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The history and future of the revenue cycle in healthcare
Overview
Tune into PwC's Next in Health for an overview of the history of the revenue cycle and what’s ahead. Topics include:
- The history of the revenue cycle
- People strategy: How to retain good people
- Seeing ROI when implementing new technology
- Using data in a more sophisticated way to help identify pain points
Topics: Healthcare, revenue cycle, patients and providers, technology, transformation, ROI, digitalization, industrialization
Episode transcript
Find episode transcript below.
00:00:05:24 Welcome to HRI’s Next in Health podcast, I'm Igor Belokrinitsky, and I work with leading health organizations on their strategies and operating models. And today my guest is Jacob Shurbet.
00:00:17:24 Jacob is a Managing Director, here at PwC, and he co-leads the work that we do in revenue cycle managed services for our clients. And so he is here to talk about revenue cycle. Welcome, Jacob, to the podcast.
JACOB SHURBET:
00:00:31:06 Thank you, Igor. I'm excited to be here.
IGOR BELOKRINITSKY:
00:00:33:08 Excellent. Well, it's that time of the year. They're evergreens everywhere. And I feel like revenue cycle is an evergreen topic in health care. It's always important and there's always something new happening in the space. So I wonder if you'd start by giving us an overview of what's going on in revenue cycle.
JACOB SHURBET:
00:00:52:21 Yeah, sure thing. It's a lot to unpack, but I figured the best place to start to help people kind of understand where revenue cycle is today is to maybe give a bit of a history lesson because the revenue cycle today, it's really at an inflection point and it's changing faster than it has over the last, you know, really prior 30 years.
00:01:10:13 So if you think about what the revenue cycle has gone through, it's actually pretty fascinating. I'm a bit of a revenue cycle nerd, so, so maybe I find this more fascinating than most. But think back to the late 80s and early 90s where health care was in general, right. So everything was still mostly on paper. And then in the late 90s and early 2000s, there was really a hyper focus to digitize everything.
00:01:32:13 And then in the mid-2000s, there was a huge push around workflow tools, working by exception and a really big push on standardization and mass adoption of those digital tools.
00:01:43:13 And then really in the last decade, it's really been about evolving the business algorithms and now the buzz is automation and AI. But we really still have so much administrative waste in the revenue cycle and the rapid change of the day is coming from the pure need for providers to do more with less due to the financial pressures.
00:02:03:07 So right now, it's just a fascinating time because more than ever, providers are feeling the crunch with COVID and the great resignation, as well as how their financials has kind of been flipped on their head due to how quickly things have been changing.
00:02:17:13 In fact, we did a recent survey where we worked with Becker's, and 82% of respondents said they're experiencing labor shortages across the revenue cycle, 82%. That’s a large number.
00:02:28:09 And guess what? Nearly 63% of those respondents indicated that leveraging new or existing technology was going to drive the most impact to combat the challenges today.
00:02:35:09 So there you have it, the history and the future of the revenue cycle in about two minutes, whereas today it's just evolving so quickly.
00:02:46:13 There's so much that has to happen for providers to be prepared for what's coming next. And they really have to stay on their toes and keep their head on a swivel to stay ahead of the curve, which today it's harder to do than ever.
IGOR BELOKRINITSKY:
00:02:57:03 Very impressive summary and very helpful to get the lay of the land and also very consistent with some of the conversations that we've had before about how all of healthcare is industrializing and becoming more standardized, more digitized, more automated.
00:03:12:13 But it's not a straight and easy path. There's some growing pains and transformation pains, especially sat aside all the other kind of external things that are happening.
00:03:22:19 So for someone at a health organization responsible for our revenue cycle today, what are some of their biggest concerns? You already started enumerating some of them.
JACOB SHURBET:
00:03:32:13 Yeah, if I were a health system leader, whether it be a CFO or in charge of the revenue cycle, there’ll really be three things that would keep me up at night concerning these challenges. One is, my people strategy. So how am I retaining good people given the ability for people to move between companies more so now than ever in the competition that exists more than ever has, right?
