E-News Exclusive

Four Ways RCM Can Support the Latest in Collaborative Care

By Charlie Hutchinson

One of the upsides of value-based care is the emphasis on collaboration. Integrated care is no longer an obscure concept, but one employed regularly by providers.

Regulations such as the Centers for Medicare & Medicaid Services’ Psychiatric Collaborative Care Model offer primary care providers (PCPs) and behavioral health (BH) providers incentives for working together to provide high-quality care and improve clinical outcomes. Teamwork is also a key component of the Merit-based Incentive Payment System program under the Medicare Access and CHIP Reauthorization Act as a means to achieve Triple Aim goals: better health, lower costs, and a superior care experience. As expected, private health payers are following suit, rolling out care coordination and risk-based, shared-savings plans or contracting with providers through bundled payment programs.

However, we’re still playing catch-up on the revenue cycle management (RCM) side.

Many providers still rely on simpler, more straightforward approaches to RCM, centered on billing and collections and tailored to fee-for-service paradigms. On top of that, existing infrastructure doesn’t always support these complex collaborative care models; staff productivity and patient experience may suffer as a result.

Unsurprisingly, the rate of bad debt is rising for many practices, as well as denials, as they struggle to keep up with financial performance benchmarks.

To maximize the benefits of value-based, team-driven care, we need to reduce outdated RCM technologies and processes. We need to support clinical collaboration on the front end and the back end, so we can be more productive, efficient, and profitable.

Understanding RCM Trends
Before the 2010s, much of our medical care existed in silos. Patients were treated for low-acuity issues in one setting, and for chronic issues—such as ongoing mental health problems—in another. Doctors didn’t share information regularly.

Today, we rely on EHRs and other technology systems to ensure information flows freely from one medical setting to the next, across the care continuum. For example, we have the clinical technology to conduct remote psychiatric consultations or we can access a patient’s medication history with the push of a button.

But the revenue cycle gets tricky—even more so when you’re talking about collaborating with BH. Telehealth, for example, causes questions around state billing codes and requirements, physician costs, and payer network reimbursement.

While it’s impossible to swap out old RCM practices overnight, providers can improve productivity and financial performance within collaborative partnerships by promptly doing the following:

1. Outline collaboration goals. Integrating care with outside providers sounds easy but requires all partners to be on the same page. As a few health care writers have noted, forecasting payments is more challenging because revenue streams are dependent on new quality and cost performance measures, benchmarks compiled from peer groups, and episode costs beyond the walls of a brick-and-mortar practice. Communicating with outside partners (eg, BH providers) to ensure all parties in a collaborative relationship share the same patient-care goals is critical to success and saves a lot of time, energy, and money.

2. Take inventory of IT. Physician groups will have to improve data analytics capabilities and HIT infrastructure to keep up with collaborative care models, which aren’t as straightforward as their fee-for-service counterparts. Assessing key performance indicators at regular intervals—and deriving insights driving payment trends—will become essential to a practice’s bottom line. A practice should ensure that RCM technology investments can support these functions.

3. Improve scheduling efficiencies. Collaborative care is successful only when it runs like a well-oiled machine. Multispecialty practices realize this and are starting to leverage smarter scheduling platforms to streamline care for patients who need to interface with multiple providers. While a PCP’s scheduling software may differ from that of its BH provider, online appointment scheduling software can improve patient engagement while streamlining billing and RCM.

4. Change the patient revenue cycle. The real disruption to this cycle is consumerism—patients want more transparency into their costs of care. They’re more likely to possess high-deductible health plans and have higher out-of-pocket health care costs. Many patients receive surprise bills—in paper, I might add—for several hundred dollars months after their visit and aren’t always ready to pay them. In fact, a 2017 TransUnion analysis noted that as many as 68% of patients with bills of $500 or less did not pay their balance. Needless to say, patient bad debt and days in accounts receivable continue to skyrocket, and establishing smarter patient billing strategies, analytics, and up-front eligibility can go a long way.

As providers enter into more collaborative-care partnerships, the focus is still the same as it’s always been: patients. RCM must support providers as they transition into new care models, so they can focus on what they do best.

— Charlie Hutchinson is the CFO of InSync Healthcare, a provider of solutions for behavioral health and primary care practices.