3 major technology shifts impacting Revenue Cycle Management today

How to optimize talent to maximize value creation

By Chris Grimmig and Matt Reilly

New technologies are changing the game for revenue cycle management (RCM). Industry shifts towards value-based care have pushed the function to adapt to new metrics, adjusted payment models, and more sophisticated coding than traditional fee-for-service models. Similarly, the widespread use of electronic health records has changed the way financial and clinical data interact – creating an opportunity to build a more seamless and efficient mechanism for billing processes, claim submissions, and patient engagement, resulting in streamlined workflows, improved data accessibility, and scalability of operations.   

These changes have magnified the value creation opportunity in RCM. As a result, in the past year, investors have taken a renewed interest in field, with activity ranging from large acquisitions to middle market deals. So, what exactly are the key elements driving this technological transformation and how can the right talent optimize value creation? 

1. Automation  

 Tasks such as claim submission, payment processing, and denial management are targets for advanced automation technologies. While routine, these processes are highly manual, time-consuming, and costly. Organizations need leaders who can successfully identify areas where automation can drive efficiency, increase speed while minimizing errors, maximize reimbursement, and reduce overall risk. Likewise, as automation becomes increasingly sophisticated with the addition of AI and large language models (LLMs), leaders’ ability to assess automation tools will be paramount. Recruiting leaders who can construct an RCM strategy that includes both the opportunity identification and tool evaluation aspects of automating processes will create significant value.  

2. Interoperability  

 Given the challenge of interoperability within the healthcare sector, there has been a tremendous effort to secure and streamline the exchange of health information to improve both patient care and financial operations. Within RCM, leaders with expertise improving interoperability, implementing technologies like cloud-based RCM platforms, cybersecurity, and API solutions, will significantly reduce administrative burden, optimize reimbursement rates, improve patient collections, and ensure patients have the necessary coverage for their care plan. Going forward, businesses that prioritize value creation need to evaluate and hire RCM leadership with this skillset.   

3. Patient Use & Engagement  

As patients increasingly take control of their healthcare, providers are also emphasizing patient engagement in their care financially, from technology that enables cost of care estimation to payment plan options. These self-service software solutions, like mobile apps, online portals, and chat features, can improve how patients engage with providers while reducing financial surprises and collection delays.  As organizations look ahead, hiring talent that approaches RCM from the financial, technical, and patient perspective will be critical. 

Impact on talent & value-creation 

New technology is changing RCM, and the talent needed to lead the function into the future is following suit. Organizations that seek to take advantage of emerging advancements in technology need leaders who are operationally focused, tech-driven, and adaptable – those who successfully collaborate with IT and finance to ensure solution integration will maximize value creation and optimal patient outcomes.