Solving Revenue Cycle Management with Documentum


Right now, I am sitting at a confluence of events. Not earth-shattering events like those impacting the Muslim and Arab worlds right now, but a confluence nonetheless.  In my last post, I talked about why it might be worth investing in a partnership with EMC right now, given the right circumstances. That has happened and today my company announced a new solution for Health IT, the afore-mentioned Revenue Cycle Management, built on EMC’s Documentum xCP platform.

So how did this come to pass? Let’s look back over the past year.

Health IT

New Picture Those of you paying attention may recall that last year I attended the HIMSS Conference, the leading Health IT conference, and wrote a few posts on what I learned while there. This year I am not attending, but five of my colleagues are there as I type.

It was a whole new world and made me realize a couple of things. The first was that healthcare needs a lot of help in Content Management and IT as a whole. There are a lot of smart people in the industry, but most of them know healthcare and aren’t as savvy about IT. They tend to treat content in the same manner as SharePoint 2003, just one more thing.

The second was that it would take me a lot of work for me to become a domain expert. I know this because as I walked the floor with one of my colleagues, former clients would walk up to him and start a conversation. I would quickly get lost in the terminology. I would later learn that I understood the technical challenges, I was just lacking on the lingo.

I decided at that point that while I would continue to support my Health IT colleagues, I would let them lead the efforts because they know healthcare cold. I would focus on making things work the way they wanted them to work and being a resource.

Enter Revenue Cycle Management

Flash forward to this past fall. As I discussed in my last post, EMC reached out to my company as a partner. While very skeptical, and busy, I decided to meet with my “new” partner representative (I didn’t know I had one) and see what he wanted. I have known him for years in various roles, so I thought it would be a good chance to at least catch-up.

What I learned was that EMC was looking for some partners to develop solutions. Due to some minor issue, he threw the entire list of solutions onto the screen and not just the ones he was focusing on in his role. As we looked and talked about the desired solutions for the Federal space, I decided none of them seemed appealing. We didn’t have deep domain expertise in the business areas and no discriminators.

As he talked, my eyes wandered down the spreadsheet to some healthcare solutions that they were looking to build. Two of them caught my eye and I asked about them. Being a Federal partner rep, he wasn’t that familiar with them, but quickly arranged a call for us to learn more.

That was an important call. I brought my favorite Health IT guy, Brad, and we talked to one of EMC’s Health IT experts. By the end of the call, we decided that Revenue Cycle Management was the perfect fit for Washington Consulting and EMC had decided that we knew enough about the solution to be able to successfully design, create, and deliver the solution.

Just like that, Documentum went from something that we do into a strategic thrust for us.

Whirlwind of Activity

image Since then, we have worked on defining the solution and begun the build process. We presented the solution at the EMC Worldwide Sales Kickoff last month and have been engaging with people since then. I’ve been busy learning more about Revenue Cycle Management, helping to build the solution, and making sure that the right technical talents are brought to bear on the solution creation.

I’ve learned a lot, and not just that there is a strong ROI and market need. To illustrate, let’s imagine a routine patient visit.

You are becoming a parent. When it is time to give birth, you go to the hospital and everything goes well. After a couple of days, you go home with your expanded family. During this, a lot of things are taking place.

  • At check-in, your identity and insurance information was confirmed and a file was opened specifically for your stay. Consent forms were signed and stored.
  • Different procedures were done during the stay. The OB/GYN delivered the baby, anesthesiology provided the epidural, and pediatrics checked the health of the baby.
  • Each action was captured and coded correctly so that it could be billed and/or filed with the insurance company.

While part of your overall Electronic Health Record (EHR), the billing process is a separate beast. There correspondence and bills that have to be sent and tracked. If anything is wrong, it will be denied (insurance companies love to deny claims). Fighting those denials takes time and money. Waiting for a denial to be resolved also delays receipt of money. During this, patients need to be kept in the loop and may need to provide additional information.

Revenue Cycle Management is about taking care of all those details. It focuses on capturing the right information, preventing fraud, reducing denials, and essentially improving the cash flow for a healthcare provider. That saved money can be used to improve patient care and reduce healthcare costs.

There is a lot more detail and a lot that such a solution can offer healthcare providers. When built on a solid content platform with strong security, BPM, and the ability to integrate into the EHR systems, the ROI to the organization becomes pretty easy to prove. Plus, once a Content Management system is in place, it can then be leveraged for other content challenges as well.

So Why EMC?

The question really boils down to why EMC? Why am I partnering with them for this solution and not someone else is obvious from the above story. Clients don’t care about that angle though. They want to know why it is the right choice for them.

There is a need for some hardcore BPM, granular security, and integrated scanning when delivering Revenue Cycle Management solutions. It is a solution that fits into the content-centric Case Management mold. For those solutions, you want to provide a more out-of-the-box and limit the customization and 3rd party components required.

The goal is to limit the risk around the technology. You want something that can easily meet the needs, primarily through configuration, and allow services to focus on the business needs. You also need a system that can readily interoperate with any number of external systems leveraging standards whenever possible.

On the whole, given the current vendor capability landscape, market landscape, and our technical ability to successfully deliver, EMC is a good choice. There will be some opportunities where Documentum won’t be the best choice, but right now, it will rarely be the wrong reason from a technical perspective, which is all you can ask of any technology-based solution.

This is also not to say that EMC is the right choice for all healthcare systems. We just feel it is the best choice for Revenue Cycle Management and we are pretty excited about the prospects.

One thought on “Solving Revenue Cycle Management with Documentum

  1. The platform is only one of the tools or the means to end up with a good solution, it’s a shame that a lot of customers don’t see it that way and keep their focus on asking customizations in the UI to feel more comfortable with the product.
    They waste their money changing the UI instead of redesigning their processes and searching for a better solution.

    Good post.
    Regards.

    Like

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