By Jonathan Farr, Senior Vice President North America, EFFY
Hospital leaders face substantial challenges when it comes to aggregating and comparing vast datasets to identify and correct problems. The sheer magnitude of data is prompting these healthcare organizations to recognize this deficit in their existing systems. As they learn about the value and benefits of actionable analytics to address and solve problems in virtually every aspect of operations, they are adopting new technology that is now available. A key benefit is that these new platforms overlay current transactional systems to deliver a cleaner, smarter and cost-effective solution.
The consolidation of data required to perform actionable analytics, allows astute hospital leaders to efficiently retrieve, compare, reconcile and analyze all data through multiple platforms. Because there is no large upfront investment and no need to discard existing systems, this puts organization management in control of aggregating data, and detecting/resolving issues that impact revenue integrity, as well as clinical and operational performance.
Radiology Case Study For Actionable Analytics
Let’s say a patient presented a script for a CT scan of the abdomen without contrast. The patient underwent the first test, but upon review the radiologist decided a CT with contrast was needed and updated the order. The problem was that the initial registration and authorization were for CT without contrast, and the new test and fee were completed without the proper authorization.
As a result, the bill contained several errors related to insurance authorization and an unexpectedly higher bill, leading to lower than expected revenue in the department, re-work and delays in the receivable, a late bill and the potential for an insurance denial.
With actionable analytics, the story would see significantly better results: Sophisticated actionable analytics systems would have allowed the hospital to use any data from any transactional system to set up sophisticated alarms, and the issue would have been detected immediately.
An analyst, using a Revenue Cycle Management solution built upon RAID HEALTHCARE -- an end-to-end software platform used worldwide by leading healthcare systems, telecom companies, utilities, retail and other complex industries -- would have the reconciliation and analytical tools to rapidly respond to the alert. Instead of channeling the issue up through all of the relevant departments, which is time-consuming and demands the attention of a number of people, the analyst would simply offer an integrated workflow to guide a “fix.”
With RAID HEALTHCARE, the radiology billing problem could have been managed by one individual who discovered the issue and put the fix into action, resolving the problem quickly, and improving quality for both billing and patient care.
Finding The Right Actionable Analytics Partner
Healthcare organizations should look for an efficiency platform that overlays existing systems to help them compare massive amounts of data across their total enterprise, detect exceptions and problems, and guide interventions to improve efficiency that optimizes financial, clinical and operational performance.
Hospital organizations require customizable, exception-based triggers to identify deviations from norms that enable them to reduce errors and denials, improve efficiency and productivity, meet compliance requirements and ensure financial viability.
Look for a platform that is powered with unique actionable analytics, overlays rather than replaces existing transactional and operational systems, and functions as a permanent, protective 24/7 auditing and reporting ‘umbrella’ that makes data comparable.
By choosing the right actionable analytics platform, hospital leaders can rapidly take action while generating significant ROI within months of implementation.