How Processes are Really Executed in Healthcare?


In today’s healthcare ecosystem, every health system, hospital and physician is being asked to do more with less. Healthcare providers face increasing pressure to manage revenue, optimize utilization and reduce costs. At the same time, they must also fulfill their primary duties: preventing illness, optimizing care and improving patient outcomes.

From clinical decision support systems (CDSS) to electronic health records (EHR) to medical coding and billing applications, health systems have made massive investments in technology. Stakeholders are inundated with data and, despite having access to reams of information, are often forced to make crucial operational decisions without complete insight due to disparate data definitions, data silos and operational inefficiencies.

How does one make better decisions? Process intelligence is the crucial first step in helping organizations better understand and improve the processes that drive competitive advantage. One good example is the revenue cycle.

Under the microscope – revenue cycle management

For healthcare organizations (HCOs) to improve their end-to-end revenue cycle operations, they need a clear view of what’s happening and why. The revenue cycle is obviously more than just how money flows into the organization. It ultimately touches every corner of the healthcare provider landscape – across dozens of systems, hundreds of processes and untold numbers of workers. Understanding the revenue cycle is critical so HCOs can improve the right processes to realize benefits quickly.

The revenue cycle starts at the front office with patient scheduling, insurance eligibility and treatment authorization. Too often, the critical tasks of accurate verification and upfront patient collection are not fully appreciated.

The middle office represents the clinical activity in the revenue cycle. It generates data flows between front and back offices pertaining to patient evaluation, diagnostic activities, laboratory services, medical treatments, clinical records and medical coding. While the middle office determines patient outcomes, it also impacts whether HCOs get paid for their services.

The back office handles claims and collections after patient care is completed and medical reports and coding have been submitted. This is where claims management, medical billing and final patient collection take place.

An optimized revenue cycle thus balances multiple stakeholder priorities across an already complex ecosystem. Process intelligence gives the transparency needed for buy-in.

Adapt to healthcare disruption

Healthcare disruption shows no signs of abatement, whether from pandemic variants, staffing shortages or new regulations. Simultaneous pressures to digitize, innovate and scale operations are being exacerbated by the shifting expectations of patients, technology evolution and new healthcare business models. Process optimizations and adjustments are needed, but moving forward with misdirected – or inadequate – responses will cost more lately.

A process intelligence solution decodes work at every level, with no biases, blind spots or gaps. HCOs can then use this data-driven analysis to optimize operations, automate repetitive processes, accelerate supply chains, increase compliance and controls, and streamline logistics and much more. Even with changes across business lines, regions and alliances, process intelligence provides continuous and comprehensive coverage so that HCOs can identify risks, optimize work and focus on sustainable growth.

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