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How Healthcare Leaders Are Preparing for Tomorrow

Written by Eli Santibanez | Oct 2, 2024 2:57:16 PM

Day one of Becker’s 9th Annual Health IT + Digital Health + RCM Conference provided healthcare leaders with essential strategies for navigating complex payer relationships, harnessing innovations in revenue cycle management (RCM), and managing electronic health record (EHR) transitions. The panels presented an insightful mix of real-world challenges and innovative solutions, creating a roadmap for optimizing healthcare operations in the coming years. Here’s a more detailed look at the critical takeaways from the day.

 

Enhancing Payer Relationships: The Power of Data and Dialogue

Improving payer relations was a central theme, with panelists emphasizing the importance of data-driven engagement and proactive strategies. A recurring issue highlighted was the discrepancies in data reconciliation between healthcare providers and payers, which often lead to delayed payments and inaccurate patient attribution. Randy Farmer, Chief Operating Officer of the Delaware Health Information Network, described how real-time data exchange can transform payer-provider relationships:

“We deliver results in real time… if one of our members gets discharged, admitted, or transferred, they get a notification within minutes. This enables payers to engage members immediately, reducing avoidable readmissions and improving overall care coordination” .

Similarly, Will Flett, CFO of ThedaCare, stressed that understanding payer contracts in depth—from rates to appeals processes—allows organizations to work more effectively with payers. He advocated for a collaborative approach, explaining that while disputes are inevitable, knowing the specifics of each payer’s requirements allows providers to resolve issues swiftly. He also touched on value-based contracting, noting how discrepancies in payer data can undermine performance:

“We think we’re doing well at the start of the year, but when we get data from the payers—sometimes six months later—we see where we’re not aligned. The challenge is reconciling that data and correcting mistakes before they become major issues”.

Dr. Jerilyn Morrissey brought an additional perspective, focusing on the growing significance of Medicare Advantage. With over 50% of Medicare beneficiaries now enrolled in these plans, Morrissey urged healthcare organizations to anticipate more regulatory changes. She pointed out the need for vertical integration, where hospitals collaborate more deeply across the care continuum, particularly in post-acute and pharmacy services, to improve outcomes and align better with payer expectations.

 

Protecting the Revenue Cycle - Embracing Automation and AI

The discussions on protecting the revenue cycle over the next five years centered heavily on the role of technology, particularly automation and artificial intelligence (AI). Stephen DelRossi, Interim CEO and CFO of Northern Inyo Healthcare District, emphasized that while automation promises increased efficiency, it also faces resistance from staff:

“One of the biggest challenges I’ve encountered is convincing staff that automation isn’t here to take their jobs but to free them from tedious, repetitive tasks so they can focus on more valuable work.” .

Jennifer Lavoie of Rush University Medical Center took a pragmatic view on AI, warning that organizations should carefully evaluate whether a tool marketed as AI is truly artificial intelligence or simply a robust analytic engine. The difference matters when integrating these tools with existing systems like EHRs:

“AI must have foundational information—tons of data to work with. But sometimes what’s being sold as AI is really just advanced analytics. It’s critical to understand what you’re buying, how it integrates with your EHR, and whether it will deliver the expected ROI.” .

Beyond automation, cybersecurity emerged as a top concern. With the increasing prevalence of cyberattacks on hospitals and health systems, panelists emphasized the need for constant vigilance. Penetration testing and robust security protocols should be part of every healthcare IT strategy, as vulnerabilities in these systems could result in catastrophic breaches .

 

Lessons on  EHR Transitions

One of the standout sessions on Day 1 focused on the challenges of managing EHR transitions, a process that often disrupts the entire revenue cycle. Donelle Dellar, Director of Operations and Training at VCU Health, shared lessons from her organization’s transition to Epic, highlighting the consequences of insufficient staff training. According to Dellar, the decision to provide only minimal training to front-end staff before going live resulted in significant financial setbacks:

“We spent two and a half years retraining our staff from mistakes made in the first five days of go-live. Our training wasn’t tailored to what our staff actually needed to know, and that resulted in costly errors.” .

Dellar underscored the importance of tailored training programs that take into account the specific needs of various departments. Additionally, having a dedicated in-house training team proved instrumental in addressing post-launch challenges. By closely examining workflows and aligning the EHR with the needs of their revenue cycle, VCU Health was able to recover millions in lost revenue .

Perhaps one of the most valuable insights Dellar offered was the role of listening and collaboration during an EHR switch. She stressed that engaging staff from clinical and administrative sides in open discussions about what was and wasn’t working helped build trust and fostered a culture of continuous improvement:

“We formed a process improvement team to hear grievances, evaluate workflows, and fix what was broken. Trust between the clinical and RCM teams was key to our success.” .

Success Through Collaboration and Technology

The first day of the conference established a framework for how healthcare organizations should approach the future of revenue cycle management. The key takeaway was clear: collaboration and technology are at the heart of any successful strategy. Whether it’s improving payer relationships, implementing AI, or managing EHR transitions, the focus should always be on aligning teams, optimizing technology, and preparing for the regulatory and operational challenges ahead.

By embracing proactive communication with payers, harnessing the power of AI and automation, and ensuring staff are equipped with the right tools and training, healthcare leaders can protect and enhance their revenue cycles, setting the stage for sustainable success in an increasingly complex landscape.