Midwestern Healthcare Provider Case Study
About the Customer
This midwestern healthcare provider is a proven industry leader in preventing, reducing, and eliminating the rising costs associated with prolonged, recurring hospitalization. With a focus on proactive, patient-centered care, their mission is to transcend reactive models of health and shift the industry landscape to high-quality care.
In its quest to redefine value-based care, the healthcare provider recognized the need for a trusted partner to support its network growth and enhance its revenue cycle management.
Far too often, provider onboarding, credentialing, and enrollment are improperly managed. The lack of expertise and technology solutions around these critical and complex business processes can significantly impair operations. Once declining revenue and rising compliance exposure reach a financial and legal tipping point, it’s vital to circle back to these processes.
For large health systems, the tipping point can reach upwards of $100,000 for each primary care provider and $300,000 for each specialist in revenue per month that is either not fully realized or written off as “bad debt” — a non-recoverable financial loss.
- Lack of interoperability between key functional areas — HR, Managed Care contracting and enrollment, Medical Staff, and Revenue Cycle Management — that result from siloed, legacy technology.
- Lack of industry expertise to navigate the regulatory framework that emerges from a combination of state, federal, payer, and accrediting body standards.
- Lack of scalability that impacts growth initiatives and results from the forced manual processes in place to support critical operations.