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Navigating Growth in the Healthcare Industry: Overcoming Challenges and Achieving Scalability
Summary
Scaling a medical practice in the ever-evolving healthcare industry presents unique complexities and challenges. This article delves into the strategies involved in scaling a business within this dynamic sector. It explores key strategies, including gaining a comprehensive understanding of payer processes, implementing standardization, investing in people and technology, and forging partnerships with scalable vendors. By prioritizing these strategies, healthcare organizations can streamline operations, reduce inefficiencies, and maintain a focus on delivering high-quality patient care while successfully scaling their business.
By: Irene Torres, VP of Process Excellence, Optum
In the ever-evolving healthcare industry, scaling a business can be complex and challenging. With the increasing desire for growth and expansion, particularly among larger practices, the acquisition of similar practices or new specialties has become common. While many practices excel at transitioning high-level functions like marketing and payroll, the integration of operating models remains a significant challenge. Dealing with multiple technology platforms and operational processes further complicates the ability to scale effectively. Additionally, the inability to expand the workforce further complicates expansion efforts. To overcome these obstacles, understanding payer processes, implementing standardization, investing in people and technology, and partnering with scalable vendors are crucial. By adopting these strategies, healthcare organizations can streamline operations, reduce inefficiencies, and prioritize quality patient care while successfully scaling their business.
Understand payer positions
For practices that are seeking to expand their businesses, particularly into new specialty areas, it’s critical that business leaders have the skill set and expertise to navigate the payer landscape and understand payer reimbursement and coverage guidelines. Dealing with payers and understanding their positions, processes and policies are one of the biggest challenges facing practices today.
For example, there's a lot of advancement in the field of technology right now and new technology is becoming more readily available to medical practices. For practices that are looking to develop and grow their business and offer the latest in medical advancements to their patients they have to also understand how payers are applying policies around those new technologies and care models. Often times, providers may need to work with payers as they are evolving their policies to guide and clarify application of these services as it relates to bringing the best quality of care to their patient.
The willingness to understand payer positions before engaging on a growth trajectory is the main starting point for organizations seeking to scale their businesses.
Standardization
Standardization plays a crucial role in scaling healthcare businesses. By standardizing processes, organizations can simplify operations, reduce inefficiencies, and ensure consistent outcomes, making them more adaptable for scalability. This is especially important for practices that expand through acquisitions, particularly across different locations. It is essential for them to establish a model to standardize their operational processes, starting with the revenue cycle management (RCM) process. A robust RCM process serves as the foundation for success. Getting the beginning right is paramount because any challenges or issues that arise downstream can be traced back to the initial stages.
When acquiring a new business, it often comes with different operational processes and EMR systems. Evaluating and deciding on a standardized EMR system becomes crucial to streamline the intake process and ensure a seamless end-to-end RCM process. Practices must decide whether to choose the incumbent system or opt for a new one, but the key is to choose one and consolidate into a universal or singular system. This simplifies the upstream and downstream processes as a whole.
Invest in people and technology
Diversity in labor and experience:
Scaling a healthcare business requires a workforce that can adapt and expand alongside the organization. By investing in a diversified workforce, organizations can easily scale their operations. One common challenge faced by practice aggregators and large multispecialty practices is the high cost of rebadging acquired employees, especially when expanding into new markets; if the business had the ability to scale their workforce in a different part of the country, it might be less expensive. Partnering with companies like Optum, who have a global workforce, provides the advantage of scalability. Optum's industry expertise and global talent pool allow them to quickly scale their workforce to meet the needs of their clients. This flexibility is crucial for handling business expansions, temporary seasonality, and other workforce demands.
Expand your workforce globally:
A diverse workforce brings a wealth of experience, which is vital for delivering high-quality services and staying competitive in the market. The value of a business is measured by the experience of its people. By partnering with RCM services vendors like Optum, who have extensive experience providing medical billing and coding services to multiple specialties, practices can scale much quicker than they would be able to on their own. Instead of worrying about expansion taking a year or longer after an acquisition, a global workforce can expedite the scaling process, allowing businesses to continue growing efficiently.
Invest in technology:
Technology plays a significant role in scaling and expanding the footprint of healthcare organizations. By adopting standardized technology solutions, healthcare organizations can overcome integration challenges and reduce the risk of errors. Implementing a unified technology platform simplifies workflows, reduces administrative burdens, and accelerates revenue cycles.
One of the key benefits of streamlining technology is the elimination of multiple entry and exit points. When acquiring new practices, expanders often find themselves with an excess of technology that may not integrate well. This can result in different systems that don't communicate effectively, creating the need for multiple entry and exit points. This increases the chances of user error and requires constant monitoring. An expander needs to ensure that system A talked to system B, and if there's a failure in that connection, an expander needs either people or a process to monitor that. However, by standardizing technology or investing in a singular system, this entire process is simplified, reducing the risk of errors.
