Intermountain's Innovative Work to Orchestrate Revenue Cycle Management

So the Craneware solution had to be carefully customized and fitted onto your self-developed inpatient system?

That’s correct, through interfacing. And also, the method of charging items at Intermountain had been decentralized, with items charged and classified differently.

So you’ve had to go through an entire revision of your existing system, essentially?

That’s correct. The charge description master that we were using had been propagated all across the system, so there had been some consistency, but it wasn’t uniform. And there was a fair amount of compliance-based risk, as we had had some departments that were using charge items incorrectly. And we didn’t have teams of clinicians and revenue cycle people—in this case, charge integrity folks coming together—to really discuss how the charge tables should be constructed. So we’ve gone about the business of constructing those teams. More than often, they’re led by the clinical department, and then our charge integrity folks play a role to make sure everything’s correct. And we’ve removed and eliminated a number of charge items that were the cause of error.

What have been the key lessons learned both among your finance and your IT leaders?

More important than the charge area is the integration of the technology to generate workflow tools for these folks; that helps us to  be successful in moving these people along to greatly enhance our ability to be paid. And the technology is somewhat disjointed as you cross the continuum. That’s why you’re seeing more and more large vendor companies achieving success because they’ve been able to integrate their technology from the front end to the back end. And there are organizations saying, we’re going to be the best registration and scheduling organization, or something similar.

The problem is that there’s no correlation to downstream areas around payment and around patients’ residual balances. So people work on those systems independently. So I think the creation of tools that integrate workflow is a very big deal. It’s about creating and leveraging tools to manage processes all the way down the stream.

What will happen in the next couple of years, as you move forward?

I think being organized as we are in a centralized fashion will be very useful as we move towards the concept of a shared accountability organization, which is slightly different form the government’s accountable care model. But there are similarities in the concept. And our abilities to do that, to share accountability, will really be enhanced by this. You’re wanting to be proactive in managing the patient as they come in to receive care, to help keep them out of a high-cost environment. And that’s different from simply billing them for services they’ve received from fragmented episodes of care. And at Intermountain, we’ve been fortunate in having a large percentage of percent-of-charge contracts, to balance our fixed-fee contracts. What’s more, the new world of healthcare is suggesting, we don’t want to pay you for the volume, we want to pay you for the population. So you have to manage your patient population more proactively. And we’re moving in that direction.

So this integration of processes is going to be more important than ever.

That’s correct. Number one, it will be easier for us to measure the results of our efforts; and number two, we’ll be able to do it in a much more productive way. I would add that it’s a little bit more scalable if you can do this centrally. And from a technology perspective, Intermountain has been relatively proactive in a number of ways and with a number of different systems, and that’s been helpful.