Healthcare Technology Featured Article

December 12, 2017

Hospital and Clinic Revenue Drivers for 2018-the Interoperability of Wellness, Chronic Care and Service Care Transitions

One ageless trend emerging for 2018 is the quest of hospitals, larger carriers and clinics to identify new revenue streams; not just managing revenue cycles, but creating them. The healthcare industry is now looking at revenue which can be generated through the interoperability of Annual Wellness Visits (AWV), chronic care and service care transitions between physical and behavioral health services. Hospital systems and other healthcare facilities that can connect these services with technologies such as bi-directional information flow will benefit by offering these services and creating a new profit centers of revenue through reimbursements by CMS and private insurers.

These types of market drivers are noted in The Global Healthcare Revenue Cycle Management (RCM) Software Market report for 2017-2021, issued a few months ago. The report predicts that the global Healthcare Revenue Cycle Management (RCM) Software market will grow at a CAGR of 4.50% during the period through 2021.

Meanwhile, global business researcher Radiant Insights issued a study in November reporting that the healthcare information technology market will have growth through 2022 of close to 50 billion.  Factors such as increasing focus on improving quality of care and clinical outcomes, rising need to reduce healthcare costs and minimize errors in medical facilities along with government support for healthcare IT solutions will drive the market. Increasing adoption of technologically advanced software solutions including EHR and EHR connectivity systems, e-prescribing and clinical trial management software and clinical decision support systems is helping to improve healthcare productivity.

Radiant points to up and coming organizations such as Zoeticx, Inc., a provider of medical software, that has introduced a cloud app called ProVizion Wellness. This software can be beneficial for streamlining data integration for Annual Wellness Visits (AWV) by offering interoperability through bi-directional data flow. Hospitals and other healthcare facilities are benefiting by providing this service through private and government insurers. This system provides management capabilities for supporting tracking ability on population progress for AWVs.  The report also mentioned prominent players operating in the healthcare information technology (IT) market include 3M Health Information Systems, Lexmark Healthcare, Conifer Health Solutions, and CSI Healthcare.

As the hospital revenue trend for 2018 looks promising, we are still facing the same old interoperability issues despite the advances in technology pointed out in the previously mentioned research.  What can hospitals and clinics do to be a revenue leader? As we move into 2018, it might be a good time to examine what is necessary to solve a complex problem like the ability of hospitals to link interoperability and the benefits that arise from adopting tools, technologies and concepts from unrelated landscapes.

However, the value of health IT lies in the robustness of applications. This might seem obvious since most of the technology we have direct experience with relies on the applications which drive value such as cloud based assets. For hospitals, investing in an application seems more prudent then investing in a protocol. However, by looking at the problems faced in healthcare, changing the perspective of the problem from an application-centric one to that of a protocol-centric view brings new revenue possibilities.

Protocols do exist in EHR’s, but instead of being the major component, they are accessories to help ‘glue’ things together, but what happens when hospital CIO’s invert the focus away from the application doing most of the work, to the protocol?  With this focus, hospitals have the potential to increase value while reducing the overhead on application maintenance and expansion.

Teaching Old Data New Tricks

From the perspective of hospital administrators and providers, the goal is to capture relevant patient information and ascribe meaning to the often disconnected pieces of data. It is not missed on healthcare professionals that productivity and revenue capture is an important component of the care delivery process. The adoption of technology in healthcare has added the additional burdens of ensuring that patient data has been captured and critically analyzed to ensure high quality, effective and efficient care.  At the same time, the data needs to placed in a context that supports diagnostic and billing codes to complete the cycle of care delivery.

Most systems have not been designed to integrate the billing and care delivery workflows, necessitating healthcare professionals to bring the integration to these two aspects of care. Technology has the potential to bridge this divide, and as has been demonstrated by Zoeticx with the ProVizion solution, automating and integrating the revenue capture with the care delivery component, we can achieve the clinical and financial requirements without the use of ‘human-powered’ integration.

One of the grand issues raised and a major impetus for the widespread adoption and implementation of health IT surrounds high quality, cost effective delivery of healthcare to the masses. Technology has the potential to address this, when properly designed.  The requirements for technology are to appreciate delivery from an abstract level, for the entire healthcare ecosystem while allowing for the solving of specific, context-dependent problems in the hospitals and clinics where the care is delivered.

Using the abstract perspective of protocols and applying this to the areas of the Annual Wellness Visit and chronic care management, clinics, hospitals and health system have been able to improve or create new revenue streams while healthcare professionals have gained enhanced performance by the automation of tasks that required manual and often cumbersome tasks to complete their workflow. Designing workflows that improve and integrate the care delivery while also meeting the quality, financial and billing metrics has been demonstrated by Zoeticx in the ever changing and complex health IT ecosystem.

About the Author:Donald Voltz is the Medical Director of the Main Operating Room for  Aultman Hospital in Department of Anesthesiology.  He is also as Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.  Board-certified in anesthesiology and clinical informatics, Dr. Voltz is a researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.

Edited by Mandi Nowitz

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