By Titus Leo and Jason Besterfeldt

As today’s hospital margins are increasingly in the red, and health systems are asked to do more with less, all eyes are on cost removal. According to a recent survey on healthcare outsourcing conducted by Black Book Market Research LLC, 90% of healthcare executives are exploring cost savings through relationships with third-party vendors. Here we address three main areas for cost takeout: call center/customer service, AR resolution, and clinical functions.

Call center/customer support: In the past 10 years, providers have responded to consumer demand with more focus on the patient financial journey and a unified, seamless experience.  Omnichannel outreach leveraging both technology and phone conversation are essential to addressing the needs of a diverse patient base.  Technology has improved but the phone calls have suffered since the pandemic because of the labor shortage.  This continues to create problems whether it’s with scheduling, prearrival financial counseling, prior-authorization, or inbound/outbound calls related to patients balance after insurance.  Recent research points to increasing average hold times and the negative impact this has patient satisfaction. 

In this new environment, hospitals and health systems are leveraging RCM services companies to augment and scale their workforce.  These partners bring essential capabilities to improve the patient experience pre-visit but also address essential clinical functions like prior authorizations preventing denials.  These resources can be a mixture of onshore, offshore and nearshore talent who can assist with insurance/support functions, patient calls (both inbound and outbound) as well as provide much needed bilingual support. The review of this process, cost, and scalability can provide substantial operational cost savings, greater operational stability, and an improved patient experience.

Accounts receivable (AR) resolution: Hospitals and health systems are facing increased labor costs and payer requirements while reimbursements have fallen.  Technology has accelerated progress with bots performing  real-time claim statusing, AI driving intelligent workflows, and automation removing highly repetitive/repeatable steps.  With all of these advancements, there is still the need to review, handle exceptions, and write appeals, to maximize reimbursement in a timely manner.  Not only has COVID-19 caused a labor shortage in business offices but the cost of resources has increased at an alarming rate.  According to a recent PWC and Becker’s Hospital Review survey, 83% of respondents reported experiencing labor shortages across the revenue cycle.  Insurance companies have moved many of their calls centers off shore to contain these costs and hospitals are increasingly embracing this move.  Business offices looking to increase capacity, remove cost or mitigate risk are seeing a huge impact as they look to India/Philippines to not only meet the needed scale of their office but, do it at less than half the cost.  The right partner can bring expertise, technology, and visibility to provide confidence for those facilities looking to remove expense from their cost to collect with this approach. 

Clinical support resources: Recent American Hospital Association (AHA) research states that 95% of providers spend increasing time seeking prior authorization approval. The reason for this is often stated as a lack of front-office staff and clinical resources to have payer conversations or improper documentation.  Again technology is assisting here but, the need for resources, especially clinical, are getting expensive and difficult to find.  This presents an opportunity to partner with organizations that have access to clinical resources both here in the US and in the established clinical environment of the Philippines.  The most frequent functions for cost take out are nursing support, case/care management, care coaching, transitions of care, navigating network, case management referral, care plan generation, transport coordination, and remote patient monitoring. With blended delivery models, outside experts can provide the requisite scale and significantly reduce cost. 

From shortening patient appointment hold times to taking the frustration out of prior authorization and billing—the right cost takeout strategies also deliver improvements in patient experience.  As hospitals continue to reduce their cost to collect, they are increasingly turning to RCM service providers for the required scale, cost removal, and risk mitigation.