With such a stark contrast between the reality of healthcare data inefficiencies and the ideal of automated, consolidated, and integrated best practices, how can we bridge the gap? Look to the Cloud.
In an era of polarizing politics, there are few universally acknowledged truths anymore. But one thing is clear to every American: our healthcare system is inefficient.
The root causes behind the numerous inefficiencies vary from poorly implemented technology upgrades to constant diagnostic code changes. But no matter where we lay the blame, ultimately, we have to face the challenge to find solutions.
At Saxony Partners, we believe in problem solving. Here is why cloud-based data integration might be the key to transforming the healthcare industry into a well-oiled machine.
Common Healthcare Inefficiency Pain Points
Let’s start with the problems.
Two of the biggest roadblocks healthcare organizations face today are billing errors and regulatory changes. Alan Stein, Vice President of Saxony’s Healthcare practice, hears examples of these inefficiencies from clients every day. He said that issues surrounding billing errors and insurance coverage have changed the way patients seek care and clinicians provide it.
“Because healthcare costs are so high and insurance coverage is so sporadic, people have become more cautious about accepting services,” Stein said. “They are afraid to accept treatment they might actually need and risk paying out of pocket.”
Billing errors can originate from preauthorization, eligibility confusion, or diagnostic coding mistakes. The prevalence of these problems has led to an industry-wide trend of consumerization—patients are suddenly more concerned with the cost of their care than the quality.
“Patients have become more inquisitive, asking ‘What is this going to cost me?’ before they agree to start treatment,” Stein said “Healthcare providers are used to following the clinical pathway and providing the best possible treatment options, trusting that insurance will cover the bulk of it.
“Now it is much more complicated for physicians who are just trying to do their jobs.”
Stein said this phenomenon often leads patients to make decisions that aren’t really in their best interest, like substituting home remedies for prescriptions or putting off necessary treatment.
This is ultimately more expensive for insurance companies, because many of those patients will need a more aggressive treatment plan in the long run. It’s a problem for payers, providers, and most importantly, for patients.
Sometimes in an attempt to tackle inefficiencies head-on, our government has missed the mark. Upgrades to technology have cost the Centers for Medicare & Medicaid Services (CMS) $37 billion since 2011. But making the transition has not improved efficiency, and in some cases has made it even worse.
Similarly, updates to the diagnostic codes meant to provide additional clarity are ultimately time-consuming. One of the best examples of this phenomenon was the transition to ICD 10 in 2015.
But even minor ongoing changes cause disruption. Cameron McClintock, Business Development Executive for Saxony’s Healthcare practice, explained that if the software platforms healthcare organizations use do not update diagnostic code changes at the same pace, it can cause discrepancies in critical patient data.
“If your revenue cycle management (RCM) system doesn’t keep up with those changes, it is going to slow down your processes or deny claims as they come through,” McClintock said. “In order to stay on top of that, your RCM team needs to be trained in diagnostic code changes every year, or the software solutions you are using need to be reprogrammed to make sure everything is up-to-date.”
Healthcare Industry Goals
We know the practices in place for healthcare data management are not ideal. But what would the healthcare sector look like in a perfect world? Stein and McClintock said the focus is on three key areas: automation, consolidation, and integration.
Using resources like artificial intelligence and machine learning, healthcare providers can now reduce both time wasted on data entry and the potential for serious mistakes. This serves as a solution to physician burnout, to billing errors, and to the constantly evolving diagnostic codes.
“Automating as much as possible eliminates the potential for human error,” Stein said. “Automation reduces the complexity that’s driving errors within RCM and simplifies the process. Using a rules engine or machine learning, your technology platform can catch errors before they happen, make suggestions, and make it easier for humans to get things right.”
The RCM software market is hugely fragmented, so providers must pay multiple vendors and use different types of incompatible software. Consolidating that market would alleviate this problem.
“Since the RCM software market is so fragmented, providers have to juggle multiple different software platforms for all of their data,” Stein said. “That leads to duplicate entries for patient information, and greater potential for errors.”
All of the different software systems on the market store patient data differently. Payers and providers both need one single source of truth for data to eliminate errors and inefficiency.
“There are so many different systems and software tools used within a single healthcare organization that sometimes the data doesn’t match up,” McClintock said. “This forces the providers and the clinicians to log into multiple different programs just to submit or view a report. This causes conflicts or delays and wastes money and time. If they pull all of their data into a single source of truth within one platform, they can report on it without all of the headache.”
Healthcare Industry Data Solutions
With such a stark contrast between the reality of healthcare data inefficiencies and the ideal automated, consolidated, and integrated best practices, how can we start to bridge the gap? Here’s where the cloud comes in.
Before you can begin to automate internal processes, you have to make sure the data you’re working with is clean and organized, McClintock explained. Dirty data or data siloed into multiple different software programs will break the programs used for automation.
“You have to have clean data to automate these processes efficiently,” McClintock said. “At Saxony Partners, we break down the silos of disparate data. We focus on bringing data sets together so that you can transport clean, integrated data into an automation or machine learning platform.”
While consolidating the marketplace of RCM software is outside of healthcare payers’ and providers’ control, they can and should focus their efforts on data integration. One of the best ways to do that, Stein said, is to move data onto the cloud.
“Due to risk aversion, HIPAA compliance, and elevated data security challenges, the healthcare industry has been slow to move data to the cloud,” Stein said. “That exacerbates many of the key problems with integration and inefficiency. The good news is, cloud technology is more secure than ever before. We have helped numerous healthcare organizations take poorly integrated data solutions on-premises and move their information into one single source of truth on the cloud, while remaining HIPAA compliant.”
In order to embrace new automation technology that can make physicians’ jobs easier, healthcare organizations must embrace this new universal storage solution for their data as well.
“All of the latest innovation is happening within the cloud,” Stein said. “If you try address any of the inefficiencies we talked about without using the cloud, you aren’t going to catch up.”
Moving Your Healthcare Organization into the Future
Whether you are a healthcare payer or a provider, inefficiency is likely something that regularly causes problems within your organization. But you don’t have to wait for better products to hit the RCM market to start improving internal processes.
At Saxony Partners, we specialize in data management and custom software development. Our team members have real experience in healthcare and understand the pain points facing payers and providers today. We know the industry, and we have the technology. Let us help you build a better integrated data warehouse on the cloud and propel your organization forward to embrace automation and efficiency in 2020.