Transformation of RCM industry the big data way

Every day, several exabytes (1 exabyte = 1 billion GB) of data are generated around the world, and healthcare information accounts for a considerable proportion of this. About 33% of the US healthcare sector is on digitized healthcare record applications - a trend that is expected to grow at a rate of 19%. A deluge of information vis-a-vis electronic medical and health records, utilised by disparate billing systems, throws up multiple challenges, including charge capture problems, data consolidation, manual data errors, and many more. This flood of medical data that is processed in coding, billing, and payment transactions, demands an advanced system of management.

The most efficient approach to tackling this problem of the healthcare system is the introduction of Big Data analytics. Due to its innovative contribution to decision-making and strategic development across the healthcare sector, Big Data analytics is grabbing substantial attention in the field of healthcare. The ever-evolving technological and analytical capabilities mean the healthcare sector could be at the cusp of a data-driven transformation.

Holistic RCM strategy and Data Analytics

The healthcare journey of any patient is subject to a complex cycle involving multiple processes, often managed by disparate systems. The pandemic and rapid advent of technology last year have made health systems realize the need for a more hands-on holistic approach to manage their revenue cycles. A cohesive view with current information is essential to provide the right care and process payments efficiently. Coupled with powerful analytical tools, a holistic and agile RCM strategy can deliver significant real-time insights.

With the right IT infrastructure, analytic tools, workflow solutions & visualization approaches, and interfaces, the insights provided by Big Data and the entailing impact on the healthcare industry will be enormous. By harnessing the data from disparate sources into a unified database, Big Data analytical solutions can examine the variances within the RCM processes and facilitate automation of workflow processes. This can streamline the billing and collection cycles, track payment trends, ensure compliance and resolve denials efficiently. This will help the sector gain smarter insights and thereby offer more accurate and efficient revenue predictions.

The Role of Big Data

There is no area within the revenue cycle that cannot benefit from Big Data. Analyzing areas of insurance, billing, coding, revenue reimbursement, claims processing, Big Data can help manage each of these sub-processes more efficiently.

• Reducing claim denials, automating claims approvals

There can be several reasons for claims being denied. This can prove to be costly for healthcare organizations as it translates into revenue losses, with far-reaching implications on the decision-making process. Organizations can use automation to analyse claims and mitigate the denial even before they are submitted, unlike the traditional reactive process. A well-calibrated platform can help reduce the time for processing a claim from weeks to just minutes. Within minutes the chances of a claim being rejected and the reasons can be analysed, flagging the claim from being processed further.

• Streamline billing and collection cycles

Healthcare organizations subscribe to services from multiple service providers, and managing them can prove complicated. Each vendor is different and brings distinct methodologies, touchpoints, interfaces, and data types. However, Big Data provides hospitals with the advantage of directly extracting the data from the vendor rather than using those provided by the vendors. This helps hospitals to make informed decisions based on the performance of each vendor. By analysing the data, steps to optimize collection times and improve billing process can be determined.

• More accurate treatments, fewer errors

Though most data generated are about administrative overheads, including claims and billing, Big Data plays a major role in a patient’s overall health and well-being. Big Data can help in the patients' diagnosis and treatment, and predict health risks to develop a long-term healthcare plan. Healthcare providers can be well informed about the medical histories of patients and the population at large, and come out with more accurate diagnosis these minimizing pitfalls. Big Data, with the ability to analyze outcomes for improvement, will benefit the health sector in the long term.

• Elevating staff productivity

Highlighting ineffective or broken processes within the workflow analytics can elevate staff efficiency by creating opportunities for targeted training or process optimization. If any department experiences errors, they can evaluate the workflow and proactively implement measures to mitigate future instances. Big Data can help automate mundane activities and enable more analytical work to be executed in the same time taken to complete those activities. Analytics and reporting toolsets can help organizations set productivity monitoring standards, monitor past and current performances of the staff, and set goals accordingly.

• Enhancing patient experience

The healthcare sector is constantly evolving in tandem with the growing adoption of technology. There has been an aggressive adoption of EHRs and EMRs, pushing for seamless sharing of patient information across healthcare systems and geographies just to deliver accurate care. Telemedicine - which is expected to reach $130.5billion by 2025, $500+billion by 2027 at a CAGR of 25% - is changing the very delivery of care today. Combined with healthcare IoT, it has led to the emergence of a new paradigm called health informatics. It enables enhanced knowledge, analysis, and sharing of information, thus facilitating a better experience for patients, albeit their location. At the crux of all this transformation is Big Data, Cloud Computing and Analytics.

In a world where healthcare data is expected to double every 73 days, Big Data will, without a doubt, be the primary driver of the healthcare of tomorrow. Patient-oriented care has garnered a higher priority, especially in these pandemic times. The implications of Big Data can even be life-saving, providing timely, invaluable insights that could help avert/overcome epidemics, discover new cures, and optimize costs for everyone in the healthcare ecosystem.

Healthcare is evolving to be a competitive industry, and especially now, with the shift towards consumerism, data analytics will be key to a profitable revenue cycle management process. Higher levels of patient satisfaction and employee engagement are certainly the other key factors that will define an organization's success in a dynamically evolving marketplace.

By Vijayashree Natarajan, Senior Vice President – Head of Technology, Omega Healthcare Management Services Pvt. Ltd.