In sync for success: Industry challenges require collaboration among providers and suppliers | Viewpoint

Once considered luxuries, new technologies and AI-enhanced solutions to manage the business side of healthcare have now become necessities for providers.

Tom Cox

We saw interest in modern approaches gain great momentum during the COVID-era, which is now transitioning into widespread adoption. It comes at a poignant time.

As the industry is increasingly burdened by inflation, complex regulations, staffing shortages, and ever-changing payer rules, the role of these innovations and the administrative partners that provide them have evolved warranting a much closer and collaborative relationship.

Both healthcare and solutions providers must embrace new technologies and work together to move toward a more integrated, efficient, and patient-friendly healthcare system. It’s a big task, but the industry has made a lot of progress in this respect and both parties are poised for a breakthrough year.

What provider and supplier moves will dominate 2024

While the pandemic accelerated adoption, the healthcare industry is just finding its groove with technology to address administrative and operational challenges. As a result, we’ll continue to see a flurry of technology and AI-powered solutions launched with vast experimentation by providers, while the supply chain will condense as suppliers seek to win market share in this space.

Providers will look to technology with vigor in 2024 to address key issues including the staffing shortage and rate of claim denials. It’s warranted. A recent survey shows that 96% of respondents reported a direct impact on their organization's revenue channels due to staffing shortages. Specifically, 32% identified patient collections, and 22% cited payer reimbursements as the most affected areas due to shortages. There will be high demand for automation tools and digital front door services.

For those supplying these services, we can expect more mergers and acquisitions, and strategic alliances among small companies to offer a robust and streamlined experience to providers. We already saw movement in 2023 with companies like Olive AI winding down operations by divesting its revenue cycle unit to Waystar and R1 RCM, a revenue cycle management company, acquire Acclara from Providence, one of the largest health systems in the U.S.

System complexities call for AI

One of the biggest challenges for providers in 2024 and beyond will be the growing complexities of managing revenue cycle data, workflows, and claims with an increasingly decentralized system.

The industry's trend towards fragmentation, characterized by the rise of urgent care centers, standalone laboratories, niche imaging facilities, and ambulatory surgery centers, presents a double-edged sword. On one hand, it offers consumers greater convenience and accessibility to healthcare services. Patients now have more options than ever for where and how they receive care, often with reduced wait times and increased availability.

On the other hand, it introduces more complexity. For healthcare professionals and institutions, it poses challenges in maintaining continuity of care and effective communication across different facilities.

Providers and payers must adapt to a more complicated billing and reimbursement environment. As a result, there will be more expectations on technology and services to collect and manage data faster and comprehensively so that providers have the right information at the right time during the patient journey.

We’ll see more AI-powered solutions that can provide real-time data and insights but it’s up to providers to harness them. Currently, adoption on the business side is still low due to initial underperforming solutions on the market that didn’t deliver true AI with attributes like predictive modeling. However, there is progress on this front so providers should keep an open mind.

Revenue cycle taking center stage

There is no question that optimizing the revenue cycle must be a priority. The American Hospital Association (AHA) released a chilling report last year revealing severe financial strains on hospitals, impacting patient care.

In 2022, expenses, spanning workforce, drugs, supplies, and operations, surged by double digits compared to pre-pandemic levels. This created the toughest fiscal year since COVID-19's onset, with over half of hospitals ending 2022 in financial losses, and negative margins persisting into 2023.

Providers should be developing a proactive strategy and look across the patient continuum for opportunities to improve data flow and collection, especially on the financial front. This starts at the beginning of the journey when patients register and schedule appointments all the way through to claims submissions after care is delivered.

There are several ways technology can help improve this process to make it easy and streamlined for the patient while delivering efficiency and accuracy for the provider. Unfortunately, a third of hospitals haven’t used automation in revenue cycle management and nearly two-thirds haven’t automated any part of claim denials management.

Beyond using newer technology such as AI, there is skepticism in general about applying technology, especially in place of human hands, hindering advancement. Providers should not tackle strategic planning alone. They should collaborate with suppliers to discuss needs, challenges, and key performance indicators to feel confident in using new solutions while being able to measure success. A close symbiotic relationship can only help both parties move the needle towards an improved healthcare system.

The future of a healthcare system that is more efficient, financially robust, and more in tune with the needs of patients is possible. It rests upon providers and suppliers guiding the path forward together.

Tom Cox is president of Experian Health, which provides revenue cycle management and patient engagement services.