Conference

Nashville - AGS Health works with scores of hospitals providers on revenue cycle management and helping sure organizations get money more quickly, but the company is also working with organizations on health equity.

Cheryl Cruver, chief revenue officer of AGS Health, spoke about the growing interest in health equity in a conversation with Chief Healthcare Executive® at the ViVE Conference.

“Health equity is on what I call the whiteboard of priorities for most health systems,” she says. “It is certainly an imperative.” (See part of our conversation with Cheryl Cruver. The story continues below.)

AGS is working with coders at health systems to ensure that they are putting in essential information on the social determinants of health: the factors in a patient’s neighborhood or home environment that could be affecting their health.

Some patients might have “limited access to transportation, live in a food desert … they don't have family to take care of them if they're discharged from the hospital,” Cruver says. “All of those are social determinants that can be coded in the medical chart.”

“So we not only do that with our coders, but our technologies also capturing that type of evidence in the chart,” Cruver adds. “And then you have some of the data so you can do something with it.”

As Cruver says, a payer could have a program to provide ride-share services for patients with limited transportation options, so the health system can follow up with the patient after being discharged from the hospital.

“By having that data in the coded chart, then you have the ability to use analytics and identify cohorts of patients that you can then have specific interventions that can help deal with health equity issues,” Cruver says.

Health systems are increasingly interested in health equity, she says. AGS Health held a webinar on health equity that drew 1,000 coders.

“We know that it's a high priority for our customers,” Cruver says.

Health systems and hospitals continue to struggle with serious financial headwinds, and they’re facing difficulty with talent shortages, including coders.

“A lot of medical coders are nearing retirement age and coding is more important than ever now for health systems,” for clinical and billing reasons, Cruver says.

Given the economic challenges health systems are facing, more hospitals are looking for help with revenue cycle management, she said.

“Health systems are dealing with declining reimbursements or an increase of denials because payers have made it more and more difficult to cross the hurdle to get paid with pre-authorization requirements that are increasing,” Cruver says.

Health systems are running toward automation to take some of the repetitive tasks away from organizations and allow staff to work on more critical and complex processes.

“We’re working with many health systems that are looking to lower costs,” she says.

At the same time, health systems need to find ways to not just cut costs but get more revenue.

“Hospitals are looking for solutions that can ensure that they’re getting paid for the work that they’re doing,” she adds. “So that means accurate coding.”

Some leaders are coming together to devise solutions on revenue cycle challenges and collecting money more quickly and efficiently.

Some are learning from each other on “the art of the possible,” Cruver says.

“We have some customers that get together as revenue cycle leaders, along with their IT leaders and share best practices,” she says. “And I think that's awesome. And so, having that ability to see where others have found impact, and then deploy similar strategies that might work for their particular situation, I think is really helpful. We learn from each other.”

Health systems and hospitals are increasingly focused on spending less time and money in battles with insurers over approval for treatments.

“One of the things most of our customers are focused on is reducing denials. So that is one of their top priorities,” Cruver says. “Some of it is understanding the denials. And we can do that through analytics. But then it's really having a plan to target the causes of those denials.”

That’s where healthcare leaders need to utilize technology and partner with experts in revenue cycles to get preauthorization “and then the denial on the back end is reduced,” she says.

“That impacts how quickly the customers are paid,” Cruver says.