Business Solutions: Leveraging technology to streamline the healthcare revenue cycle

This episode of the MGMA Business Solutions podcast features Matt Seefeld, executive vice president at MedEvolve and a frequent MGMA podcast guest. With more than 24 years of management consulting experience in the healthcare industry, Seefeld has extensive expertise in the assessment, design and implementation of process improvement programs and technology development across the entire revenue cycle.  

MedEvolve provides technology and services for healthcare organizations to improve margin, reduce labor dependency and increase net collection rate in revenue cycle management (RCM). MedEvolve aims at empowering physician practices to work smarter with data-driven solutions that provide transparency, automation and accountability.  

MGMA Sr. Editor Daniel Williams, MBA, MSEM. sat down with Seefeld to discuss MedEvolve’s role in improving profitability and streamlining efficiency by leveraging technology within the healthcare revenue cycle.   

Editor’s note: The following Q&A has been edited for length and clarity. 

Q. Can you give us an idea of who MedEvolve is and what you do there? 

A. I came on board about seven years ago to take a look at the business and it was a privately owned company out of Arkansas. It was a practice management company, did not have an EHR and had a small RCM business primarily focused on insurance A/R. The first thing I started looking at was where were the gaps in the practice management (PM) system that allows our RCM company as well as our clients that use our PM to really understand in real time the production and the outcome of their RCM staff. We call it “effective intelligence,” but it's basically, “Let me bring you intel on your people that allows you to then act on that intel, and you can choose to act or choose to not act.” 

What was interesting was when we started to build this out, we started to see the gaps in a lot of other PMs than our own. This is something that I've seen throughout my career. I've been in healthcare rev cycle consulting, technology and software development for 24 years. I don't blame the PM/EHR companies. There's a lot of competition there. They have to focus on physician experience and they have to focus on the consumer experience now, but who gets left behind, ironically, are the people that actually manage the revenue cycle, which gets providers paid for what are now pretty expensive-to-deliver services. 

So it's really been a focus on how we give empowerment back to our clients that say, “these individuals are doing a great job and these need to be promoted, recognized, rewarded, retained — these other ones have to have an opportunity to improve or show they want to.” And if not, you've created capacity within your team. You've also created an opportunity to reduce some of your labor costs, which I think everybody would enjoy a little more margin today. 

Q. Since your role there is always evolving, what are you focused on right now? 

A. I oversee a lot of departments — sales and marketing being one of them — but I also oversee the implementation of our Effective Intelligence Suite, which is this workflow automation system that we can put on any PM system in the market. That's a pretty big focus of mine and I also still run all the strategy and the ideation behind this. 

Since 2003, I realized that there was an opportunity to build something that could bolt onto any PM system. Back then, I was working with large health systems and academic medical centers that would help bring margin back to the organization and create an opportunity to recognize and reward employees that were going above and beyond. I'm working closely with our VP of Product Strategy, looking at other ways to bring in AI automation. AI coding is a big one. We just did a partnership with a fantastic company in that space.  

What we're trying to do is be the company that helps our clients understand the total touches it takes to get the outcome. This is one thing that continues to be missed, in my opinion. 100-plus years ago, Henry Ford decided whether he could have one person make an entire car, or he could figure out the true order in which things need to be assembled to be able to produce more at a higher margin, get better costs on raw materials, etc. So how can we, in North American healthcare still not answer that question?  

As a company, we've really simplified our message. Our software paired with any PM system allows you to track every touch, and those touches are occurring to get you paid — and it's a lot. I looked at a couple of years’ worth of services that we built for. There were 357,000 touches on that, and that for us is about $5.25 per touch. Everything we do for our RCM company is still onshore, so it's more expensive. If I could reduce 50% of that cost, what is that going to do to the margin of a privately held company like us? It's going to be huge. So we have to start thinking about touches as waste. And the quote that I always use is, “Once you start touching claims – post service, post coding, etc. — your margin starts to go down and your wallet share is shrinking.”  

We want to empower our clients with tools that allow them to claw back some of that lost margin and that's really the position that our business is in now. So we still have a PM system we integrate with any EHR out there and I still have an RCM services business — both on the self-pay side as well as the insurance side — but it's the effective Intelligence Suite where the majority of the conversations that we're having now. That's where we want to be as a company, and we want to continue to push the frontier on what we're doing.  

Q. Can you give us a better understanding of how executives can leverage AI and use automation the right way in the rev cycle? 

A. The cool thing about AI today is looking at all the structured data that's being generated between the EHR and the practice management system – and the MedEvolve solution even adds another layer of structured data around the actions that are being taken and the outcomes they're getting in the rev cycle. 

Imagine a provider being able to come in and just read their insights. This engine just told you where your problems are and then went further and told you what to do about it. It even told you the economic benefit if you act on it. This is why I'm so bullish on capturing more structured data around what's happening with claims and revenue cycle than the PMs are capable of doing — because you’ve  got to have that next step of data. Just telling me that a claim is in this status isn't enough. What I did with that claim, what was the outcome of the action and did it actually yield anything — now you're getting much more sophisticated. We're not in Pivot Tables anymore. We're not in Excel. I actually think what's going to happen is going to be a leap over that.  

This is why we're focused so much on insights and adaptive AI. I'm not even going to ask you to go figure it out. I'm just going to tell you what to do. I think that's where we are and I'm totally okay with it because it's going to surpass our ability to do analytics quickly. The other principle that we've introduced is this concept of we what call “zero touch rate.” What it really means in a colloquial sense is that no human had to get involved after you deliver the service — very different than a clean claim pass. That's just one component.  

Our clients are now able to look at how many claims go out the door and get paid without human intervention, but the inverse of that is where humans are having to get involved. This is really important because I think there's a lot of investment going into potentially the wrong areas of the revenue cycle. When people are at the shows, they see these cool AI bots. What if that's actually not your problem? Do you know where your humans are getting all involved? If your problem is refiling, or first pass analysis, or tasking — whatever it is — you've got to be able to understand that because that's where your 20-Plus dollar-an-hour employees are spending their time. So we want to look at that and then based on where humans are getting involved in most, that's when we start to look at where we fill the gap.  

It is the reason we like the AI coding machine that we're putting in now (there’s a great company we're working with) because we know that's a gap. It's expensive to code charts. If you could code 30%, 40% or maybe 50% with the AI engine and you can reduce first pass denials for coding, that's a huge win for anybody. Same thing with prior-auth automation. If a bot can go out and tell you, “Yes, you've got it," "No, you don't," or, "Yes, but you’re waiting on it,” it's going to help clean up the front end of the revenue cycle just a little bit more.  

MedEvolve’s approach is more as a partner now. We built a lot on our own. We don't buy companies and we're looking at partners that kind of fit this ecosystem that drives automation and, at the end of the day, drives less touches. That's the whole goal — less touches to get the outcome or, ideally, no touches.