Change Healthcare Predicts Exponential Impact of Rev Cycle AI

We’re seeing increased leadership provided at the process layer in terms of technology as well as a redefinition of the service model. Technology is becoming more intelligent and more data is being brought into the conversation for predictive insight.

Penetration in outsourcing is outstripping sector growth. One out of every four providers is leveraging tech vendors and penetration is growing at a rate of over 4x the overall market — a strong sign that providers need more support executing their RCM frameworks.

• Processes are becoming more complex.
• Reimbursements are shrinking.
• Providers are consolidating, creating challenges in rev cycle and IT infrastructure.
• Regulations that impact the revenue cycle continue to emerge.

All of these contribute to RCM becoming more complicated and more difficult for providers to navigate on their own.

This is mostly happening in the form of high-deductible health plans (HDHPs). Patient balance after insurance (PBAI) has jumped over 80% since 2012 according to TransUnion and represents over 30% of hospital revenues. Patients are now a main point of revenue cycle friction, changing the way providers are thinking about RCM.

RCM is evolving in two areas. Core traditional jobs (scheduling, eligibility, claims management, patient collections) will continue, but providers will need to achieve higher levels of performance. This will increasingly encourage providers to turn to automation in an effort to reduce cost to collect, e.g. AI enablement. Additional evolution will occur in relationships with patients as RCM becomes more of a direct-to-consumer discipline.

There is consensus that data analytics can unlock tens of billions in the revenue cycle ecosystem, but providers aren’t taking advantage. According to Beckers, 40% of hospitals are struggling to establish and maintain an analytics team, even as providers only leverage a fraction of their data (estimates sit as low as 10%).

• Denials and underpayments: There is potential to unlock 2-3% easily as low-hanging fruit.
• Patient collections: Analytics can identify new opportunities.
• Up-front collections: Analytics will be key to identifying coverage sources.