00:03:54:12 Healthcare revenue cycle professionals now have a lot more options at their disposal and can go to different company’s digital health startups, other types of vendors. You think about big payers that are getting into the provider operations space.
00:04:10:12 There's a lot of competition for good revenue cycle professionals. And then, scaling a global workforce. A lot of organizations are looking at taking some of their work either overseas, near-shore or offshore more than ever.
00:04:23:21 And that's not easy. Providers aren't equipped and built to go stand up a global workforce, if that is one of the strategic pillars that they're going to consider to try to combat some of these challenges of the day, with not only keeping their workforce whole and combating the labor shortages, but also reducing cost. And then, training people to work smarter.
00:04:42:16 How do you train individuals to think about more complex problems, to focus on those problems and then how to really look at things in a different way, right?
00:04:53:12 This is becoming more important with automation and AI and allowing those capabilities and those technologies to do what a lot of people have done in the past. And so how do you take the folks that have historically done those jobs as pure kind of transactional type efforts and how do you upskill them? So that's kind of the people strategy. That's one.
00:05:11:09 Two is seeing an ROI when implementing new technology and automation. And I'm not talking about just pure numbers on a page, but like how are you seeing that help combat these challenges today? There's the qualitative and quantitative side of that equation, and that's becoming much more important, as you saw from some of the statistics that came forth in that survey that we did.
00:05:32:02 And the number three, is how do you use data and more sophisticated ways to help you identify the pain points across the revenue cycle and better collaborate with payers?
00:05:40:02 Collaboration is a keyword there because in today's age, providers need to look at ways to collaborate with payers and other partners across their revenue cycle ecosystem and data is going to be the best way to do that in the most effective manner.
IGOR BELOKRINITSKY:
00:05:54:00 Jacob, that's a helpful description, but it seems really hard because you're saying you got to be more global while we're in this time of global unrest and you're saying you got to use the data better and collaborate while we're also facing all these cyber risks and privacy concerns.
00:06:12:00 And then you're also saying you got to upskill your workforce and we're seeing all these labor shortages and quiet quitting and all these workforce issues.
00:06:22:10 So it seems like we're sort of, picked a very challenging time to make these changes and upgrade. And so, again, you already imagine that, you know what you would do as a health leader and you advise health leaders every day. How do they tackle these challenges?
JACOB SHURBET:
00:06:36:18 Yeah, we could probably spend hours really unpacking that, because it is a lot. You're absolutely right. You know, this is probably some of the most challenging times.
00:06:44:18 In fact, we know it is, right, with the pandemic and what healthcare organizations as a whole have been facing the last several years. I mean, this isn't just about the clinical facing side and the patient facing side of those organizations.
00:06:57:07 This impacts the administrative and the financial side as well. I would say there's really two key ways that organizations should be thinking about this and how they go about tackling these challenges and preparing themselves, right? One is, make sure that revenue cycle leadership has a seat at the table and gets the investment in the attention that it deserves.
00:07:16:09 I think often times, you know, revenue cycle kind of get put to the side. But while revenue cycle is only about 3 to 4% of the expense line items on a P&L, and if you think about it in terms of cost to collect and how we measure that, I mean, it's really the glue that holds the financial health of the organization together.
00:07:33:23 So, really making sure that revenue cycles are part of the strategy. It's a part of how an organization is thinking about what they're doing day in and day out to help combat these challenges.
00:07:44:18 To your point, Igor, right like scaling globally using data, while all of that is going to present an uphill battle for organizations that have been doing that in the past, the revenue cycle absolutely has to be embedded in those decisions and a part of how that would fold into that team as a whole, because some organizations have revenue cycle of thousands and thousands of resources.
00:08:06:05 So I mean, you can imagine just the pure logistics and need to make sure that, you know, that group as a whole, those departments are a part of the decision making, a part of the technology enablement and are thinking about it right from a people process and technology standpoint, holistically.
00:08:22:18 Number two, I think organizations need to think about who they partner with across the revenue cycle. And I'm not talking about just your typical vendors or technology partners that are a part of the everyday blocking and tackling.
