Healthcare Information Management, or HIM, in 2020 finds itself at a time of rising healthcare costs, but also of expanding opportunities through telehealth and outsourcing.
In the United States, the only industrialized nation in the world without universal healthcare, medical bills reached an average of about $11,000 per person in 2018. Even then, medical organizations have had to find ways to cut back on expenditures, with the average American hospital needing to reduce costs by 24% by 2022, to be able to break even.
Why does healthcare cost so much? Among the considerations are administrative costs, drug costs, wages, new technologies, and other diverse costs. Add to this the circuitous, oftentimes complex processes for billing, which involves tracking the healthcare information of every single patient, and coordinating with various insurance firms and payers to process claims and payments.
Following this, HIM’s continual evolution is characterized by finding the best way to cut down on costs and improve efficiency, while helping patients through the system, and medical practitioners to be able to focus on providing services.
Lessening Administrative Burdens
Among the keys to HIM’s development as an industry has been outsourcing. Outsourcing is the hiring of a third party to perform tasks that would otherwise cost the organization more to do so. Because of the digital nature of a lot of the material that has to be processed in HIM, outsourcing is a sure direction for it.
One of the applications of outsourced HIM can be seen in the realm of telehealth. Telehealth is performing the operations around healthcare via communications technology. This includes such diverse applications as patients filling up intake forms online before visiting the hospital, being able to zoom call with health practitioners, and making use of apps to keep track of their health. When operationalized successfully, telehealth has the potential for better coordinated care, and improved accessibility to healthcare.
Another application for outsourced HIM is in managing patient logistics and billing through Revenue Cycle Management.
Revenue Cycle Management is the process of tracking each patient through the cycle of registration into the hospital system, scheduling appointments, noting the health care services provided, and tracking revenue and payments. A key function of RCM is coordinating with patient insurance companies and ensuring that services are properly filed and billed, and that rejections are avoided.
Outsourcing one’s RCM has the primary advantage of shifting the considerable operation of managing patient information away from the healthcare organization. Currently, billing and collecting funds costs the healthcare industry $250 billion a year. RCM lets healthcare organizations cut down on operating costs, allowing the work of many staff members, or even entire departments, to be performed by outsourcing groups.
This also potentially improves internal efficiency, as RCM firms employ highly skilled personnel whose sole focus is the cycle – this includes keeping up with industry updates and changes, differences in process across different states, and the nitty-gritty which frequently results in lost revenue or unnecessary billing of patients, such as following up on AR settlements, and reducing denial rate.
Most importantly, this allows healthcare groups to focus on their primary concern – the wellbeing of their patients. Unburdened by administrative concerns, medical organizations can focus on providing health services, and improving patient quality of life.
Focusing on Patients
Patients benefit from more robust HIM structures in that they can rest assured that their healthcare information is being managed and brought to the proper channels, even before making a hospital visit.
This is especially important for patients who need continuing access to healthcare, such as those with chronic diseases. In addition to needing medical attention on a regular basis, chronic disease patients also tend to suffer multiple coexisting conditions. This presents several challenges, including the need for multiple specialists to coordinate efficiently, and having to keep track of billing while this is ongoing.
These considerations are addressed through Chronic Care Management. CCM is disease management for chronic conditions, with the primary goal of motivating patients to persist in their therapies. It includes coordination of care among a patient’s pharmacy, specialists, hospitals, and more, as well as following systems for improved reimbursement throughout the process.
CCM is recognized by the Centers for Medicare & Medicaid Services (CMS) as “a critical component of primary care that contributes to better health and care for individuals”. Smoothly-running HIM is required for this system to be able to help those who need healthcare through the most difficult time in their life.
Stay One Step Ahead with Visaya
As part of the HIM industry’s charge towards providing more holistic and cost-effective support for patients, providers, and payers, Visaya Knowledge Process Outsourcing services aim to deliver accurate, timely, flexible and secure solutions for healthcare organizations.
Among our offerings are RCM-specific functions like claims and payment management, medical coding, clinical document improvement, process excellence, and practice management.
Visaya also provides services to support chronic care management in oncology, cardio vascular and diabetes.
HIM in 2020 is setting the pace for where outsourced telehealth can go over the next few years. Putting down healthcare costs is only one step in creating a landscape that is more efficient and supportive for both healthcare practitioners and patients.
Resources:
US Healthcare System Explained – https://www.youtube.com/watch?v=DublqkOSBBA
Why are American Paying More for Healthcare? – https://www.pgpf.org/blog/2020/04/why-are-americans-paying-more-for-healthcare
Outsourcing – https://www.investopedia.com/terms/o/outsourcing.asp
Outsourcing in Healthcare The Pros and Cons – https://www.hhmglobal.com/knowledge-bank/articles/outsourcing-in-healthcare-the-pros-and-cons
Telehealth: Technology meets health care – https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878
Outsourcing Revenue Cycle Management: What to Expect – https://medusarcm.com/blog/outsourcing-revenue-cycle-management-what-to-expect/
15 Benefits of outsourcing your revenue cycle management process – https://smrtdomedicalbilling.com/15-benefits-of-outsourcing-your-revenue-cycle-management-process/
Benefits of outsourcing Revenue Cycle Management – https://ipatientcare.com/blog/benefits-of-outsourcing-revenue-cycle-management/
CCM Patient Resources – https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/ccm/patient-resources
MLN Booklet: Chronic Care Management Services – https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf