REVENUE CYCLE TRANSFORMATION Improving performance through revenue cycle automation. It’s not about whether or not to transform. The real question is how to make it sustainable. These are not easy times for financial operations at many U.S. healthcare organizations. Many are now expecting an increase in the insured population (as more Americans become eligible for health insurance) and a decrease in reimbursement (as healthcare systems move towards new payment models). At the same time, margins are getting squeezed. Now is the time for healthcare organizations to turn their attention toward improving their revenue cycle processes and activities with the aim of increasing efficiency, driving out costs and—ultimately—shoring up sagging margins. Five potential benefits of automated workflow Reliability: Processes are repeatable, automated, and more streamlined, which helps reduce variability Profitability: Aligning revenue cycle activities with high value outcomes may positively impact the bottom line Improved efficiency: Identify the next highest value activity for maximum value; repeatable processes may contribute to a smoother-running business Predictability: More potential for projects and tasks to be completed on time with a reduced cost model Increased productivity: Higher request resolution means that end users have what they need to do their jobs RC 1.0 Traditional assessments, recommendations, and options and implementation Due to a change in organizational focus or change in personnel, benefits erode over time. RC 2.0 Automated workflow design and deployment Automated workflow allows for repeatable, quicker paced, and sustainable improvements even when personnel changes, since workflow is hard-coded. RC 3.0 Automated workflow with process enabled analytics Allows for deeper penetration into root cause issues and enables automated workflow to be able to perform continuous monitoring of microprocesses that are likely to contribute to delays in processing bills, delays in cash flow, loss of revenue and increase costs. 80 + Percentage of organizations experienced clear benefits as a result of automated workflow implementation according to the Info-Tech Research Group. “ We believe healthcare organizations must urgently start to evolve the way they manage their revenue cycle by moving towards an automated ‘workflow’ environment rather than a traditional ‘work list’ approach. In other words, they need to supercharge their process from the traditional ‘Revenue Cycle 1.0’ to jump to something more like ‘Revenue Cycle 3.0’. ” -Randy Notes, Principal, KPMG © 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks of KPMG International. Printed in the U.S.A. REVENUE CYCLE TRANSFORMATION A five-step lifecycle At KPMG LLP (KPMG), we view revenue cycle transformation as a five-step process, allowing our clients to deliver truly transformative activities within a controlled environment. 1 2 3 4 5 odeling: Revenue cycle processes are modeled to document current M state. imulation: The revenue cycle processes are simulated in order to identify S process gaps. treamlining: The processes are streamlined through reengineering to fill S gaps and help eliminate bottlenecks. utomation: Automation is introduced into the processes wherever A possible. anagement: The processes are monitored through process analysis, M alerting management when changes are needed, thereby ensuring improved outcomes are achieved. Leveraging process analytics to drive improvement Process Analytics By combining automation, process codification, and process metrics, organizations can create a process analytics driven model. An automated approach to the revenue cycle provides three key business benefits: (pros-es an-l-it-iks) n. the ability to access data about individual instances of a process by using data to monitor, analyze, and improve an organization’s critical operating processes. 1. It improves processing efficiency (some claim up to 50% reduced processing times in key areas), which ultimately means more money is being collected on time. 2. It reduces the workload for end users which, in turn, means that more work can be done or headcount can be reduced through the utilization of automation techniques for those more consistent and routine tasks. 3. It can help reduce some of the risks inherent in the revenue cycle by allowing the system to determine when and where activities should take place. Do you need an automated workflow? • Have you driven 20% of costs out of your revenue cycle over the past five years? • Have you improved net revenue annually? • Have you reduced your headcount by 10%? • Have you improved processing times by 50%? • Have your revenue cycle improvements been sustained over time? If you answered “no” to any of the above questions, you likely need to think about implementing an automated workflow approach. “ By taking a process analytics approach, organizations understand not only where the anomalies are in their processes, but also identify the root causes of those anomalies. Knowing you have a problem is great, but knowing what to do to resolve that problem and reduce process cycle time is even better. ” -Michael Duke, Managing Director, KPMG For more information about the benefits of automated workflows, contact: Michael Duke Managing Director [email protected] Sue McBride Principal [email protected] The information contained herein is of a general nature and is not intended to address the circumstances of any particular individual or entity. Although we endeavor to provide accurate and timely information, there can be no guarantee that such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one should act upon such information without appropriate professional advice after a thorough examination of the particular situation. Some or all of the services described herein may not be permissible for KPMG audit clients and their affiliates. Randy Notes Principal [email protected] Patrick Spoletini Managing Director [email protected] © 2014 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. The KPMG name, logo and “cutting through complexity” are registered trademarks or trademarks of KPMG International. Printed in the U.S.A.