Revenue Cycle Management Continues to be a Key Priority for US Healthcare Leaders

The US healthcare industry, marked by the highest global spending both in absolute terms and per capita, has long been a complex landscape. For years, it has been undergoing significant transformation. Healthcare leaders are grappling with mounting pressures from evolving care models, supply chain disruptions, stringent regulations, labour shortages, and rising costs. These factors compel them to carefully balance the need for delivering quality care with managing administrative operations, including revenue cycle management (RCM), to ensure financial sustainability.

Outsourcing of non-clinical tasks across the healthcare value chain is gaining traction as a viable solution, while the industry is also exploring technology-driven solutions to address staff shortages, streamline operations, and redefine future workflows.

Our Enterprise Technology & Services team recently attended the Becker’s Health IT, Digital Healthcare and RCM Conference in Chicago, where the discourse centered how provider systems are managing the RCM function and increasing focus on AI and Gen AI. Here are some key insights and takeaways:

1. Outsourcing of RCM Operations is becoming critical: The increasing administrative burden on provider systems and physicians underscores the need for external support in managing RCM-related tasks, such as scheduling, credentialing, patient access, and denial management. RCM vendors that can offer robust solutions in these areas stand to benefit from the rising healthcare spending.
2. Accelerated adoption of technology across operations: Hospital CIOs are collaborating with both clinical and non-clinical teams to drive the adoption of AI and machine learning (ML) technologies across hospital operations. These include AI-driven diagnosis and treatment, telemedicine, remote nursing, and the application of technology solutions in the RCM continuum, further boosting efficiency.
3. Deeper understanding of payor behavior: Aligning RCM processes with payor trends, historical collection rates, and improved denial management is crucial for maximizing ROI. Staying updated with policy changes on the payor side is also critical for healthcare providers seeking to optimize their RCM spending and increasing collections.
4. The importance of choosing the right EHR system: As electronic health record (EHR) systems continue to evolve, their role in supporting both clinical and RCM operations has become increasingly important. Today’s EHR systems enable greater interoperability, a significant improvement over past siloed systems. Healthcare providers are now carefully assessing and upgrading their EHRs, and RCM vendors are playing a key role in guiding these transitions.
5. Cautious optimism around AI and Gen AI: AI and Gen AI hold immense potential to alleviate the administrative burden on healthcare providers. However, their primary applications currently lie in the clinical realm. Healthcare leaders are approaching AI integration with caution, focusing on data-sharing protocols, data quality and measurable ROI before fully embracing these technologies.
6. Cybersecurity as a top priority: Recent global cybersecurity breach events have heightened awareness of the threats facing provider systems. In response, healthcare providers are prioritizing data security, integrity and business continuity planning (BCP) to mitigate future risks.
7. The need for uniform standards: To ensure long-term success in deploying new technologies without compromising privacy, there is an urgent need for standardized protocols governing the handling of PHI (Protected Health Information). These standards must balance individual privacy concerns with the interoperability of data across systems, creating a secure foundation for predictive and prescriptive analytics in healthcare.

As the US healthcare industry continues to evolve, a well-calibrated approach combining strategic outsourcing and the adoption of advanced technologies will be critical for navigating the challenges ahead. Providers, payors, and vendors must work in tandem to ensure that these solutions not only address immediate operational needs but also pave the way for a more resilient healthcare system in the future.