Managed Care Innovator: A Passion for Revenue Cycle Management

Diana Allen, PhD, took the helm at The SSI Group just as the COVID-19 pandemic was emerging. In an exclusive interview, she discusses what that was like, notes the critical need to educate patients about their financial obligation, and addresses important trends that are taking hold.

In March 2020, just as the COVID-19 pandemic was about to emerge in full force, Diana Allen, PhD, was named CEO of The SSI Group. SSI helps providers and payers with revenue cycle management solutions. It is no understatement to say that help in this area was of paramount importance to managed care stakeholders as the pandemic unfolded. As part of our Managed Care Innovator series, we recently spoke with Dr Allen about the challenge of running the company in the midst of a public health crisis and how she mobilized her team to pivot quickly and respond to the needs of SSI clients. She also outlined the keys to revenue cycle management and collections as the pandemic subsides.

The obvious way to begin this interview is to ask what it was like to take over a health care company as COVID-19 was emerging. But before that, I’d like to ask what were the driving factors that compelled you to take on this leadership position in the first place?

I am passionate about revenue cycle management. I have been in the business for 25+ years. The work I want to do and the difference I want to make are around the changes we can bring to those payment cycles. People in the industry talk a lot about the cost of health care, but they rarely address the cost to collect and the burden that puts on providers. Payers share that burden. It comes down to the provider negotiating and managing the cost to collect. I want to bring about faster cash collections. That is what drives me today and every day in the work I do.

What key trends are impacting revenue cycle management?

One of the trends I hear the most from hospitals and providers is the inability to predict cash, especially when revenue comes from a multitude of payer sources. There is always a lag there, as well as a lag in patient payments. We have spent a lot of time, especially during the pandemic, thinking about this. We have done some work around how we can better facilitate faster, more accurate adjudication, and then how to help our clients be able to predict revenue better.

We have built some really strong prediction models and a reliable cash forecasting tool. This helped our clients more accurately forecast revenues prior to COVID-19, but it is especially important during the pandemic recovery.

The other trend that we are working, which is extremely important to me, is education for patients about their financial responsibility in health care. This is a huge deficit in area in payment collection. We want to help patients to understand their insurance benefits and medical costs. It is not enough to send them a paper statement and expect that after two or three notices, they are going to pay. The advances we have made in cost estimation makes it possible to help patients understand their financial responsibility. This approach allows hospitals and providers to collect patient out-of-pocket expenses prior to providing services. Just the other day I was visiting my orthopedic physician and the front office was collecting from patients up front. I thought to myself, “Yes!” I believe that the right patient education can make this a more common occurrence.

Is the focus on patient education something new?

It is a relatively new space that has not been focused on to the extent that it is now. We are taking a very disruptive, innovative approach. People in our industry talk a lot about propensity to pay. There is a lot of analytics around that, and that is all well and good. But our goal is to get patients to really understand what their benefits are and then what their expected costs are in a more global, inclusive way. We want patients to be more cost-savvy. That is what really creates the propensity to pay.

What role should managed care stakeholders, particularly payers, be playing in this area?

You cannot help but notice the news stories about patients receiving surprise bills or exorbitant bills. Patients become unhappy beneficiaries and blame their insurance carrier and providers. But a surprise medical bill is really the result of misinformation. Patients do not fully understand their coverage benefits, which are determined by their employer or the managed care company.

The thing is—it is not always up to the insurers themselves. We see this a lot when we are educating patients about screenings and diagnostics. The procedure might involve two different benefits policies, and the out-of-pocket share for the patient under each policy could be quite different. One could be a fully covered benefit. The other may have a high cost-sharing amount. That is the area we want to focus on, and we think that insurers and managed care should be a part of it. They need to help us share the burden of better educating patients in this space.

Can you talk about taking the helm of a health care organization just as the COVID-19 pandemic was emerging?

I took over as CEO in March of 2020. Two weeks later, I sent our entire workforce from five offices across the country home due to the pandemic. We closed things down in 3 days, which was quite an accomplishment, given that a lot of our employees had never worked remotely before.

What was that like for you?

The most challenging aspect for me, both professionally and personally, was the unknown. COVID was such an unknown for all of us. Everyone from top executives to rank and file staff felt the pressure and the stress—the strain of not knowing what was coming next. I had to find ways to communicate remotely with staff members who did not really even know me that well, but had to trust that I was making the right decisions for them. That was quite an undertaking.

So what did you do?

I kept reminding our team of the important work that they do for our clients in revenue cycle management—how critical it was that we continued to support their cash flow during such a challenging time. That was a rallying cry for our teams to get behind. Even though we were dealing with many uncertainties, we could unify around the mission of keeping our hospitals as whole as possible around revenue. And that is what we did. We buckled down, we pushed through, and we supported our hospitals and our providers in ways that were creative. We kept our business continuity strong, which I am extremely proud of. Our staff did an amazing job.

