Understanding the Claims Lifecycle: A Step-by-Step Guide
Grasping the details of the claims lifecycle in healthcare is crucial for getting timely reimbursements and maintaining financial well-being. As...
By Jonathan G. Wiik, Vice President, Healthcare Industry Insights, FinThrive
HFMA Western Region Symposium celebrated its 25th anniversary this year and pulled out all the stops with its “Carnival” theme. Regions 10 and 11 came together with masks, parade floats, drums, live exotic birds and many hugs to commemorate this important milestone.
I have attended this event for more than a decade and it has always been my favorite of the HFMA events, primarily for three reasons:
- It’s in my backyard – these are my states, my people and my network.
- High-quality educational content – It sets the foundation for industry themes for the remainder of the year.
- Vegas – We always have a good time in Las Vegas!
This year, there were great sessions from payer-provider collaboration and RCM best practices to CFO panels.
Opening Sessions Discuss Top-of-Mind Industry Issues
The event opened with a think tank with esteemed leaders from the region, discussing important industry topics, such as staffing, RCM automation, AI and much more. Some key insights surrounded issue-focused hiring (i.e. a denials-staffed team) and during a live poll, the audience indicated that more than half of the organizations had a level of over 40% automation in their revenue cycle. Regarding AI, the group summated that use cases should “not boil an ocean.” Instead, it is important to be very focused, start small and then scale from there.
A session on healthcare federal policy kicked off the second day. In addition to insights on transparency enforcement, Medicare Advantage plan rules and mental health subsidies, predictions on the upcoming presidential election were also shared. However, I do not want to spoil things. All I can tell you is it may not be who you think, and you’ll just have to tune in – and of course, GO VOTE!
Keynote Session Highlights Need to Reduce Waste in Healthcare
The keynote session starred HFMA CEO Ann Jordan, and HFMA National Chair Dennis Dahlen (also CFO of Mayo Clinic). They both highlighted the need for change and that the status quo is not sustainable, given the amount of waste in healthcare, citing:
- More than $900 billion wasted dollars in US healthcare
- 30% of the financial waste is attributed to unnecessary administrative burdens (i.e., denials)
- 50% of the financial waste is attributed to care delivery (e.g., wrong care, wrong resources, wrong time)
Pharma costs were also highlighted, specifically that the US spends twice as much on brand drugs as other industrialized nations. Dahlen explained that, “No one wakes up and goes to work wanting the healthcare system we have – something has to change.”
Jordan added that, “Our healthcare today is a bag of angry cats fighting in a bag…unless we see change on a macro level, we will be stuck for some time.”
They also quoted the CEO of Providence, Rod Hochman, MD, who stated, “we expose the complexity and ridiculousness of our country’s healthcare to our patients every day.”
Jordan closed the session out with the vision for HFMA and a focus on the explosive growth in enterprise membership. Over 90% of HFMA membership is now delivered through enterprise, and the association, along with its chapters, need to pivot to meet members’ needs at the individual level. “It’s great that we grew, but now we need to focus on managing what’s next with that membership”, she said. Dahlen closed by sharing the most prominent themes he noticed during his cross-country travels as HFMA national chair – workforce, an aging population, rampant insurance denials and the need for Medicare Advantage plan reform.
Vendor Relationships, RCM Strategies Emerge as Key Themes
In other sessions, provider representatives from Nebraska Medicine, UK King’s Daughter, CommonSpirit Health and St Luke’s (Idaho) shared their perspectives on how vendors could best interact with healthcare organizations, emphasizing the importance of ROI and how to measure solution impact with disciplined KPIs. Timing and resources are also a major consideration, and vendors should not assume timing is right with each interaction.
It’s also important for vendors to build relationships and instill trust with providers, and they can do this by keeping their word and maintaining consistent conversations. They concluded by stating the importance of celebrating wins and successes with their partners, especially considering how they believe their organizations would not have made it without their vendor partners over the past few years.
One of my favorite finance breakout sessions focused on ROI and prioritizing projects, and highlighted a Velocity, Value, Security, Strategic (V2S2) model for evaluating project impacts.
Velocity = How quickly change can be measured, primarily in cash
Value = Impacts to operating margin and pinpointing the steps that contributed to that change
Security = Related to bond security, ensuring covenants and cash flow are insulated so borrowing expense is stable
Strategic = Actual IT resources, training and people all needed to be considered prior to any implementation
RCM strategies were highlighted across multiple sessions, and covered the usual suspects – AI, denials and payer relations. Here were a couple takeaways:
- AI is being tested in areas, such as coding, claims and more, along with an emphasis on payer use of AI.
- It’s important to broadcast change management and involve the teams at every level and every step of the way throughout the process to get the most out of your RCM workforce.
- Payer-provider collaboration works best when the two parties rally around a common goal, and several case studies highlighted its effectiveness.
CFO Panel Concludes Conference
The conference concluded with my favorite session of the week – a CFO Panel, which included panelists from OHSU, CommonSpirit and Peace Health.
All of the panelists were masterful in their discussion of how their role has changed in both scope and priority. They spoke of the challenges in workforce, and how contract labor has driven up costs for the long-term. While challenges persist in both costs and sluggish top-line revenue, the key for providers to serve their patients for the long-term will be to capitalize on payer reimbursement strategies and to keep labor costs in check. The panelists finished with a discussion on the role of the CFO – they have become strategists in which they rely on their team of experts to provide them with data that helps drive successful decision-making. The group remained optimistic for the upcoming year and believe the industry is positioned for the best year since early 2020.
Overall, the Western Region Symposium was a great event – as always. As I reflect on the networking, learnings and insights I can apply in my travels, I am thankful to HFMA and all the time from the speakers and planning to pull off such an amazing event. I hope to see you at the next HFMA event.
Above all, be well.
About the Author
Jonathan G. Wiik, MSHA, MBA, CHFP
Vice President, Healthcare Industry Insights
Jonathan Wiik, VP of Healthcare Industry Insights at FinThrive, has over 25 years of healthcare experience in acute care, health IT and insurance settings. He started his career as a hospital transporter and served in clinical operations, patient access, billing, case management and many other roles at a large not-for-profit acute care hospital and prominent commercial payer before serving as Chief Revenue Officer. Wiik works closely with the market and hospitals on industry best practices for revenue management. He is considered an expert in the industry for healthcare finance, legislation, revenue management and strategic transformation.
