Enhancing Healthcare Revenue Streams: Key Steps for Your RCM Team to Improve Patient Collections
According to a recent survey from the Healthcare Financial Management Association (HFMA) and Eliciting Insights, hospitals and health systems find...
If we were designing the healthcare system from scratch, Brook Ward says most of us would have a clear vision for what it should look like.
“What you’d want is to keep people healthy, to prevent them from getting ill and having serious illness,” says Ward, CEO of Washington Health System. “You wouldn’t want what we’ve done in our country for the last five decades—waiting until someone gets seriously ill and then trying to fix them.”
As the head of a regional health system, Ward works toward that vision with a community-focused approach to care. Armed with population health data, Ward and his team strive to improve the overall health of patients with proactive intervention and community partnership.
Other regional health systems can follow his lead. On a recent episode of FinThrive’s Healthcare Rethink podcast, Ward identified several ways regional hospitals can fulfill the mission of being the heart of community health. These three initiatives are good places to start.
1. Embrace value-based payment models.
Global payment models, such as the Centers for Medicare and Medicaid Innovation (CMMI) rural health models, provide the financial support that allows health systems to allocate resources to keeping people healthy.
“Value is more important than ever,” Ward says. “We’ve been contracting with payers around gain-sharing programs, value programs, where if we can provide great satisfaction, high quality, lower utilization, and lower costs, then we share in those savings.”
Shifting to a wellness focus means providers often must think creatively about how to improve outcomes. For example, Ward and his team coordinated a hotel stay for a victim of domestic violence rather than house the patient in the ED. The solution protected the patient while social services worked to secure more permanent housing. It also avoided high utilization ED costs in a situation where they were not medically necessary.
For regional health systems, the value model is also proving to be mutually beneficial. While the pandemic left many hospital systems in financial peril, Washington Health System maintained a consistent stream of revenue that allowed the team to stay focused on providing quality care.
“With that global budget, we can take time, step back, and say, ‘How do we really work on preventative care versus sick and illness care?’” Ward says.
2. Collaborate with payers on areas of common ground.
Yes, there’s animosity between payers and providers, but Ward notes there’s opportunity for collaboration in areas of common interest—particularly around lower utilization costs and gaps in care.
“If you think about it, what [payers] want to do is to make sure, genuinely, that their members are healthy and that the quality of care those members receive, when they get it, is high.”
To bridge gaps in care, Ward is exploring data sharing efforts that would allow payers to help with patient follow-up and ensure patients are getting the support they need in order to avoid readmission or escalation to the ED. Patients show up daily at every ED in the country, he says, for issues that could be addressed through telemedicine, a primary care visit, a discharge follow-up appointment, or even some social work. Delivering the right level of care is a goal upon which both payers and providers can agree.
3. Focus on areas of greatest impact.
By continually assessing the needs of the community and examining utilization data, community health systems can ensure they’re focusing on initiatives that will truly move the needle on quality care.
After making strong inroads on diabetes and breast cancer with previous initiatives, Washington Health System is shifting for the next three years to focus on colon and lung cancer, which emerged as community challenges in their latest Community Health Needs Assessment. Other major priorities are OB/GYN programs, especially prenatal and teen pregnancy prevention, and orthopedics.
From a Social Determinants of Health perspective, food insecurity and transportation are significant needs. Washington Health Systems is working to partner with local social service agencies in ways that make sense—such as making boxes of food from the food bank available in primary care offices.
Finding balance
As a guiding principle overall, Washington Health System is always focused on the equilibrium of ensuring utilization rates are “appropriate.”
“We don’t want patients to overutilize. We also don’t want them to avoid care if they need it, specifically preventative care.” That sweet spot is what keeps the ecosystem in balance.
The full podcast includes Brook Ward’s thoughts on the staffing shortage, Washington Health System’s internal patient quality and safety measurement system, and more. Watch it here.
