Too Many Walls and Not Enough Bridges: Bringing Together the Great Minds of Revenue Cycle and IT

By Beth Carlson, VP of Revenue Cycle, WVU Medicine

One of the simple truths is that “none of us is as smart as all of us.” This rings especially true as IT and revenue cycle teams seek to establish a more symbiotic relationship in defining a strategy that meets the organization’s cost reduction and technological advancement needs. The revenue cycle plays a pivotal role in ensuring the financial health of an organization while IT provides the necessary technological infrastructure and support to run it. Finding synergy between these two departments is critical, yet often fraught with challenges as both teams feel overburdened by pressures to adopt new technologies at excessive speeds.

The expectation of the modern revenue cycle leader to stay in tune with emerging technologies and navigate pressures to adopt new solutions – amid payer challenges and diminishing margins – is founded on realizing that our challenges can no longer be solved with people. It is also making us some of the most desperate for advancements in driving modernization into our operations; however, revenue cycle priorities to implement high-impact solutions rarely come with low-effort commitment. Meanwhile, IT is facing some of their biggest challenges to provide a robust and reliable technical solution while also having to protect, constantly upgrade, and completely reimagine it. Both roles are becoming more complex, diverting further from how they have been typically defined in the past, and will continue to require more collaboration to be successful.

Revenue cycle and IT teams should develop shared performance metrics that reflect the objectives of both departments to help align their efforts.

The distinct capabilities of each team that have historically allowed them to operate in silos have become the same qualities that make it a perfect alliance. IT departments prioritize system stability and security whereas revenue cycles are focused on immediate financial outcomes and process efficiencies. IT teams don’t necessarily understand the processes that need to be supported, and revenue cycle teams don’t typically have the ability to create or implement the solution themselves. Balancing these priorities requires careful coordination since both areas are so specialized, and neither team has the excess capacity to become experts in solutions that present as too complex to learn into.

Revenue cycle success is so dependent on the execution tactics and timeliness of IT – a department that has limited resources and competing priorities – but increasing financial risk may not allow for prioritization among in-flight or pipeline initiatives. With revenue cycle outsourcing becoming more common in recent years, we must consider the overwhelming requirement to explore, manage, and integrate multiple technologies as a contributing factor. An organization must commit to accommodating these trends internally or support seeking out alternative solutions. Meanwhile, organizations are becoming more skeptical of vendor overpromises and the non-delivery of solutions that lack proof of concept and further remove us from the patient experience. An established IT partnership can explore these options as strategic developments rather than evaluate them at a critical decision point.

Any revenue cycle solution requires significant expertise in claims, reimbursement, payer behavior, and policy. An advanced level of technical expertise may not exist at all levels of the revenue cycle as it does in IT, but the deep understanding of financial workflows, patient interactions, and billing processes provides critical insights into the practical application of existing and proposed technical solutions. Some revenue cycle departments have dedicated analytics functions and citizen development capabilities established within their department to cater to ongoing and specialized revenue cycle technology support needs. This model can work well, but will need to avoid the silo and remain well aligned with an organization’s overall innovation strategy. Integrating IT staff into the day-to-day operations of a revenue cycle can provide them with operational knowledge to suggest automation opportunities or exception-based workflows and avoid bolt-on solutions where untapped capabilities may already exist. Traditional revenue cycle leaders are also still developing experience in managing an automated workforce, in which it is more challenging to attribute performance and quality issues to technology, and where results and processes aren’t as easily traceable to defects. Revenue cycles also have a giant cyber security target on its back, so IT is becoming more aware of the need to understand and contribute to solutions, especially when they are not the ones delivering them. Technical solutions identified by only one party are also more likely to result in tech debt or unintended consequences. Many other industries that have already solved these challenges are ones that fully understand the user experience.

Revenue cycle and IT teams should develop shared performance metrics that reflect the objectives of both departments to help align their efforts. The impact of IT initiatives on revenue cycle efficiency or an operational team’s contribution to quality assurance can measure the benefits of collaboration and promote shared commitment.

Revenue cycle leaders are uniquely positioned to meaningfully contribute to the digital transformation of the human experience. The collaboration between revenue cycle and IT departments is not just beneficial, but essential. It requires intentional effort to evade the give-and-take mindset that our own balancing acts create. When the great minds of revenue cycle and IT come together, it not only produces a more realistic and impactful technology roadmap, but enables us to innovate better, and faster.