CUF, a leading healthcare provider and scientific institution in Portugal generating $700 million of revenue per year, needed to accurately capture and manage information across their expansive network of offices and facilities. Learn how Effy and RAID Healthcare brought their enterprise together to optimize business efficiency and provide outstanding patient care.
Managing a healthcare provider system like CUF is complex, since you are constantly required to coordinate with many different types of stakeholders – patients, employees, insurance companies and suppliers. Decision-makers needed the most accurate and updated organizational and financial information available. Leadership needed a solution that would accurately track operations, inventory and optimize revenue. They required a system that could look across their organization and aggregate data into a central location for analysis and monitoring.
Identifying the issues
CUF’s goal was clear: to optimize and standardize operational processes across all their health units. Gaps within various processes and networks were impacting business performance and, ultimately, the patient experience.
CUF was buried under manual processes and relying upon costly auditing tools that were unable to actively respond to the organization’s needs. An increased number of healthcare units, the range of new services offered, and the demands of patient care reinforced the need for a new approach.
Investigations into key organizational processes such as billing and collections, cost control, and compliance and risk management revealed the pathways to operational, financial and clinical success. CUF required:
Standardized operational and clinical processes
Detection of operational and clinical discrepancies and failures
Revenue stream tracking from first encounter to final bill across all segments
Control, measurement and monitoring of costs across suppliers and internal units
Analysis of costs and revenue according to payer
Introducing the solution
A healthcare business assurance approach was ideally suited to significantly improve business and clinical performance. RAID Healthcare technology would accommodate the launch of multiple collaborative optimization efforts to improve operations and boost revenue while providing the outstanding service and care CUF patients rely on.
A collaborative approach produced a comprehensive plan to automate and standardize workflows, aggregate real-time data, identify inefficiencies, and allow for the redesign and correction of business processes.
The more efficient, and now pro-active, system would ensure users received real-time notifications from multiple in-house systems. Alerts and case resolution tracking through to closure would create a new cooperative workflow across all clinical and business units to ensure the detection of discrepancies and the correction of failures.
Tracking, monitoring, measurement and analysis for the entire organization – across all platforms and locations – would be accessed and managed from a single source.
In addition to fixing existing issues, RAID Healthcare would allow CUF’s team to avoid problems arising in the future with its 24/7 monitoring capabilities.
By gathering process and system data and running performance auditing rules, RAID Healthcare provided CUF with better corporate alignment, a successfully executed healthcare business assurance strategy, improved overall performance and delivery of both short and long term financial returns.
CUF leveraged RAID Healthcare’s flexibility to achieve its goals within each mapped process:
Billing and Collections
Compliance and Risk Management
RCM optimization including reduction and elimination of denials, increased clean claims and fewer days in A/R
Decrease in average medical consumables wastefulness
Standardized, monitored protocols to ensure that all medical interventions, exams, medicines and consumables are properly registered
Improved payer negotiations due to accurate cost and profitability analysis
Ensure that the medicines and clinical services provided and billed are the ones that have been prescribed and provided by the doctor.
Analysis and control of outsourcing costs
Increased revenue from accurate documentation and coding
Higher labor productivity rates and less administrative overtime
Constant monitoring of payments to ensure they fulfill contractual obligations, with alerts for payments falling below thresholds
Analysis of clinical care patterns to ensure patient health and safety
Reconciliation of delivered medications and services against medical orders
Prioritization of management initiatives according to documented needs
Improved budgeting and predictive reporting
Beyond operational efficiency
In terms of process and consumption standardization, RAID easily identified and quantified cases of potential revenue leakage and operational inefficiencies amongst the various health units. In fact, the platform not only provided an end-to-end solution to mitigate organizational gaps, but it also revolutionized the CUF’s internal management approach.
CUF created a new department focused on the implementation and management of healthcare business assurance, powered by the RAID tool.
Today, CUF’s management team is able to continuously review business process performance, measure and detect deviations from projected levels, and provide a rapid transformational response.
In partnership with Effy Healthcare, CUF established a vision to shape the concept, business case and design of its operating model – allowing the launch of multiple collaborative clinical care optimization efforts. Moving forward, the healthcare business assurance approach will significantly improve business performance while improving healthcare quality and patient outcomes.