Hospital Systems Place High Value on Acquiring Actionable Analytics to Optimize Efficiencies, Improve Revenue Cycle Management

Author: Jonathan Farr, Senior Vice President North America, EFFY

Hospital leaders face substantial challenges in terms of aggregating and comparing vast datasets to identify and correct problems. The substantial amount of data is prompting these healthcare organizations to recognize this deficit in their existing systems.  As they learn about the value and benefits of actionable analytics to address and solve problems in virtually every aspect of operations, they’ve begun to adopt new technology now available on the market. A significant benefit is that these new platforms overlay current transactional systems to deliver a cleaner, smarter and cost-effective solution. 

One new platform fine-tunes an existing Revenue Cycle Management (RCM) transactional system, and eliminates the need to replace any existing system, even if that system is not ideal. Costs are reduced because RAID HEALTHCARE -- an end-to-end software platform used worldwide by leading healthcare systems, telecom companies, utilities, retail and other complex industries -- costs less than a replacement system, and is more powerful.  

Furthermore, there are no disruption costs related to adapting to new processes, which can take months for a full system conversion. Even after completion, disruption is magnified by delays associated with playing “catch up” and making corrections. In fact, a new RCM system, including disruption challenges, can cost a large enterprise as much as $50 million.

By simply overlaying an actionable analytics system powered by RAID HEALTHCARE, managers can quickly gain control of aggregating data, and detecting/resolving issues that impact revenue integrity, as well as clinical and operational performance, in a way that is the most cost-effective.

The first step is to understand the value and benefits of actionable -- not simply transactional -- analytics to address and solve inefficiencies in virtually every aspect of operations.

The Function of Data Varieties

Healthcare enterprises have three varieties of physical data located within their numerous information systems, each characterized by their data types and purpose within the organization. Transactional data supports the on-going operations of a healthcare organization; analytical data is the numerical values, metrics and measurements that provide business intelligence; and master data plays a key role in the core operation of a business.  

Actionable data is where hospital organizations gain the ability to define the rules and set validations. The most effective, efficient approach to data at the enterprise consolidation level stems from completely merging all data from multiple sources, so that comparable data has the same name and format.  

By merging the data, users can create the ability to answer consolidation questions, such as “What was total revenue throughout the enterprise?” From there, organizations can drill down to see all the component parts that make up that revenue number.  

Here’s an example of how actionable analytics work: If a drug treatment is changed to one that requires pre-authorization, an alarm is sounded, so the pre-authorization can be requested.  The alarm is triggered by data originating from the pharmacy system (or module if incorporated across one large system) and matched to the third party payer’s requirements for pre-authorization. Without this capability, payment is denied. With it, a series of 14 questions enables the organization to save millions of dollars.

Analytic Tools in Action

Sophisticated actionable analytics systems allow a hospital to use any data from any transactional system to set up sophisticated alarms to detect issues immediately.

An analyst, using a RCM solution built upon RAID HEALTHCARE has the reconciliation and analytical tools to rapidly respond to any alert. Instead of channeling the issue up through all of the relevant departments, which is time-consuming and demands the attention of a number of people, the analyst can simply offer an integrated workflow to guide a “fix,” resolving the problem quickly, and improving the bottom line.  

Finding the Right Actionable Data Platform

Healthcare organizations should look for an efficiency platform that overlays existing systems to help them compare massive amounts of data across their total enterprise, detect exceptions and problems, and guide interventions to improve efficiency that optimizes financial, clinical and operational performance.

The platform should also be powered with unique actionable analytics and function as a permanent, protective 24/7 auditing and reporting ‘umbrella’ that makes data comparable. By choosing the right actionable analytics platform, hospital leaders can rapidly take action while generating significant ROI within months of implementation.