Revenue-Based Analytics Inform Clinical Operations and Enhance Health Equality Case Study

Provider using analytics as part of clinical operations

When COVID-19 patients began appearing in emergency departments, it challenged every aspect of Geisinger’s operation. Not just the clinical operations, but every aspect of the health system, including patient and staff scheduling, revenue cycle activities, clinical practices, population health initiatives, and even patient satisfaction.

Like many valuable discoveries, the solution came from an unexpected source. Obviously, the business health of any organization has a significant effect on the way they can carry out their mission. COVID-19 created measurable challenges to the health system’s operations, but working together with business analytics partner, VisiQuate, the two organizations collaborated in an effort to create some specifically focused analytics-based solutions in record time: COVID-19 monitoring and financial impact analytics, and telehealth activity analytics.

Besides helping the health system realize revenue for services performed, these analytics had a ripple effect, with benefits that spread across the organization and the community. By adding valuable new data dimensions to the longitudinal record of each patient, the data of patient visits, times and locations visited was readily available to several clinical analytics solutions, where it helped monitor hot spots, reevaluate priorities, and deploy resources, services, personal protective equipment and tests to impacted communities, down to the ZIP code level.

COVID-19 Monitoring and Financial Impact Analytics

VisiQuate already had a number of analytics solutions in place at Geisinger, so there was a foundation in place to create these COVID-19-specific solutions quickly. The result is a comprehensive view of the enterprise for all the health system’s hospitals and clinics that compares daily admissions and discharge trends to the corresponding daily and monthly totals from the previous year. Today, the health system uses these insights to fine-tune activities and work with the new realities of COVID-19.

For example, this solution presents a public health-focused view of the data that identifies COVID-19 hot spots on a geospatial map that leverages patient demographic data, like ZIP codes. By aggregating this data into clinically relevant information, the health system is able to proactively monitor their patient population to catch COVID-19 hot spot or reduction events over their full patient population. This helps in reacting to quickly changing situations, and proactively decide how to staff specific clinic locations and be ready to conduct the appropriate number of tests.

The solution also analyzes activity from both an inpatient and outpatient perspective, along with the revenue activity from the physician side of the operation. This gives the health system the ability to use data intelligence to answer the following key COVID-19-related questions:

  1. How are payers behaving?
  2. Was there a spike or a reduction in denied claims?
  3. What was the effect on account receivable days when workers from the health system and workers from all the payers shifted to remote work nearly overnight?

Telehealth Activity Analytics

Telehealth activity analytics monitors telehealth activity volume from a revenue cycle perspective, providing a series of reports and analytics that deliver insight into revenue activity, service volumes and claims accuracy on a daily basis. It tracks where each telehealth visit occurs, and supports revenue integrity and claims accuracy by ensuring that all the proper place of service, CPT and modifier codes are in place when the claim is submitted.

Additionally, that same data are given to Geisinger’s clinical operations, where it is used to add valuable detail to each patient’s longitudinal patient record and enables clinical operations to understand the operational impact of telehealth encounters on provider schedules.

Unexpected Benefits Improve Patient Lives and Satisfaction

In any healthcare organization, the most basic of all business functions is to generate enough revenue to keep the lights on, so they can continue serving their community. The reductions in all patient services caused by COVID-19 certainly posed challenges, but these new analytics, combined with an overall strength and resolve, helped mitigate the effects. Just as importantly, they helped the health system provide the most effective COVID-19-related services to their most vulnerable communities without imposing financial hardship.

Whether self-pay or any other status, no COVID-19 patients should ever receive a bill for care. So Geisinger uses these analytics to pull COVID-19-related accounts out of their general billing and claims life cycle, and submit them to Medicare for COVID-19 reimbursement, ensuring that no one receives an unnecessary accidental bill.

Joining clinical and revenue cycle data has created new level of stratified insights that has led to the success management of clinical operations and supply chain operations, and added value to the effective management of the patient population. The word holistic comes to mind, because the more the whole organization is operating from the same complete, verified datasets, the more effective they can be.

Looking Forward to the Better Normal

It’s clear that, even if a vaccine eliminates all future threats from COVID-19, that the normal we all return to won’t be the same normal as before. But the phrase “new normal” doesn’t have to mean a world where we live with permanently lowered expectations.

The effective use and operationalization of data intelligence technology has brought the very best qualities of the health system’s people to the forefront. By reacting quickly to affected populations, and creating new best practices across the organization, Geisinger looks forward to a better normal—with the business, mission and community emerging healthier than ever.

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