For example, let's consider XYZ healthcare organization (XYZ) in growth mode after acquiring new practices. XYZ needs to invest in a new electronic medical record (EMR) system, perform eligibility checks, validate insurance information, enable self-scheduling and appointment reminders, and facilitate payment collection at the time of service. Managing all these requirements individually would involve multiple products and service offerings, along with the challenges of vendor contracts and seeking competitive pricing. Alternatively, partnering with an end-to-end vendor like Optum provides access to a comprehensive range of technology solutions and service offerings, eliminating the need to piece together multiple vendors and products.
This one-stop-shop approach streamlines the implementation process. This one-stop-shop approach streamlines the implementation process and allows organizations to leverage Optum's experience and expertise in the industry. Consolidating vendor contracts simplifies management and ensures a seamless end-to-end RCM process, which is crucial for successful scaling efforts.
Automation is key:
Automation is a game-changer in healthcare organizations, revolutionizing claim processing and payment reimbursement. By automating these critical processes, organizations can achieve remarkable speed and efficiency compared to manual methods. This translates to faster payment reimbursement, significantly boosting the organization's cash flow and financial health.
However, the benefits of automation extend far beyond mere speed. It serves as a catalyst for overall success, driving transformative changes throughout the organization. Automation reduces the margin of error, ensuring greater accuracy and reliability in claim processing. It eliminates the need for repetitive manual tasks, freeing up valuable time and resources for staff to focus on more meaningful activities, such as providing exceptional patient care and pursuing strategic initiatives.
Moreover, automation empowers organizations to handle larger volumes of work without the need for exponential workforce growth. This not only leads to substantial cost savings but also enhances operational efficiency. By automating routine tasks, organizations can streamline their operations, optimize resource allocation, and achieve higher productivity levels.
Ultimately, automation becomes a key driver of accelerated revenue generation. It enables organizations to scale quickly and successfully by efficiently managing increased workloads and maximizing revenue opportunities. By leveraging automation, healthcare organizations can unlock a multitude of benefits that contribute to their overall success and growth.
Consider working with a vendor who can scale with you
As I have emphasized throughout, partnering with a vendor like Optum is a key strategy for practices and aggregators looking to expand their footprint. These large end-to-end RCM vendors possess the necessary resources and expertise to scale quickly and effectively. With a global workforce, cutting-edge technology, proprietary automated workflows, and extensive experience across multiple specialties, they are well-equipped to meet the demands of expanding organizations. When selecting an RCM partner, expanders should prioritize vendors with expertise in various markets. This breadth of experience allows the vendor to gain insights into industry changes, challenges, and regulatory requirements.
Large multispecialty practices often face significant challenges managing their RCM operations in-house. By adopting a standalone perspective, they may find it difficult to gain insights into industry-wide challenges and trends. In such cases, it becomes crucial for them to seek knowledge-sharing with others, including their competitors, to understand whether the issues they encounter are unique or shared across the industry.
Alternatively, large multispecialty practices can gain valuable insights into common challenges and potential solutions by partnering with vendors like Optum. By leveraging their extensive client base, RCM vendors like Optum can provide valuable insights and benchmarking opportunities that a standalone practice would not have access to. This collaborative approach ensures that healthcare organizations stay informed about payer changes, market trends, and best practices, enabling them to navigate the complexities of RCM with greater efficiency and effectiveness.
By partnering with a vendor like Optum, practices and aggregators can tap into a collective knowledge pool, benefiting from the vendor's industry-wide perspective. This collaboration not only helps address challenges more efficiently but also drives continuous improvement in RCM operations. Additionally, a strong vendor can expedite growth and maximize return on investment, providing the necessary scalability and expertise to support the organization's expansion efforts.
Partnering with a reputable RCM vendor like Optum offers significant advantages for practices and aggregators seeking to expand their footprint. By leveraging the vendor's global workforce, advanced technology, and industry expertise, organizations can achieve scalability, gain valuable insights, and drive continuous improvement in their RCM operations.
In the healthcare industry, scaling a business can be complex. To overcome challenges, healthcare organizations should understand payer processes, implement standardization, invest in people and technology, and partner with scalable vendors. Understanding how payers reimburse for new specialties is crucial for expansion. Standardizing processes and technology simplifies operations and reduces errors. Investing in a diverse workforce and partnering with global vendors allows for quick scalability. Automation improves efficiency and accelerates revenue generation. Partnering with an end-to-end vendor like Optum provides access to expertise and resources. This collaboration helps address challenges, gain insights, and drive continuous improvement in revenue cycle management operations.
With the right combination of standardization, workforce diversification, and technology, practices and aggregators can successfully navigate the complexities of scaling and achieve sustainable growth, while driving continuous improvement in revenue cycle management operations and patient care.
Bio
Irene Torres has worked in the healthcare industry for over 25 years, specializing in revenue cycle management operations. Irene oversees operations teams responsible for multimillion dollar annual revenues, leads intelligence automation initiatives and oversees implementation processes for several Optum products. Irene holds a Bachelor's degree in Business from Purdue University and is also certified in medical billing.
