An optimal revenue cycle and a positive patient experience are intrinsically tied to a provider’s ability to deliver a seamless clinical and administrative experience. However, this requires the integration of systems that, until recently, didn’t talk to each other, such as electronic health records (EHRs), scheduling systems, and billing systems.

Today, systems integration has enabled the EHR to become a central repository for both clinical and administrative data. This data is what fuels appropriate and effective care plans, enables quality coding for timely and accurate reimbursement, allows accurate patient billing, and provides seamless patient encounters.

The Benefits of Integrated Clinical and Administrative Systems

There are many examples of how integrated systems improve patient services and revenue. Having high quality documentation is essential for meeting payer regulations around prior authorizations and medical necessity. The lack of appropriate documentation to support these requirements can cause delays in care and deteriorating patient conditions. It can also cause patients to put off care altogether, which can lead to poor outcomes and reduced reimbursement for providers participating in value-based care models.

Quality documentation in the EHR is also vital so that coders can submit complete, accurate claims. If coding is incorrect, the claim may be denied or only partially paid, which can cause providers to write off much-needed revenue. Inaccurate coding can also result in a patient receiving a surprise bill for a service that should have been covered. When patients receive a bill they didn’t expect, it can harm the patient-provider experience, patient satisfaction scores, and the provider organization’s brand reputation.

Another benefit of integrating clinical and administrative systems is that accurate patient demographics and benefits information are always available to any provider with access to the EHR. The information can be viewed in real time when scheduling the patient’s appointment or registering them for their service. It can also be accessed when the patient shows up for their service. This eliminates the need for multiple eligibility verifications and reduces the need for patients to fill out the same information repeatedly. It also reduces the likelihood that a patient will forgo care that was actually covered under a secondary health plan that they had forgotten about.

Having accurate benefits and coverage information also reduces denied claims and the extensive rework required to research and appeal them. Now that denials are one of the top concerns of healthcare leaders, it is essential that providers do all they can to avoid denials in the first place. Integrated systems allow that to happen.

Provider portals connected to the EHR are also helpful. Patients can upload their coverage and demographic information, including a picture of their insurance card, which can reduce wait times when they arrive for their appointment. Patients can also use portals to self-schedule or request an appointment, check their balances, set up payment plans, or pay a bill.

Yet another benefit of integrated systems is that they keep track of a patient’s communication preferences. Patients can choose how they prefer to be contacted, whether by text, email, a mobile app, the patient portal, U.S. mail, or a phone call. These communications can include appointment reminders, payment reminders, information about changes in office hours, announcements about upcoming health fairs, or reminders to get their annual vaccinations. Integrated systems make this all possible, ensuring patients show up to get the care they need while making it easier for them to stay informed and manage their financial responsibilities.

The Role of Change Management

The only way to receive maximum return on investment for systems integration is if staff understand the new processes and are able to seamlessly adapt to new workflows. This requires an effective change management program. An article published by Harvard University explains, “When done properly, (change management) lays out a step-by-step process to identify a challenge, make changes, and execute successfully.” The article lists Kotter’s 8-Step Process” for successful change management, which healthcare organizations can implement to improve the success of systems integration. These are summarized below.

• “Create urgency” by discussing with staff why the change is vital and what the consequences might be without changing.
• “Form a guiding coalition” of stakeholders with cognitive diversity from varying disciplines to lead the change initiatives.
• “Create a vision” that includes a vision statement and “strategic initiatives” that will promote accountability and commitment to “shaping and improving the community culture.”
• “Rally and communicate” by bringing people together to share their concerns in a way that shows “openness to feedback and error.”
• “Remove barriers” that would inhibit change and empower individuals to “work cross-functionally to keep the initiative advancing.
• “Execute on and celebrate short-term wins” by creating goals that are “easily achievable,” which helps reward those who embrace the change while building “momentum for future action items.”
• “Don’t let up” on the vision or stall activities that are necessary to achieve the vision, including making “necessary institutional changes” or “other systemic improvements.”
• “Further cultural and institutional change” by recommending that they become a “part of the organization.” It’s important to remember that “forming new habits and unlearning the old ones can involve training and a new reward system for workers.”

Providers can read more about Kotter’s “8 Steps for Leading Change” to learn additional strategies for “producing lasting change” in their organizations as they seek to integrate their clinical and administrative systems.

The Role of Analytics in Successful Change Management

We’ve all heard the saying, “What can’t be measured can’t be managed.” While this may or may not be true, it is a fact that monitoring success requires measurement, and measurement requires data, especially when it comes to systems integration and change management. Leveraging data analytics is vital for highlighting issues, enabling continuous improvement, and tracking ROI.

For example, data analytics can identify problematic trends, such as denied claims, along with the cause for the denials, such as coding errors or issues with documentation quality. This could mean staff are holding on to old, familiar workflows instead of transitioning to new ones. It might also indicate that systems are not being utilized as planned.

Staff who are hesitant to change must understand that improving the revenue cycle could enable the hiring of additional team members, which could alleviate backlogs, stress, and burnout for them and other existing staff. They also must understand how patients could be affected if change efforts are unsuccessful, such as procedures being delayed due to documentation issues related to prior authorizations.

Poor change adoption could also mean that staff needs additional training or that the change coalition needs to develop additional tools or better communications to ensure staff understands the need for change and the consequences of not complying.

Next Steps

Optimal revenue and patient services require a seamless healthcare experience. The only way to achieve that is by streamlining clinical and administrative processes through systems integration, a comprehensive change management program, and in-depth data analytics. Conifer Health can help.

Conifer Health’s technology-enabled solutions integrate with a provider’s existing system to enhance patient experiences and improve financial performance, while its intelligent process automation boosts productivity and reduces operational risk.

Learn how Conifer Health can help you develop integration and change management strategies to help improve revenue and patient experiences. Visit https://www.coniferhealth.com/solutions/