Provider Revenue Excellence

Americas

Enabling health systems’ top-line performance through proven analytical- and technology-enabled operations approaches to growth, pricing, and yield realization

Health systems face mounting pressures against top-line performance, including a greater range of sites of care competing for consumers’ utilization, an increasingly complex payment process, and declining reimbursement escalators for services rendered, that pressure top-line performance. We draw on our extensive industry experience and pool of experts to provide distinctive insights and deploy proven analytical and tech-enabled operational approaches to support health systems.

What we do

Holistic approach to revenue excellence

We partner with health systems to earn appropriate patient volume across all sites of care; ensure that payer contracts provide a fair unit price; design effective, value-based agreements; and achieve optimal yield realization through the revenue cycle for services rendered.

Increased share of addressable markets

We bring expertise to health systems on asset-footprint strategies, clinical program and workforce development, continuity of care, and more, using a comprehensive approach to the operational activities that support appropriate volume growth.

Improved partnerships with payers

We bring distinctive capabilities, including a focused approach to aligning contracting outcomes with operations, that enable health systems to excel along the full managed-care-contracting life cycle.

Optimized end-to-end revenue-cycle performance

We use ready-to-deploy assets, playbooks, and practical experience across the revenue cycle to ensure optimal yield realization while maximizing important, adjacent variables, including patient experience, cost to collect, and cash flow.

Featured capabilities

We invest in developing a variety of proprietary tools and databases to assist in provider-revenue excellence.

Referral-mapping insights: We help health systems improve care continuity and overall experience for patients and providers through improved physician-network integrity, including use of insights on physician-to-physician and physician-to-facility referral patterns to identify gaps in access and gaps in knowledge of relevant options within the health system.

Physician prioritization tool: We partner with health systems’ business-development teams and use a tool to facilitate prioritization and alignment of team capacity to physicians in a market, including the use of a data-driven approach to implement call logs and ongoing tracking to understand the team’s impact.

Denial prevention suite: We use a suite of tools to automate denial-prevention workflows, with transparent sharing and reporting of the root causes of denials and potential solutions. In conjunction with these tools, we have developed proven processes and training materials that complement the technology.

Rapid revenue-cycle diagnostic: We developed a detailed analytical tool that helps assess revenue-cycle opportunity across six priority levers highlighted based on our experience in revenue-cycle transformation and achieving near-term operational results.

Comprehensive benchmarking insights: We deploy our benchmarking tool to assess the competitiveness of negotiated rates at varying levels of granularity (by market, payer, provider, and service) and identify underlying drivers of variability by using market data and proprietary benchmarking algorithms.

Examples of our work

Continuity of care

A regional health system had approximately 25 percent of its patients with commercial insurance report not having an existing relationship with a primary-care provider or practice. We helped institute a process for follow-up scheduling for unattached patients after emergency-department visits, realizing a $3 million contribution gain in a pilot facility. When rolled out across the system, it contributed to up to 8% of growth over 12 months.

Network integrity

A large, multistate health system had flat rates of network integrity over an 18-month measurement period across its core markets. Using our referral-mapping suite, we helped the system improve its continuity of care, resulting in a 20 percent increase in in-network-consult referrals, a more than 25 percent increase in per-month visits, and contributed to over 11% of growth over 12 months.

Revenue-cycle performance

A large not-for-profit system was struggling with high initial denials rates and high denial-related write-offs. We developed a comprehensive denial prevention program to address these issues. Data flows were established to push a subset of denials through the suite to end users to identify root causes and develop actionable solutions. Support infrastructure of denial committees and reporting analytics were implemented to manage solution deployment and track impact. In a short period of time, the client achieved a 15-20% reduction in initial denials in regions where the efforts had focused, with an expected run-rate impact of over $10M and cash acceleration in excess of $40M.

Major contract renegotiations

A large health system that was struggling to secure market access at rates commensurate with its value sought to improve its managed-care-contracting capability and optimize contract performance. Over nine months, we partnered with the system to transform the function, implementing a system-level-contracting capability and securing more than $250 million in incremental contract value across ten markets.

Featured insights

Article

Ensuring financial sustainability while serving a growing Medicaid population

July 19, 2019 -

High-performing health systems have succeeded in “breaking even” in Medicare, but many continue to struggle to achieve similar results in Medicaid. A concerted effort to improve revenue can strengthen a system’s financial sustainability.