Operationalizing Technology to Drive Bottom-Line Benefits

Beacon Health System is an integrated not-for-profit healthcare system with 1,240 inpatient beds, 7,550 associates, and 4,000+ patients daily. Leadership sought to optimize and standardize the revenue cycle system and associated clinical and revenue cycle workflows prior to rolling out its Oracle Health EHR to two recently acquired hospitals.

Key Challenges:

The organization faced a number of common challenges:

• Several clinical and revenue cycle workflows were not best practice, standardized, or in some cases fully defined, resulting in inefficiencies, revenue leakage, and a high volume of denials.
• Gaps in system design resulted in a lot of manual intervention and user dissatisfaction, and the organization’s lean IT team was having difficulty keeping up with the large backlog of help tickets.
• Beacon’s outdated EHR was preventing them from leveraging some of the system’s newer features and functionality, and a general lack of trust in the technology meant teams relied on manually built reports rather than system-generated ones.
• Capacity constraints and lost revenue resulted from inefficiencies in staffing allocation and role definition.

Our Approach

Impact Advisors started with an 8-week assessment to compile a list of recommended revenue cycle and clinical workflow opportunities and system design changes to be addressed prior to rolling out the Oracle Health EHR to the acquired hospitals. Assessment objectives included:

• Revenue Cycle: Target cash flow improvements in front and back-end revenue cycle through people, process, and technology initiatives through a focus on alignment to best practices.
• Clinical: Improve provider productivity and efficiency by optimizing clinical documentation and reducing time in chart.
• Technology: Understand the current state of Cerner implementation planning to date, support the design and development of an implementation Project Guide, and validate cost model and project budget.

The assessment included over 30 hours of interviews and a review of over 50 metrics, producing over 150 opportunities throughout the patient journey, which were prioritized based on value both toward Beacon’s bottom line and toward ensuring the organization’s long-term success.

Utilizing a “quick win” approach, the team set about quickly demonstrating opportunity and value, which not only delivers financial impact but has the added benefit of motivating client teams by showing them what is possible.

Our Impact

The team achieved several quick wins over the course of the next 6 weeks, then continued the optimization effort for another 4-5 months. In total, Beacon was able to achieve millions of dollars of bottom-line benefit.

Results included:

• Achieved 1.1 days reduction in DNFB Aged > 11 days
• Cancelled and regenerated 2,417 non-primary acute claims ($1.3M); made 23 claim rule additions, modifications, or deactivations; improved Clean Claim rate by ~10% since implementing system changes
• Identified 435 claims submitted out of Oracle Health but not in the claim scrubber ($489K)
• Reduced encounters with a DNFB reason of Late Charge by 14% ($913K)
• Achieved ~$30M through A/R > 90 backlog improvement
• Achieved $107M in cash in a single month—Beacon’s highest cash month ever—the month following the 6-week quick wins
• Updated 100 CARC/RARC codes to align to best practice and standardized 37 835 adjustment rules, adding 4 net new rules
• Achieved compliance with the No Surprises Act (mandatory as of January 1, 2022)
• Increased insurance verification rate and preauthorization rate
• Decreased denials and edits due to missing authorization, eligibility, and MSPQ information
• Redesigned 5 key workflows to drive labor benefits of increased productivity, efficiency, and accountability
• Restored confidence in the Oracle Health system among Beacon’s teams and their own ability to identify and resolve issues
• Created a scalable model to roll out to acquired hospitals

From the beginning, Impact Advisors’ goal was to deliver measurable value and teach the Beacon team to be self-sufficient. By working collaboratively with their Operations and IT teams every step of the way, Beacon’s teams are now making ongoing improvements on their own to the system and workflows.