The healthcare industry is seeing a rise in value-based care, which is forcing hospitals to share more financial risk. As a result, financial information systems will have to adapt to this updated landscape.
The expectation is that next-generation healthcare finance tools will utilize three major features: artificial intelligence (AI), blockchain, and visualization. In addition, all of these features will be delivered through cloud services.
Visualization, AI, and Blockchain
Though some economic sectors don’t consider visualization to be “next-generation,” healthcare’s slow adoption of IT allows it to make the cut. More intuitive visualization tools will allow end users to search for data as needed without having to rely on common reporting functions IT shops must deal with these days.
Financial management systems will increasingly rely on AI, but rarely on-premise. Established companies, like SAP and Oracle, are likely to acquire AI capabilities and add them to their solution suites. Start-ups will be able to get into the mix by leveraging open source tools, like Google’s Tensor Flow.
Blockchain, which has rapidly grown in popularity, could drastically change how global financial institutions deliver financial technologies. These institutions are dedicating quite a bit of money toward more robust business platforms.
In the healthcare sector, transactional processes deal with a lot of friction thanks to claims adjudication and processing. These processes amount to over 20% of healthcare’s total spend, but smart contracts and blockchain could combine to alleviate this problem.
Risk Adjustment and Value-Based Care
The next generation of healthcare finance will also require financial IT to adapt in three major ways: risk assessment tools, performance analytics, and resource allocation. Healthcare is moving toward a future where everything is centered on managing some level of risk. Consequently, financial management technology needs to reflect that shift.
The first way this will materialize is through the creation of risk adjustment tools that can help a health organization appropriately understand and increase its risk profile. It’s important that health organizations can document and accurately realize the risk of its patient population. Health systems will also have to seek out and resolve any cases where a patient’s risk is documented inaccurately.
If patient risk is understated, the health system won’t be paid enough. Conversely, if risk is overestimated, they could face audits and even fines. Healthcare finance tools will have to accurately identify potential gaps in risk to avoid these audits and fines. The tools will present these potential issues to clinicians for review and resolution.
In order for health systems to earn outcome-based bonus payments, they will need performance analytics. A health system’s financial tools must allow the system to see how close it is to earning these outcome-based payments. Even better, these tools should identify specific initiatives the health system can undertake to ensure a bonus is reached.
Finally, healthcare finance tools must have robust reporting for resource allocation and utilization. Since health systems are taking on an increased risk, they need to know how they are spending the money.
This isn’t an issue in the current fee-for-service healthcare environment. However, in the future, organizations will have to know how much patients are paying for care, whether or not the care is being provided in a timely manner, and whether the care is proper and priced appropriately. Healthcare finance tools will need to give physicians the power to understand where their resources are being expended.
The coming shift toward value-based models will force health organizations to deliver on patient outcomes in order to remain profitable and in business. As the direction of the industry shifts, healthcare decision-makers must understand the requirements of payment models and align their goals appropriately.