Well my first HFMA conference is now in the books, and I’m excited to have been able to attend last week. The conference itself had around 2,500 attendees, mostly healthcare executives, and comprised 50 sessions covering a range of relevant topics in healthcare. For those of you unable to attend, I wanted to take the opportunity to share some of my key learnings from HFMA 2019.

1. Healthcare 3.0 is on the Horizon

Rapping physician and opening day key note speaker, Zubin “ZDogg” Damania, believes the healthcare industry is trapped between the care-giving of the past (traditional doctor/patient relationships) and a technology-infused future. According to ZDogg, Healthcare 1.0 included paper-based medical records and was very focused on the doctor/patient human aspect. The next iteration, Healthcare 2.0 is where we are now – dominated by data, EHRs and quality measures.

We need to make the transition to the next level, Healthcare 3.0, which takes the deep human emotional aspect from Healthcare 1.0 and layers in data to identify causes of individual health issues and then educates and motivates patients on an emotional level. The human relationship and patient engagement are at the center of this process.

Personal Note: The process to 3.0 needs to transcend the caregiving aspect of healthcare and make its way into all aspects, including financial. That is, we need to use data to derive financial insights. Then, keeping the human relationship front and center, we work together with the patient to help them meet their financial obligation associated with their care.

2. Change or Become Disrupted

Marcus Whitney, CEO and Co-Founder of Health:Further, talked about the need for “Disruption Insurance.” Providers tend to think of other providers as their only competition. Well that may have been the case years ago but not any longer. Legislation and federal government demands have opened the door for your patients to consider options other than you. With healthcare reaching nearly 20% of gross domestic product (GDP), it’s no wonder it has attracted the attention of behemoths such as Amazon and Walmart. They are positioning themselves right now to encroach upon your territory and disrupt the industry if you don’t take action now.

What does this mean? It means that providers need to overcome a negative public sentiment that’s been fueled by historically hefty price tags in healthcare. Providers need to make a change and innovate to face their ongoing threats. This means:

  • Evolve your care model
  • Leverage your strengths
  • Get your message out there
  • Engage the marketplace with the story of how you are different
  • Reinforce why they should choose you

It’s a whole new world out there. Those who fail to make change happen will be disrupted by emerging players.

3. There’s a Dangerous Reliance on EHR Providers to Solve the Revenue Cycle Problem

One of the sessions divided the audience into 15 groups for a hands-on problem-solving exercise. Hands down, the top problem the groups chose to solve was denials management. Clearly it was top of mind.

Two VPs of Revenue Cycle were on my team. Both happened to use the same EHR provider, and both had grown tired of waiting for this provider to address revenue cycle issues. It’s just not coming.

They both agreed that a tool to better help them manage denials would be better than continuing to throw staff at the problem. Actually, it was pretty alarming to hear so many providers taking a sedentary approach and waiting for their EHR provider to solve the issue for them.

Revenue cycle issues continue to grow and are costly in terms of delaying or losing reimbursement and consuming internal resources. Providers need to grab the bull by the horns and address the problem rather than wait for someone else to do it.

4. AI is a Key Player in the Future of Revenue Cycle

The AI session was particularly interesting as it served as a primer into concepts like machine learning, supervised and unsupervised learning, classification, regression and clustering. In addition, the speakers explored use cases from Population Health Management to Revenue Cycle Analytics. The coolest part of the session though was the team white-boarding of an AI Development Process. The approach was:

  1. Define the actual problem – What are you trying to solve?
  2. Define data requirements (input) – What data will you need?
  3. Data preparation – One speaker mentioned this is often the hardest part.
  4. Modeling and review of steps 1-3 – The data science part that was above my skillset.
  5. Evaluation

It is clear to me from points 3-6 that data science tools and expert guidance or oversight on how to properly use those tools are paramount to solving revenue cycle problems.

HFMA 2019 just ended, and I’m already looking forward to HFMA 2020. I think there are some exciting times ahead for those on the non-clinical side of healthcare. That said, I agree with Marcus Whitney that it’s ripe for disruption and as Michael M. Allen (HFMA Chair) stated in his address, he needs everyone to dare to rise to the occasion. That’s right, he wants folks off the sidelines and people to actually make a difference. So the question for you is, “How will you dare to move healthcare forward?”