Specialist
Former executive at nThrive Revenue Systems LLC (FinThrive Revenue Systems LLC)
Agenda
- Major drivers in the healthcare RCM (revenue cycle management) space, discussing insourcing vs outsourcing and provider consolidation
- Cost-saving, efficiency and expansion opportunities
- Threat of encroachment from large EMR (electronic medical record) names
- Contract dynamics, rip-and-replace costs and customer customisation
- H2 2022 industry growth outlook and consolidation dynamics
Questions
1.
What major trends or drivers have you been following in the US RCM [revenue cycle management] industry over the past 6-9 months?
2.
How are provider burnout and staffing shortages impacting RCM vendor partners? How are players changing their strategies to alleviate provider workflow burden and create efficiencies?
3.
Could you break down health system insourcing vs outsourcing trends for RCM services? To what extent are we seeing an increase in outsourcing due to labour shortages and profitability pressures?
4.
What are we seeing in terms of provider consolidation as large health systems continue to aggregate? How has provider consolidation impacted health system RCM needs as well as the dynamics of those systems building out their own capabilities in-house?
5.
To what extent does locality play a role in who providers or health systems choose to partner with? Do providers typically prefer an RCM vendor in the same region or locale, and how would you juxtapose this against larger national players with wider solution suites?
6.
What are your thoughts on the use case of business or clinical process outsourcing to offshore players such as Access Healthcare and Omega Healthcare as a cost reduction or margin expansion play? What are the benefits and drawbacks of offshoring?
7.
What opportunity do you see from NLP [natural language processing] technology? Could this perhaps accelerate outsourcing to geographies with friendlier cost structures?
8.
What are the major decision criteria for health systems on whether to opt for an RCM software vendor or RCM services? How common is it to use both, and what are their respective use cases?
9.
What are the typical costs to get outsourced RCMs integrated with the health system EHR [electronic health record] platform, as well as any other implementation costs to get up and running for claims processing?
10.
To what extent do implementation and integration costs factor into stickiness or churn? How much do customers consider switching costs when choosing a vendor?
11.
How much incremental revenue can be unlocked via upselling or cross-selling from additional services? Has pricing offerings as more holistic solution suites become the norm across players?
12.
Where do you see further room for automation in RCM to make these solutions even more efficient? What is the low-hanging fruit for automation?
13.
What’s your assessment of the growth runway for RCM solutions for payers? How are you viewing the overall demand and growth in the payer end market over the next couple of years?
14.
To what extent are we seeing any pricing pressure on contracts from competitive saturation? How much of a risk is that for the industry?
15.
How do health systems view RCM vendors that are owned by payers? To what extent does any friction factor into winners and losers on new bids in the marketplace?
16.
What is the impact of the shift to value-based care on the RCM value proposition more broadly?
17.
What levers do pure-play RCM vendors have to fight encroachment from large EMR [electronic medical record] providers such as Epic, Cerner or Athenahealth? How are they customising their solutions to specific customer needs or providing differentiated value propositions?
18.
What are the more attractive RCM software niches – for example, labs, dental or radiology – for growth and revenue expansion? How would you compare relevant market opportunities here?
19.
What are the key go-to-market considerations when attempting to penetrate these adjacent settings for RCM players?
20.
How would you compare contract negotiation leverage between RCM vendors and more consolidated entities such as DSOs [dental service organisations] or a name such as Radiology Partners? Are vendors able to secure relatively favourable pricing against some of the more consolidated entities?
21.
How could RCM players approach building out a solution to penetrate dual-eligible populations, and what kind of revenue opportunity could be realised here?
22.
How are RCM vendors thinking about macro population shifts such as an ageing population, or even a higher mix of Medicaid members if the economic environment sours? How could players shift business models to manage any pain points with revenue collection and a shifting reimbursement mix?
23.
How might large players execute on inorganic growth strategies? What acquisitive opportunities could be attractive to make solution suites more comprehensive?
24.
What will the RCM landscape look like in 5-10 years? Are we likely to see a significant amount of consolidation in the software vendor space? Could there be more horizontal solutions or specialty-specific RCM platforms?
25.
How much greenfield opportunity remains in the US or global RCM market, and how do you see adoption trending over the next few years?
26.
How could HIPAA [Health Insurance Portability and Accountability Act] regulation amendments and evolving data privacy standards impact RCM players going forward?
27.
What’s your claims volume outlook as we enter a more normalised environment post-coronavirus? How could demand for collections and billing trend given macro care utilisation dynamics?
28.
Is there anything we haven’t discussed or that may be underappreciated that you’d like to reiterate or highlight?
Gain access to Premium Content
Submit your details to access up to 5 Forum Transcripts or to request a complimentary 48 hour week trial
The information, material and content contained in this transcript (“Content”) is for information purposes only and does not constitute advice of any type or a trade recommendation and should not form the basis of any investment decision.This transcript has been edited by Third Bridge for ease of reading. Third Bridge Group Limited and its affiliates (together “Third Bridge”) make no representation and accept no liability for the Contentor for any errors, omissions or inaccuracies in respect of it. The views of the specialist expressed in the Content are those of the specialist and they are not endorsed by, nor do they represent the opinion of, Third Bridge. Third Bridge reserves all copyright, intellectual and other property rights in the Content. Any modification, reformatting, copying, displaying, distributing, transmitting, publishing, licensing, creating derivative works from, transferring or selling any Content is strictly prohibited
