The Major Revenue Cycle Management Trends of 2014
Revenue cycle trends have varied from payment platforms shifts to increased investments in IT solutions.
- There have been a number of developments from the last year that impacted revenue cycle management trends. From shifts in payment platforms and transparency to increased investments in IT solutions and care consolidation, it has been a busy 12 months. Here is a look at the top trends from 2014.
Value-Based Care
New payment and care models have been more prevalent as the transition from fee-for-service to value-based care becomes more popular. Insurance companies and Medicare and Medicaid programs are pushing for better relationships with accountable care organizations and different payment models including shared savings, co-management of service lines, bundled payment and patient-centered medical homes.
New government incentive programs were created throughout the year making the shift to these payment models more attractive. Recently, the Department of Health and Human Services announced that it has distributed $43.6 million in Affordable Care Act funding to 1,113 health centers across the U.S. for improved quality of care and the use of electronic health records.
Accountable Care Organizations have also had a larger impact in general. Earlier this year, there were 626 ACOs identified in the U.S. – 329 with government contracts, 210 with commercial contracts, 74 with contracts from both entities and 13 with no contract details. These health organizations service an estimated 20.5 million lives. These numbers have certainly grown since then.
The Centers for Medicare and Medicaid Services has also been tweaking the program. Most recently altering the risk/reward elements to improve enrollment and the quality of care.
“This proposed rule is part of our continued commitment to rewarding value and care coordination – rather than volume and care duplication,” CMS Administrator Marilyn Tavenner said in a press release. “We look forward to partnering with providers and stakeholders to continuously refine and improve the Medicare Shared Savings program.”
Transparency
The Sunshine Act and the Open Payments Database have made headlines since being enacted in September. The system is a living database of payments made to physicians and teaching hospitals from drug and medical device manufactures. It has received much criticism for being incomplete and requiring more vetting before it can be considered useful. This has lead some experts to call for patience.
This is not the only example of transparency in the healthcare arena. A number of platforms have also resulted in the release of payment information. Earlier this year, a court order was overturned that allowed access to payment information on individual physicians dating back to 1979. This new information is useful for improving care.
“Greater transparency in the healthcare sector, achieved by making information on the cost and quality of health services more widely available, ultimately could encourage providers to compete on quality and efficiency and lead to broader improvement in the delivery of care,” an analysis by the Commonwealth Fund of the court order states.
Healthcare Organization Consolidation
In 2013, there was a major trend of “mega-mergers” in the healthcare landscape. 2014 saw a different trend emerge as consolidation became more popular. This happened, largely because of the Affordable Care Act and the growing need for coordinated care.
The pressure of increasing operation costs, physician alignment initiatives, new care models, technology advancements and the limited access to capital has caused a number of different organizations to seek consolidation as a way to stay afloat or to take their operations to the next level. Companies could be looking to gain access points, create greater critical mass, population health management knowledge and a stronger presence in geographic areas or regions.
Healthcare Information Technology
It is no surprise that as society embraces more technology, the healthcare world is doing so as well. Over the last year, one of the bigger focus has been on population health analytics. There is less emphasis on diagnostic and therapeutic equipment and facilities. This has lead to an increase in telehealth, e-visit, mobile apps, electronic data warehouse, population analytics, big data, electronic health records and electronic prescriptions.
A recent report found that the North American payer IT industry is the largest contributor in the global healthcare payer IT market. It accounted for a share of 58.92 percent in 2013. Through 2018, the marketplace is projected to grow at a combined annual growth rate (CAGR) of 5.7 percent.
“With the increasing number of patients, the demand for a cost-effective and efficient accounting and recording system is increasing in the region, where payer IT solutions have been observed to meet these demands most effectively,” the report reads. “In addition, a high return on investment in healthcare IT sector has attracted heavy investments from the governments as well as top companies in the region.”
DIY Healthcare
With the growing increase in mobile devices and health applications, more patients are taking a “Do-It-Yourself” healthcare. While products like the Fitbit are already being used by consumers to improve their personal health, Apple made a major announcement this year when it introduced the HealthKit.
Unveiled during the summer’s Worldwide Developers Conference, it was officially added to the operating system (iOS 8) in October. It includes a dashboard that displays a health data including heart rate, calories burned, blood pressure, blood sugar, cholesterol and other similar functions.
This also came with the HealthKit, which is the accompanying developer application programing interface (API) included in the iOS Software Development Kit for the Mac. It can be used by software developers to design applications that have extensibility and that can interact with the mobile app.
Because of this increase in DIY monitoring, healthcare facilities will need to ensure they have the right systems and tools in place to access this information and improve overall care. Aftercare can be a challenge, but DIY monitoring creates a wealth of information that needs to be tapped into, but without a digital approach, it can go to waste.