In addition to working at home, in what other ways did the business have to adapt?

In the beginning, we provided a different type of support. We have hospitals all over the country, both rural and urban community hospitals. Some of them were in COVID-19 hotspots and had to deal with the pandemic aggressively. We jumped in and supported billing operations for those hospitals because the billing staff had to shift their duties to help manage through the crisis. This was particularly true for our hospitals in New York and Washington State—it was all hands on deck. We took on responsibilities and provided services that we had not traditionally done before. We rolled up our sleeves and said, “Sure, we’ll do that. No worries.”

For our hospital clients that were not in hotspots, many did not have revenue coming in because they were forced to postpone elective procedures. We did things to help them accelerate revenue and make sure that they were staying as financially whole as possible.  Here, too, we offered a different type of support than we have done in the past. But they were all things within our wheelhouse.

We checked in with our clients regularly. We made sure that they had the insights and the analytics to see where their performance was at risk and determine the right steps to mitigate that risk.

You seem really proud of your group for stepping up. What else are you proud of?

The biggest challenge for our clients was not being able to predict cash during a significant down turn in health care utilization. This was the first-time health care has ever been impacted in this way. We have always had patients in our hospitals for elective procedures. This is the first time we did not, and that decline in utilization was very challenging and unnerving for a lot of our hospital leaders. CFOs had no easy way of predicting what the pandemic was going to do to their cash flow. How were they going to be able to assess the recovery period, and what would it look like?

We put a team together of our data scientists and engineers, and they built the COVID-19 cash predictor, based on factors of utilization that could be impacted and during the pandemic. The predictor was customized with levers and filters that could be tailored to a specific type of hospital. That was very helpful for hospital finance staff, who were able to see the path forward more clearly.

What unique qualities stand out that differentiate SSI from competitors?

First, we are privately owned, which is not a common structure amongst our competitors. Being private allows us to pivot faster and be much more responsive to our clients’ needs. We have such a broad array of clients who have a variety of different needs. It is very important to me that we are able to pivot quickly based on their performance criteria, whether for small community hospitals or larger urban hospitals.

Our strategic partnerships are also critical. In fact, to me, those are what truly differentiate us in the market. We can respond very quickly to the issues and concerns our clients have because we are privately owned and we have partnerships that broaden our skill set.

What are the key trends to be mindful of over the next 3 to 5 years?

One is in the area of adjudication. I’ve been in revenue cycle for 25+ years, and in that time, we have not done much to advance this area. We have done a lot to develop better tools for claim processing on the provider side, but not for claim adjudication. But it is time. We are working on medical claim adjudication, looking at advances in technology to enhance claim processing and lower costs for both payers and providers. The aim is to reduce the substantial overhead that exists today around the cost to collect. Many hospitals are working with legacy systems that are quite archaic. They are patching them and keeping them going as best they can. But there is an opportunity to take advantage of the technology advancements that can increase efficiency in this area.

We are working with the US Department of Health and Human Services on processing COVID claims for the underinsured. We have built an adjudication engine that shortens the process and automates it. We are building a much more robust system with less manual intervention that still pays the claims appropriately.

The other area, as I have already mentioned, is increased patient engagement. There is more to come on that. We are launching some interesting patient-facing products that will help providers engage patients more effectively in their financial responsibility for care.

The bottom line is that revenue cycle management is going to be more important than ever as hospitals recover from the impact that the pandemic has had on their revenue. Engaging patients in their out-of-pocket responsibility and reducing cost to collect will be strong focuses. In fact, strengthening patient financial communications and engagement is probably one of the most important initiatives that hospitals and practices will undertake to bolster the patient experience and their financial performance. 

More About The SSI Group

For more than 30 years, the privately owned SSI Group has partnered with health systems and health plans to optimize financial performance and ensure health care providers are paid in a timely, efficient, and accurate manner. The SSI Group provides products and revenue cycle solutions designed to enhance the collections process from payers and patients. For more information, visit TheSSIGroup.com.

“I am excited to continue the extraordinary success The SSI Group has achieved in putting actionable revenue cycle data into the hands of healthcare revenue cycle executives across the country,” said Dr Allen in a press release announcing her appointment as CEO. “I respect the work SSI has done, especially around its claims analytics solution, which uses artificial intelligence to predict, down to the hour, when claim payment will be received from payers. In an era of transformation in healthcare, access to actionable insight is key to helping revenue cycle leaders establish an informed approach to managing their organizations’ financial operations. I am thrilled to lead SSI in the continuation of this journey of excellence, and I look forward to the coming innovations that will further benefit our clients.”