Nearly a third of health systems rely on manual processes for prior authorizations, patient- generated pricing estimation, charity screenings, appointment reminders and other revenue cycle processes, according to a report from Eliciting Insights.
The study, which focuses on patient access – the specific portion of the revenue cycle encompassing everything that happens prior to the patient coming in – also found more than half of health systems surveyed did not offer a patient financial engagement platform, kiosks or patient self-serve scheduling.
The high cost of tech
Jackie Harder, Eliciting Insights principal consultant, explained many areas of the patient access workflow remain manual due to a combination of factors, among them the high cost of implementing a new technology.
She also noted that while new and best-of-breed technology may automate one area of the revenue cycle, if those platforms are not fully integrated with a health system’s core systems – say from EHR to patient accounting or registration systems – it is often more work to use two disparate systems.
“Due to the nature of the business problem, it is often difficult for vendors to prove a hard ROI,” Harder said. “Tools that work in patient access will typically have results that impact an entirely different area of the business.”
For example, a tool that helps prevent denials due to a lack of prior authorization would need to show that it helped prevent claim denials – this requires looking at years of trending.
No clear leader
She said the most surprising finding from the study was the lack of a clear market leader across the entire spectrum of patient access workflows.
“For core capabilities such as eligibility and registration quality, there are dominant vendors that have had the majority of the market share for years,” she noted. “But looking more broadly into newer areas like patient self-service, pre-service payments and solutions for uninsured or underinsured patients, there is an entirely different crop of fragmented vendors.”
Meanwhile, health systems are investing in patient self-serve scheduling, kiosks for patients to enter information when they arrive for treatment, and portals offering patients’ views into their financial as well as medical affairs.
“Very few vendors are able to offer health systems solutions across the entire spectrum of patient access,” she said. “We looked at 26 workflows across six main areas, and no vendor had penetration across all 26 areas.”
Tech must be better than the core vendor’s
She noted a common comment from health system executives is that technology has to be significantly better than what they can get through their core vendor to consider purchasing.
“We are seeing health systems continue to look to consolidate vendors while adding new capabilities around patient self-service,” Harder said. “Health systems are focused on collecting more patient cash up front, so I would also expect to see additional investment in technologies that help facilitate collections.”