The impact of the COVID-19 pandemic on the U.S. healthcare system is substantial. Healthcare providers are implementing new procedures to ensure the health and safety of their patients, staff, and families. Many have implemented processes that require thorough decontamination prior to interacting with their loved ones after a long shift at the hospital or clinic. Providers are also leveraging newer technologies, such as telemedicine to provide support for patients when in-person visits are not advised. Challenges in revenue cycle management are emerging as patients in emergency situations are being treated by out-of-network providers, increasing patient financial obligations, impacting the provider’s collection efforts and challenging payers to explain why out-of-network treatment is not covered. Additionally, providers are seeing their incomes drop as a result of lower patient volume as elective procedures are delayed and emergency procedure volumes declines. Technology will play a critical role throughout and after the crisis as providers and payers look to provide the best care and support possible for their patients and members.
Many patients in the healthcare system today have chronic conditions and co-morbidities increasing their susceptibility to illnesses like COVID-19. Additionally, many patients need the assistance of caregivers to make appointments and provide much-needed support during the visit, increasing the potential of virus transmission. In Oncology, for example, patients are generally immunocompromised due to the impact of chemotherapy and radiation therapy on the body. However, patients with cancer do not have the luxury of postponing doctor visits, especially if they in the middle of treatment. Any delay could have a material impact on potential cancer remission and the patients’ survival. With that in mind, providers are moving new consults and follow up appointments to virtual visits (more on that below) and prioritizing patients in active treatment, reducing density in clinics and improving distancing opportunities to keep patients safe. We may see some of these paradigms persist post-crisis as providers and patients become more comfortable connecting with their providers online for certain appointments.
Healthcare providers utilize a variety of technology tools to support their clinical, operational, and financial workflows. The electronic health record (EHR) is capturing clinical information that can be analyzed to glean insights on treatment and outcomes during this time of crisis. Clinical decision support (CDS) is used to ensure the appropriate treatment is prescribed and can ensure all necessary tests are ordered. The practice management (PM) system provides the appropriate billing framework to maintain the practice’s financial integrity, critical in the crisis environment. A newer technology has been thrust into the provider workflow gaining significant traction and utilization growth. Telemedicine allows the provider to connect with the patient through a secure video web interface alleviating the need for the in-office visit. A few factors are leading to the increased adoption, social distancing requirements and new CMS rules providing greater access to telemedicine services, including increased reimbursement for providers and reduced cost to patients. In Massachusetts, senior adoption of telemedicine jumped from 5% to 27% from early March to early April. With reimbursement and regulatory limitations removed and overall positive provider & patient experiences, telemedicine’s popularity will likely persist beyond the crisis.
As new technologies like telemedicine see a sharp rise in utilization, traditional solutions for revenue cycle management are due for an upgrade. Optimizing the revenue cycle process has never been more important, as patient volumes decline due to a reduction in elective procedures and a heightened concern of COVID-19 infection. Providers are looking for solutions to streamline key aspects of revenue cycle, including prior authorization, claim submission, and denial management. Glide Health’s Intelligent Revenue Optimization solution leverages machine learning to provide predictions and recommendations leading to higher efficiency in prior authorization management, a reduction in denied claims, and improvements in accounts receivable performance. Additionally, the Glide Health Intelligent Financial Forecasting and Optimization solution provides real-time forecasting for AR, revenue, and cash, as well as recommendations to optimize performance of these key metrics. The focus on streamlining revenue cycle will persist beyond the COVID-19 crisis as providers make up for lost volume and prepare for changes to the care model resulting from the shock of the crisis.
One area where machine learning can help provide insights and a better patient experience is in the acute care setting. Many large health plans are covering COVID-19 testing, diagnostics, and treatment in-network costs for their members, including ER & hospital admission. As patients are admitted to the hospital, they may be treated by providers that are out-of-network thereby increasing the patient cost burden and hospital accounts receivable risk. The result is an increased financial burden to the provider and patient at a time when their income is already impacted by the crisis. Ensuring a patient is treated by an in-network provider is critical to address these challenges. Integration between the hospital EHR and payer’s provider registry in real-time through FHIR (Fast Healthcare Interoperability Resources) or APIs can ensure that patients are treated by the appropriate provider. The new CMS Interoperability and Patient Access final rule continues the administration’s promise to put the patient first, providing access to critical information to support patients as they move through the healthcare system. This will include requirements for providers and payers to make data available to support that effort.
We can expect that the COVID-19 crisis will forever change healthcare. Some of these changes, including new patient safety protocols, an increased focus on revenue cycle management, and technology solutions like telemedicine are welcome, should persist, and increase the value of healthcare in the U.S. Ensuring patients are connected to in-network providers will also be important in reducing patient financial impact and provider exposure. Ultimately, this crisis will make the healthcare system stronger and more resilient for providers and their patients.