The advantages and challenges of developing revenue cycle management (RCM) solutions in-house within a healthcare organization are vast and complex. Particularly, the balance between retaining valuable internal knowledge and managing the higher costs and time commitments compared to collaborating with external vendors can be a daunting task. At Grady Health System in Atlanta, this delicate equilibrium is exemplified through One Grady, the organization’s billing subsidiary, which boasts a dedicated team of seven developers solely focused on RCM solutions. This relatively small team is particularly noteworthy because, despite its size, it engages in a wide array of essential functions such as data analytics, process improvement, and automation support across the entire healthcare system. Jacqueline Samuel, the director of revenue cycle integrity, strategy, and analytics, underscores the importance of effectively prioritizing their limited resources to ensure the greatest impact.
Effective Resource Allocation and ROI
To make in-house RCM development worthwhile, One Grady mandates a collaborative approach where all staff members are encouraged to propose new solutions during quarterly meetings. Each proposal must include a thorough assessment and presentation of the anticipated return on investment (ROI). This rigorous process is designed to ensure that only the most promising RCM tools, which justify both the effort and expense, are developed. Once proposed, these solutions do not automatically move forward; they undergo further scrutiny during governance meetings. Here, the team evaluates alternative, less resource-intensive solutions, such as maximizing existing electronic health record (EHR) capabilities, before committing to more complicated in-house developments. This multi-layered approval process exemplifies the critical role of evaluating ROI to ensure effective resource allocation and, ultimately, achieving the best possible outcomes.
The consensus within the team is that while in-house RCM development comes with substantial perks, meticulously evaluating the ROI is crucial. This evaluation ensures that resources are directed towards viable solutions promising significant returns. By engaging all stakeholders in the ROI assessment process, One Grady not only fosters a culture of accountability and innovation but also ensures that the developed RCM tools align with the organization’s broader strategic goals. This method has proven effective in maintaining a pipeline of high-impact projects while avoiding the potential pitfalls of misallocation and inefficiency.
Balancing Internal and External Capabilities
One Grady’s approach to in-house RCM development reflects broader trends in healthcare. Many organizations have found that a hybrid strategy, combining in-house capabilities with external tools, often yields the best results. For One Grady, this means leveraging internal expertise to create tailored solutions while remaining open to external innovations that can enhance their efforts. This dual strategy enables more flexible revenue cycle processes, offering a competitive edge in a complex healthcare landscape.
Effective governance structures are crucial for balancing these internal and external capabilities. At One Grady, governance meetings serve as the key platform for evaluating alternate solutions and hybrid approaches. This allows the organization to ascertain whether an internally developed tool provides more value than an external option, or if a combination of both is more effective. This careful assessment helps maintain a balanced, strategic approach to RCM development, maximizing ROI.
One Grady’s experience demonstrates that a balanced, strategic approach to in-house RCM development, while continually assessing ROI, is vital for healthcare organizations. It ensures that revenue cycle processes stay sustainable and efficient. Through this method, One Grady has successfully navigated the complexities of in-house RCM development, showing that with the right strategies, benefits can outweigh challenges. This approach not only safeguards financial health but also fosters continuous improvement and innovation.