00:08:36:18 I'm really talking about a true partner that can help in every aspect, whether it be technology, consulting, manage servicing is. Organizations should seriously think about how the market is changing and how a true managed services partner could really help them with their revenue cycle.
00:08:52:00 And when I say managed services, I don't mean just purely outsourcing. There's a difference. Outsourcing is done to you, but managed services is done with you.
00:08:59:00 The revenue cycle is just too complex to fully manage in-house, but too strategic to simply outsource. So hopefully that resonates with some folks in terms of why that's such a critical component of how organizations provide.
00:09:13:03 Organizations should think about leveraging the right partners going forward. So you really have to find that Goldilocks balance. In a top tier revenue cycle managed services organization can really help provider to get things right in all aspects that are needed to help combat the challenges of today.
IGOR BELOKRINITSKY:
00:09:27:01 Very helpful and reassuring to hear, especially that you don't have to go it alone if you don't have a revenue cycle organization that has thousands of people in it, so this was great advice. And maybe just ask here for one final bit of advice.
00:09:41:01 If you're speaking to an executive in the space and they're trying to find a way to both perform great on a day to day basis and make sure this area is working well, but also continue to transform and prepare for the future. Any final words of wisdom of how to strike that balance between transforming and performing and continue moving forward despite the uncertainty?
JACOB SHURBET:
00:10:06:08 I try to make things pretty simple. I have three children under the age of six, so I think I've mastered the art of explaining things in a simple way. And I think sometimes we overcomplicate what we think the solution is when it comes to these really challenging, really complex things.
00:10:21:00 But I really think, to put it simply, is health care leaders and executives, they should hire the right leaders or the right partners, give those leaders or partners the autonomy to run things, give them the support and the investment they need, and I think the rest will take care of itself.
00:10:38:05 Steve Jobs said, I don't hire smart people to tell them what to do. I hire smart people so they tell me what to do. Hiring the right leaders or selecting the right partners is one of the biggest decisions organizational executives can make to ensure they're meeting today's challenges and preparing for the future. And the leaders in the partners I'm talking about need to be progressive thinkers.
00:10:58:21 They need to really be looking around the corner and skating where the puck's going, and that's a rare breed. So I think that should be kind of an element that executives are really looking for when they're deciding how are we going to continue to evolve, how are we going to continue to scale, how are we going to meet those challenges?
00:11:16:13 And then the other thing that you may have caught kind of a theme in, in my other answers is to think about data, think about data and think about data. And data is kind of the new frontier. And using data, whether it be through enabling new automations or analytics, it's going to be paramount to the future success of health care providers.
00:11:33:09 And I'd love to say the data usage and utilization and the privacy and the cybersecurity is simple. I know it's not. And that's going to present its own myriad of challenges. But leaders really need to be thinking about how they're doubling down and making data an imperative and a cornerstone of how they operate specifically within the revenue cycle.
00:11:50:00 And what that's going to afford them to be more collaborative, more agile, and again, really help with some of those challenges that I described earlier in our conversation.
IGOR BELOKRINITSKY:
00:12:00:23 That’s fantastic. So put people first, don't go it alone. Look for treasures in the data, pick the right partners. Great counsel and thanks for taking this important topic and bringing nuance to it and urgency, but also simplicity. It is very much appreciated and great to have you on the podcast, Jacob.
JACOB SHURBET:
00:12:18:07 Yeah, thanks for having me, Igor.
IGOR BELOKRINITSKY:
00:12:20:03 For more on these topics and other health industry insights driven by policy, innovation and care delivery changes, please visit our website at PwC.com/HRI. Until next time, this has been Next in Health.
ANNOUNCER:
00:12:39:22 This podcast is brought to you by PwC, all rights reserved. PwC refers to the U.S. member firm or one of its subsidiaries or affiliates and may sometimes refer to the PwC Network. Each member firm is a separate legal entity.
00:12:52:05 Please see www.pwc.com/structure for further details. This podcast is for general information purposes only and should not be used as a substitute for consultation with professional advisors.
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