R1 RCM: Partnering with Healthcare Organizations to Reimagine the Revenue Cycle

In this Business Profile, Gary Long, R1’s executive vice president and chief commercial officer and Gary Johnson, senior vice president of marketing, discuss the value in working with a forward-looking revenue cycle partner with services that span multiple healthcare settings.

How does R1 help healthcare organizations?

Gary Johnson: R1 RCM works with hospitals, health systems, and group physician practices to achieve revenue cycle excellence. We leverage purpose-built, innovative technology with more than 160 industry-leading best practices and an experienced team of revenue cycle operators to help organizations increase payer reimbursement and net patient revenue—while streamlining and reducing their total cost to collect. We manage more than $31 billion in net patient revenue for some of the largest systems, hospitals, and group practices across the country.

In addition to driving financial results, we also focus on understanding and enhancing the patient financial experience. This is critical because there are key touch points in the revenue cycle—verifying insurance eligibility, generating pre-service estimates, reconciling copays and deductibles, among others—that will make or break patients’ impressions of an organization and determine a patient’s loyalty to that healthcare provider. Making sure these touch points are integrated and work in a way that is consistent, compassionate, and patient-centered is critical to meeting a healthcare organization’s goals.

What are the biggest challenges you see affecting healthcare organizations?

Johnson: In terms of financial performance, the revenue trajectory for most healthcare providers is either flat or shows minimal year-over-year growth while costs are rising at a faster rate, equating to compressed operating margins and increased financial risk.

Additionally, with the rise in health system mergers and acquisitions, many organizations are experiencing difficulties in marrying diverse electronic health records, bolt-on revenue cycle management (RCM) technologies, business processes, and cultures.

Lastly, many organizations have voiced concern and fatigue with achieving only incremental or episodic improvements to the revenue cycle through stand-alone RCM technology or consulting engagements, with frustration mounting as they see performance regress over time.

How do R1’s service offerings help address these needs?

Gary Long: Healthcare organizations have been moving toward a model that lets them focus on their core competency—caring for patients. As such, they are partnering with companies whose primary business is to manage operational functions, such as IT services, food preparation, pharmacy, emergency department, and more. We are now seeing healthcare organizations view RCM in a similar way—realizing it requires a focused and completely aligned partner that will perform this complex work and is committed to delivering better performance.

R1 RCM offers different relationship structures that help healthcare organizations achieve their goals. One option is to partner with a hospital, health system, or large group physician practice to focus on a specific challenge area with “module” service solutions. Challenges include preventing and overturning denials or managing the entire front-end via patient access or other parts of the revenue cycle. We also offer relationships where we take full responsibility to manage the revenue cycle from end to end, called a co-managed relationship. In these cases, R1 is accountable for achieving mutually agreed-upon revenue cycle goals for net patient revenue and total cost to collect by working with a provider’s staff. We also offer complete partnerships where we onboard a client’s RCM staff. In these full-responsibility relationships, organizations can improve net patient revenue by 3 to 6 percent and reduce total cost to collect by 20 percent or more.

In addition to our service offerings, R1 recently unveiled a patient experience solution as part of our Patient Access solution set which received the HFMA Innovation Award at the organization’s 2018 annual meeting. The solution was created based on valuable feedback from patients about their consumer expectations and from providers wanting to have a singular patient experience. It includes an app that lets consumers book appointments, confirm insurance details and eligibility, get pre-service estimates, and pay their copays and deductibles online. It also seamlessly integrates with a provider’s scheduling system to facilitate smoother communication between providers and patients.

How does robotic process automation and artificial intelligence fit with what R1 offers?

Long: Fundamentally, R1 is driven by helping our health system and physician practice partners achieve transformational improvement in their revenue cycles. We are accomplishing this through our ongoing committed investment in innovative technologies like robotic process automation (RPA), artificial intelligence (AI), cognitive automation, machine learning, and blockchain, while we continuously enhance our operating model’s yield and the skills of our staff.

More specifically, R1 is investing heavily in AI/RPA technology for revenue cycle to further strengthen our ability to help providers get paid faster and correctly, and improve overall results. Health systems and large practices gain the benefits of superior technology, including AI/RPA, without attempting to piece together point solutions from multiple vendors. Because of our scope of operations and shared service centers, we have the bandwidth to leverage this emerging technology on a larger scale to help all our customers.

What are key considerations for healthcare leaders when choosing an RCM partner?

Johnson: Although hospitals and physician practices have common revenue cycle needs, there also are unique aspects to keep in mind when choosing a revenue cycle service provider. For instance, we hear from many of our hospital clients and prospects that they have more software than they know what to do with, and some of these solutions are not being utilized as they were intended. There also is duplication as a result of mergers and acquisitions, such as with chargemaster and other common RCM tools. To address these pain points, hospitals and health systems should seek a revenue cycle partner that is not merely another software vendor, but one that takes responsibility for achieving results and addressing revenue cycle needs in a holistic way.

Group physician practices—in the office or within a hospital—should be looking for a company that can manage the revenue cycle from end to end for improved RCM performance and to focus their resources on patient care. Often group practices have a small staff that handles everything from scheduling to billing to employee onboarding, and more. However, by working with a company that expertly manages every aspect of the revenue cycle, the physician can leave the business side to an experienced partner and focus more on delivering the highest quality patient care.

Organizations should also research a company’s background and long-term growth strategies. A question to ask might address whether the firm operates independently or is owned by an insurance payer or a specific health plan. Is it publicly traded? There’s a level of transparency that comes with being a publicly-traded company that will benefit providers because they can clearly understand the entity’s operations and long-term goals. Also, it’s important to work with a partner that will grow as you grow. If you plan on pursuing further acquisitions and adding service lines that expand your operations geographically, can your partner keep pace with your evolving needs? If you plan on adding both hospitals and physician practices, do you have a partner that serves the different settings so you can navigate the nuances while addressing the commonalities?

At R1, we work diligently to simplify and standardize all aspects of the revenue cycle across different delivery models to help organizations lay the groundwork for financial success. When organizations partner with us, they are able to drive financial results and enhance the patient experience while increasing efficiency and limiting variation, ensuring they remain nimble and responsive to changing healthcare dynamics.

Are there educational materials to help healthcare providers learn more?

For more information about how R1 meets hospital and physician practice revenue cycle needs, go to www.r1rcm.com/hfma.

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About R1

R1 RCM is a leading provider of technology-enabled RCM services which transform and solve revenue cycle performance challenges across hospitals, health systems and group physician practices. R1’s proven and scalable operating models seamlessly complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience. To learn more visit: r1rcm.com.