Healthcare Financial Transformation: Five Leading Strategies

As organizations continue to evolve and adapt their financial strategies to optimize performance under VBC, the following central challenges stand out:

• Delivering cost savings and passing savings to the consumer.
• 解决无报酬的护理。
• Handling outstanding bill hold accounts, reducing accounts receivable (A/R) days, and managing discharged not final billed (DNFB) cases.
• Reacting to runaway costs resulting from high labor and technology expenses, inefficient use of resources, and supply waste.
• Understanding the true cost of care.

To meet the above challenges and effectively transform under VBC, health systems are leveraging data-driven tools to better understand their costs, including what’s driving their expenses, excessive variation, and the impact of an unpaid bill. With deeper cost understanding, these organizations are identifying opportunities to improve their financial practices and save money without sacrificing the quality of care.

Five Ways Organizations Achieve Healthcare Financial Transformation

随着卫生系统承担着不断变化的挑战，即在改善护理的同时降低成本，某些战略和工具被证明对保持长期财务健康至关重要。Below are five examples of ways organizations are achieving financial transformation:

#1: Using Cost-Per-Case Improvements to Deliver Big Bottom-Line Savings

As health systems face more pressure to deliver cost savings, they’re turning their attention tocost-per-caseimprovement projects. These strategies can produce quick wins for improvement teams looking to gain momentum and buy-in. Studies show that the best cost reduction strategies start with clinical improvements. In particular, reducingclinical variationtends to hold the biggest opportunities for not only cost savings but improving care.

卫生系统刚刚开始节约成本和改善质量的努力，通过从小处着手，以个案为基础，并了解提供者每次医疗服务背后的成本，可以增加其长期成功的机会。实现这种粒度级的成本计算精度需要良好的沟通、行政支持、跨学科参与以及可靠的数据工具和资源。

#2: Leveraging Artificial Intelligence to Resolve Uncompensated Care

By collectinguncompensated care(unpaid balances) from patients for healthcare services, health systems stand to curb one of their highest costs. Propensity-to-pay tools help organizations target unpaid accounts by using artificial intelligence (AI) to leverage external and internal financial and socioeconomic data and identify the likelihood that patients in a population will pay their balances (i.e., their propensity to pay).

通过倾向付费视角，财务团队可以专注于最有可能付费的患者，并将无力支付的患者与慈善护理或政府援助联系起来。Both health systems and patients benefit, as patients can avoidbad debt, and organizations receive compensation for the care they’ve delivered.

#3: Increasing Cash Flow with Data and Analytics

According to a2018 survey of hospital CEOsby theAmerican College of Healthcare Executives在美国，财务挑战(从拒绝报销到坏账)是目前医院面临的首要问题。作为回应，医疗保健领导者必须寻求机会，通过改善财务业绩和报销来增加收入。一些常见的策略包括减少未偿付票据持有账户的数量，减少A/R天数，以及管理DNFB案例。

Organizations can take the following actions to increase cash flow usingdata and analytics:

• Understanding common reasons accounts remain unbilled.
• 发现改进的机会。
• Using data analytics and process improvement to achieve financial goals.
• Creating lasting improvements.

#4: Confronting Healthcare’s Cost Problem

长期以来，美国医院一直专注于增加收入、数量和增长。At the same time, the healthcare system haswasted hundreds of billionsof dollars on supply chain inefficiencies, variation, service duplication, and suboptimal labor management, causing expenses to exceed revenue. Healthcare has focused on revenue for so long that the industry has lost sight of runaway costs brought about by high labor and technology expenses, inefficient use of resources, and supply waste.

Recognizing thecost problemis a significant first step toward solving it. Five expense-controlling strategies can help health systems return to a stronger financial position:

1. 重新关注劳动管理。
2. Manage employed physicians.
3. Change the patient encounter environment.
4. Augment standard approaches with technology.
5. 通过卫生系统管理患者的访问和流动。

#5: Delivering Cost-Effective Care with Activity-Based Costing

Delivering high-quality,cost-effective careto specific patient populations within a service line is nearly impossible without a sophisticated costing methodology. Activity-based costing (ABC) provides a nuanced, comprehensive view of cost throughout a patient’s journey and reveals the “true cost” of care—the real cost for each product and service based on its actual consumption.

通过了解医疗保健的真实成本，卫生保健负责人可以更早地识别高危人群，并更快地实施有效的干预措施(例如，更仔细的监测和更早的筛查)。Health systems that leverage the actionable insight from ABC further benefit by implementing the same, or similar,processand clinical improvementmeasuresacross other service lines.

Better Care at Lower Costs: Healthcare’s Ongoing Challenge

Given the complexity of healthcare delivery and its associated expense, financial transformation will be an ongoing challenge for health systems in the COVID-19 era and beyond. Organizations that adopt proven tools and practices to better understand their cost drivers and how those are tied to quality of care will most successfully navigate the challenges, thereby improving their bottom line along with their patient care.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

1. Value-Based Purchasing 2020: A 10-Year Progress Report
2. From Volume to Value: 10 Essential Strategies for Navigating the Healthcare Shift
3. Healthcare Revenue Cycle: Five Keys to Financial Sustainability
4. Reduce Bad Debt: Four Tactics to Limit Exposure During COVID-19
5. The Medicare Shared Savings Program: Four Tools for Better Profit Margins and High-Quality Care

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