Connexions: A Year in Review

Whether it was face-to-face or virtually, 2023’s Connexion events gave healthcare executives multiple opportunities to brainstorm solutions to the industry’s most pressing challenges.

As we transition into 2024, data from Kaufman Hall would suggest that the industry can expect further stabilization. Revenue continues to show improvement, operating margins are elevated over pandemic levels, and Provider performance is, at least in the big picture, continuing to trend upward. There’s a story behind that progress, however, that can’t be fully told through financial metrics alone – one of continued perseverance in the face of constant labor challenges, obstructionist payer tactics, and barriers to more equitable and accessible health.

That story was shared among friends and peers, and in our case, throughout the sessions that made up Connexion 2023 and Connexion Virtual 2023. The former gave industry thought leaders and Connex members an opportunity to break bread and share insights face-to-face in the Entertainment Capital of the World. The latter gave them an opportunity to examine the year in review from the comfort of their own homes and offices, minimizing disruptions as they prepared for holiday plans with family and loved ones. In both cases, Attendees made plenty of valuable contributions across the full spectrum of healthcare focus areas.

Growth, Service Line Expansions & New Revenue
Whether it was to help address the diverse needs of their expanding patient base, a desire to break into new and lucrative markets, or to just outright expand access to care, Attendees had their sights
set on growth.

• Partner with colleges, schools, and other community institutions to drive engagement with your services, market new expansions, and even expand your talent pipeline
• Make your core operations lean before focusing heavily on growth – otherwise, administrative bloat can quickly and unexpectedly eat away at expected gains
• Market research, outmigration data, and sentiment analysis are critical, especially if you haven’t conducted them since the post-COVID proliferation of digital health delivery
• Joint ventures are strong drivers of passive income and worth taking advantage of – if you don’t, the competition will
• Consider the full financial picture and not just direct revenue, as it sometimes makes sense to accept losses if it means outperforming the market and reaping downstream benefits
• Ensure that growth plans are aligned with care goals, otherwise the progress made to reducing readmissions can quickly erode your bottom line in fee-for-service settings
• Consider income guarantees, loan forgiveness, and other incentives to capture more primary care and other outpatient physicians

Labor & Staffing
Those expansion plans, however, would be subject to many of the same challenges Providers face within their existing markets. Talent acquisition was still the number one challenge for most Attendees, forcing them to get creative in how they source, train, and retain critical staff. Thankfully, Attendees had ideas for how to get an advantage over competitors.

•  Internal contracted labor pools can dramatically reduce traveler spend by providing options within your organization for nurses interested in greater flexibility
• Several Attendees cited imported nursing talent as a major help, however, decisions by the US State Department this last summer could curb that practice significantly
• Sometimes you save by spending more – several Attendees explained that capturing more permanent employees by increasing hourly rates, adding sign-on bonuses, and tacking on other incentives reduced their total spend by eliminating the need for premium labor
• Develop a nursing institute or create programs in partnership with local nursing schools to improve long-term recruitment prospects; some are even engaging middle and high school students to spark that interest and brand loyalty early

Employee Value Proposition & Culture
Pursuant to those labor concerns, Attendees also took time to discuss how they could improve their overall organizational culture. Rewards, recognition, and other staff engagement practices were all discussed, with the consensus at both events being that retaining top staff is arguably more important than sourcing new team members.

• Cultures that focus heavily on trust, accountability, and charitable missions are reported to be outperforming their peers when it comes to staff retention and overall job satisfaction
• Forge a close working relationship between clinical and financial leaders and teams to ensure they’re aligned, as this allows for parallel growth in both areas in service of a single, unified organizational vision
• Strike an intergenerational balance – each demographic has their own workplace culture and work-life balance expectations, and leaders need to be prepared to accept and cater to each
• Flexibility and change acceptance must become cultural hallmarks, especially as younger generations of leaders prefer to make regular career changes; the organization must know how to stay consistent, even when senior leaders cycle through
• Keep avenues of staff communication open with surveys, one-on-one conversations, anonymous tip lines, and other tools, especially since frontline staff have the perspective needed to truly understand where and why the best laid plans are breaking down
• Support talent mobility and lateral trajectories – this both improves satisfaction with younger high potentials and strengthens your overall talent pipeline
  
  

Patient Access
Discussions about organizational culture, mission, and values naturally dovetailed into conversations about patient engagement. More specifically, Attendees discussed patient access; how their processes for it are adjusting to an increasingly digital world; and the ways in which they could ensure positive patient interactions.

• Align the culture of the organization with your patient access and financial goals – there are ways to pursue upfront collections, for example, without compromising on a patient-first philosophy
• Digital front doors are critical, both for shifting the burden of outreach and engagement tasks off internal teams, and for giving patients the self-service tools they’ve come to expect
• Education must take center stage, otherwise confusion around patient liabilities, insurance coverages, and the patient access process will dramatically hamper progress; like with all initiatives, focus on the why
• Transparency can be a double-edged sword that leads to just as many complaints as sighs of relief, so be sure to invest in the customer service, conflict resolution, and de-escalation skills of your frontline staff
• Consider making the frontend of revenue cycle the focus of new technology, as so many downstream issues can be prevented or addressed upfront
  
  

RCM Optimization & Revenue Integrity
The front-end wasn’t the only concern our network of CFOs, VPs of Revenue Cycle, and others had. Attendees discussed strategies for optimizing RCM operations and safeguarding revenue integrity, and while they agreed that technology no doubt plays a role in both pursuits, they clarified that sometimes the most valuable changes are more personal.

• Collaborative, cross-functional communication channels must be cultivated within rev cycle specifically given its highly interconnected nature – the more each team understands one another’s role and requirements, the more they can find mutual synergies
• Clinical leadership must be brought to the RCM table to ensure they understand what rev cycle needs from care teams to bill claims appropriately
• Don’t lose sight of the greater, strategic picture when you pursue procedural accountability and set out to address the “fires” of day-to-day RCM
• Apply the same rigorous and persistent philosophy to revenue integrity that you would to self-pay receivables
• Focus time and resources on getting good data into your systems – having bots, RPA, and AI tools won’t be helpful if they’re being fed bad information
• Establish a priority matrix to ensure that advancements in systems, tools, and processes are focused first and foremost on the areas that will net the greatest returns
  
  

Billing & Denials
Speaking of backend processes, Attendees had ideas on how billing and denials management processes could be enhanced to help reduce staffing pressures, maximize revenue, and better address the ever-mounting list of Payer demands.

• Leverage AI and automation to its fullest, especially given the volume of tasks that go into creating payer specific edits, so staff is managing tasks by exception
• Reconsider outsourcing – managing denials or getting contracts and fee schedules loaded into your system are both large lifts that can be easily and cost-effectively offloaded to third parties
• Be proactive and aggressive in setting precedents for your payers, especially when it comes to combatting retroactive denials
• Don’t be afraid to meet with and apply pressure on Payers face-to-face, armed with data that demonstrates where and how they’re failing to uphold their end
• Secondary and tertiary reviews are critical given Payers’ constant changes to documentation expectations