Why RCM Companies Are Modernizing Their Environments

Adam Robinson, vice president of platform engineering for RCM company FinThrive, says advanced solutions give providers the benefit of AI and machine learning without having to build those capabilities internally. Given the financial challenges facing healthcare, he says, providers need better ways to navigate payer processes.

“Our customers are under constant pressure in terms of their costs and being able to recover costs from insurance carriers, who have increasingly complex rules,” Robinson says. “Being able to take advantage of machine learning and AI to make people more efficient is a big area for us, so we can allow our customers to invest in areas that aren’t RCM, such as patient care.”

Microsoft Azure Offers FinThrive New Possibilities

For FinThrive, headquartered in Plano, Texas, a move to Microsoft Azure provided the right foundation to offer its customers more sophisticated, data-driven services.

In FinThrive’s previous IT environment — largely housed in data centers, with some outsourced applications — control, visibility and capacity were limited, Robinson says. The company also wanted to bring disparate systems together in the wake of mergers and acquisition activity.

FinThrive considered investing in its data center footprint but determined that cloud-deployed services was the better strategic direction, Robinson adds. “We wanted our core competency to be in developing (Software as a Service) solutions and not in building out and operating on-prem infrastructure,” he says.

In addition, Azure offers important advantages such as scalability, ease of access to cloud-native tools and services, and automation to increase capacity quickly.

“The ability for us to explore newer technologies and modernize our platforms in an iterative fashion is something the cloud in general — and Azure specifically — gives us,” he says.

In early 2022, FinThrive partnered with CDW for the 16-month process of migrating applications and preparing internal staffers for cloud management.

Instead of performing a simple lift-and-shift, FinThrive CTO John Landy says, the company used the migration as an opportunity to invest in a broader modernization. Reconfiguring applications and deepening monitoring capabilities were critical steps in transitioning to a SaaS environment.

“Aligning our cloud management practices with SaaS best practices gives us a real leg up with customers for managing change and ensuring that we’re responsive,” Landy says. “We have a metric on our ability to find issues before our customers do, which is a big client satisfaction driver.”

Through Azure Monitor and other tools, the company has increased its visibility and monitoring capabilities, including synthetic transactions to facilitate oversight and a more consistent view of customer traffic across various products.

“I might be looking at different resources, but I don’t have to learn a different way of examining that across our products,” Robinson says. “Getting that level of consistency from operational and security incident response perspectives is very important.”

Today, FinThrive’s customers are reaping the benefits of its investment, Landy says. For example, modernizing the database and deploying Azure Front Door improved load balancing for redundancy, which gives customers better performance and visibility.

DISCOVER: Here's why it may be a mistake to stretch out health IT modernization lifecycles.

Increasing FinThrive’s ability to capture and leverage cloud-based data intelligence was also a priority, Landy says. By standardizing on a Databricks Data Intelligence Platform on top of Azure, the company gained AI and machine learning capabilities that, in turn, help providers derive new insights and innovations to improve their financial operations. Ultimately, the goal is to help providers shift RCM from a cost center to a tool that enhances their financial stability.

Earlier this year, FinThrive announced a suite of predictive and preventive RCM solutions to help customers proactively manage revenue, payer information and authorizations.

“Improving the financial aspects of their business is a big part of what we do: optimizing our products to become more predictive and ensure less downtime to increase availability for 24/7 processing,” Landy says.

Experian Health Transforms Data with the Help of AI

At Experian Health, headquartered in Franklin, Tenn., RCM solutions with AI and machine learning capabilities are helping customers shift from “denial management” to “denial prevention,” says Chief Commercial Officer Jason Considine.

He notes that many denials result from missing data on patient eligibility — information often captured late in the process or not at all, leading to time-consuming research and resubmissions. To help providers minimize those issues on the front end, Experian Health has prioritized AI capabilities; for example, acquiring AI company Wave HDC in late 2023, he says.

As one use case for AI, Considine says, provider registration teams can use Experian’s platform to run a single query that verifies payer information proactively.

“We’re helping people get more efficient and reduce denials that, many times, they don’t learn about until weeks or months after the patient has left,” he says. “We’re able to fix that at the point of registration.”

Inevitably, denials still occur, but AI-enabled RCM can help providers manage them more efficiently, Considine says. That’s one way advanced RCM capabilities can help providers simultaneously improve cash flow and maximize human resources, he adds.

“If you get it right the first time, you’re going to get paid faster and you won’t need as many staff to work those denials, so you can shift that investment into areas that really need it, like delivering better patient care,” he says.

Automating certain aspects of RCM also improves the patient experience, Considine says. For example, Experian Health’s customers can run automated analyses of collections data to determine the best financial pathway for a patient, such as a payment plan or financial assistance.

“If we identify that up front, we can drive a much better patient experience, and they can focus on getting well instead of on how they’re going to pay a bill,” Considine says.

EXPLORE: These three tips can help healthcare organizations with cloud cost optimization.

Moving to the Cloud Establishes a Stronger Foundation

FinThrive’s move out of data centers and into a modern IT environment has also improved disaster recovery readiness and reduced internal troubleshooting, Landy says.

“We have seen a lot of positivity in how people are interacting with those applications that are running in the cloud,” he says. “The tooling is better, definitely better visibility, and because we did the automation around deployments, people can do a lot more in less time.”

Looking back, Robinson says, a strategic approach was key to the project’s success; for instance, investing in automation capabilities that would enable additional modernization.

“For me, the lesson was, don’t try to throw everything at a project like this,” he says. “Focus on the must-haves and set yourself up to succeed in other projects in the future.”

That’s exactly what FinThrive has planned as it now works to move its remaining data center assets, including the balance of its product portfolio, to the cloud.

READ MORE: What should healthcare IT leaders know about infrastructure modernization?