Themes Driving Innovation in Revenue Cycle Management: Looking Ahead to HFMA ANI

Each year, thousands of healthcare leaders and investors converge at the Healthcare Financial Management Association (HFMA) Annual National Institute (ANI) conference to collaborate on the industry’s most pressing challenges and captivating themes across the Revenue Cycle Management (RCM) landscape. This conference has quickly become one of the largest healthcare finance conferences of its kind, propelled in part by a reinvigorated RCM environment triggered by a combination of market forces: increasing regulatory complexity, shifting payment models and new value-based reimbursement initiatives, technological innovation and greater levels of automation, and an increasing focus on the patient as a much more critical component to financial viability and success for providers.

Looking ahead to the conference in Orlando, there are several key themes that we think will receive significant focus throughout the conference:

Patient Access Continues to be an Area of Opportunity. In an era of ever increasing complexity around benefits verification, prior authorization, and referral management, the patient access function for providers continues to be an area of focus, investment, and innovation. The importance of patient access is further emphasized by the fact that front-end RCM activities have the ability to drive enormous efficiencies throughout the back-end of the revenue cycle. As manual processes and complex, constantly changing payer dynamics place a heavy burden on providers, there is a wave of innovation coming from innovative RCM vendors positioned to solve this critical pain-point. At the forefront are new value-based “network” models of referring providers that coalesce and enhance the referral, appointment, and authorization processes as well as vendors offering advanced connectivity / eligibility benefits, patient pay estimation tools, and automated end-to-end authorization management capabilities. We see this as an area ripe for investment and innovation as these forward-thinking vendors continue to disrupt the legacy clearinghouse environment.

Exploring the Accelerating Patient Pay Opportunity. Hospitals have historically resorted to writing off large portions of their self-pay receivables due to the significant collection challenges inherent with patient pay receivables. However, patient responsibility now represents the third largest reimbursement stream for providers, forcing the need for new, innovative solutions that are able to collect these receivables in a profitable and patient-friendly manner. With legacy systems ill-equipped to handle the pronounced and continued shift to patient pay, pre-service collections, POS systems, and innovative, patient friendly payment plan solutions are becoming important investment areas for providers.

The Reinvigorated Clinical Revenue Cycle. Several rapidly evolving industry trends are expanding the scope, relevance, and growth opportunity within coding, charge capture, and compliance. Beyond the immediate challenges of ICD-10 and increases in regulatory complexity and accountability, the clinical revenue cycle is poised for long-term growth as new value-based reimbursement models take hold and the application of new, innovative technologies (NLP, CAC, mobile charge capture, etc.) create opportunities for disruption. In many respects, the HIM department is evolving into an increasingly critical area as more granular levels of clinical documentation meet intensifying regulatory requirements and reimbursement.

Connectivity and RCM Software Deployment. Vendors traditionally focused on connectivity (i.e., clearinghouse / EDI) have the opportunity to deliver additive SaaS-based tools and analytics that positively impact RCM, administrative, and provider-based care management / PHM workflows. Leading vendors in this area have a tremendous opportunity to leverage their existing connectivity footprint and data access spanning payer and provider verticals to drive a range of actionable insights and analytics.

Value-Based Care & Reimbursement. No healthcare blog would be complete without mention of the impact of new value-based care and reimbursement models – this fundamental shift in care delivery and reimbursement creates a unique opportunity for RCM vendors to span clinical-financial boundaries. As existing models are refined and new models are introduced, providers will seek solutions to help them navigate the clinical, operational, and financial challenges inherent with taking on risk and aligning reimbursement with clinical outcomes. This is an opportunity for both provider and traditionally payer focused vendors, particularly those with deep roots in navigating and managing risk.

As an investment bank with deep roots in the RCM sector, TripleTree constantly monitors the market and has helped facilitate over 35 transactions in the sector, including several recent transactions of particular relevance to the central themes transforming the industry:

• Acquisition of Adreima* by nThrive
• Growth Investment in Intelligent Medical Objects (IMO)* by Warburg Pincus
• Acquisition of HealthFusion* by Quality Systems, Inc. (QSI)
• Acquisition of Peak Health Solutions* by AMN Healthcare
• Acquisition of MethodCare* by Zirmed
• Recapitalization of eSolutions* by Francisco Partners
• Acquisition of MedData* by MEDNAX

*Denotes TripleTree client.

Our team is also researching and drafting a new Industry Perspective on RCM, where we will expand on these and other themes disrupting the RCM landscape and driving the need for innovation and positive change. We look forward to hearing your perspectives and seeing many of you in Orlando next week!  In the meantime, we’d love to hear your thoughts on the forces impacting the RCM landscape.