Tag: Revenue Cycle Management

Revenue Cycle Management (RCM) Platforms PEAK Matrix® Assessment 2023

Revenue Cycle Management (RCM) Platforms

Revenue Cycle Management (RCM) platforms automate financial processes in the healthcare industry. These platforms optimize the revenue cycle, from patient registration and appointment scheduling to the final bill payment. Healthcare organizations are increasingly evaluating RCM platform providers based on the functionalities, features, and technical support they provide. Solutions such as patient engagement, denial management, and medical coding are in demand as healthcare providers are expected to continue prioritizing solutions that not only address current challenges but also provide flexibility for future developments in the healthcare landscape.

Revenue Cycle Management

What is in this PEAK Matrix® Report

In this research, we assess 20 RCM platform providers on the RCM Platforms PEAK Matrix®. The study will enable buyers to choose best-fit providers based on their sourcing considerations, while providers will be able to benchmark their performance against the competition.
 

In this report, we:

  • Evaluate market trends for RCM platforms
  • Assess 20 RCM platform providers on capability- and market success-related parameters
  • Analyze enterprise sourcing considerations, highlighting the strengths and limitations of each RCM platform provider 

Scope

  • Industry: healthcare
  • Geography: US
  • The assessment is based on Everest Group’s annual RFI process for calendar year 2023, interactions with leading RCM platform providers, client reference checks, and an ongoing analysis of the RCM platforms market

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What is the PEAK Matrix®?

The PEAK Matrix® provides an objective, data-driven assessment of service and technology providers based on their overall capability and market impact across different global services markets, classifying them into three categories: Leaders, Major Contenders, and Aspirants.

LEARN MORE ABOUT Top Service Providers

Revenue Cycle Management (RCM) Operations PEAK Matrix® Assessment 2023

Revenue Cycle Management (RCM) Operations PEAK Matrix® Assessment

2022 was a tumultuous year for the US healthcare provider landscape. With patient volumes still below pre-pandemic levels, an increase in the average length of stay, severe talent shortages, and escalating costs, nearly half of the hospitals in the country faced negative margins. As healthcare providers face mounting revenue pressures, they are prioritizing the futureproofing of their revenue cycle operations. To overcome the current challenges, healthcare providers are seeking the support of third-party providers to optimize and streamline their revenue cycle processes.

RCM Peak

What is in this PEAK Matrix® Report

In this report, we assess 31 providers featured on the Revenue Cycle Management (RCM) Operations PEAK Matrix® Assessment 2023. Each profile offers a comprehensive picture of the provider’s service focus through a snapshot of its key strengths and limitations.

In this report, we examine:

  • The RCM Operations PEAK Matrix® Assessment 2023
  • Key insights into PEAK Matrix® dimensions
  • The RCM BPS provider landscape
  • Providers’ capabilities and market shares
  • Providers’ key strengths and limitations

Scope:

  • Industry: healthcare
  • Geography: global
  • Service: RCM Business Process Services (BPS)
  • The assessment is based on Everest Group’s annual RFI process for the calendar year 2023, interactions with leading RCM providers, client reference checks, and an ongoing analysis of the RCM services market

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What is the PEAK Matrix®?

The PEAK Matrix® provides an objective, data-driven assessment of service and technology providers based on their overall capability and market impact across different global services markets, classifying them into three categories: Leaders, Major Contenders, and Aspirants.

LEARN MORE ABOUT Top Service Providers

Revenue Cycle Management RCM Operations PEAK Matrix® Assessment 2022

Top Revenue Cycle Management RCM Operations Services

The COVID-19 pandemic added to the financial burden of healthcare providers as footfall reduced and elective surgeries were postponed. Today, although volumes are steadily reaching pre-pandemic levels, healthcare providers are facing strong headwinds due to an unprecedented talent shortage.

The surge in talent demand has intensified financial pressures on providers as they battle to match soaring wages and retain talent. Healthcare providers are overhauling their strategies and future-proofing their operations by becoming more receptive to outsourcing operations to alleviate cost pressures and ensure business continuity. Healthcare providers are also adopting technologies such as automation and analytics to reduce their dependency on talent and streamline operations.

DOWNLOAD THE FULL REPORT: Revenue Cycle Management (RCM) Operations PEAK Matrix® Assessment 2022

What is in this PEAK Matrix® Report:

  • A relative positioning of the providers on Everest Group’s PEAK Matrix® for RCM Operations

  • An analysis of the providers’ capabilities and market shares

  • Everest Group’s analysis of the providers’ strengths and limitations

In this research, we present a detailed view of 31 Revenue Cycle Management (RCM) operations service providers featured on the RCM Operations PEAK Matrix®. We provide a relative positioning and analysis of the providers’ market shares and our evaluation of their strengths and limitations. The study will enable healthcare providers to identify suitable partners to transform their business processes.

LEARN MORE ABOUT RCM OPERATIONS Providers

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Increased Deal Activity in Revenue Cycle Management (RCM): What is the Winning Formula?

What is the PEAK Matrix®?

The PEAK Matrix® provides an objective, data-driven assessment of service and technology providers based on their overall capability and market impact across different global services markets, classifying them into three categories: Leaders, Major Contenders, and Aspirants.

LEARN MORE ABOUT Top Service Providers

Increased Deal Activity in Revenue Cycle Management (RCM): What is the Winning Formula? | Blog

Health systems are increasingly seeking competitive proposals post-pandemic to outsource Revenue Cycle Management (RCM) and get the best prices and innovation in contracts. Learn what enterprises want and how providers can win these RFPs. 

Why has outsourcing gained traction in the Revenue Cycle Management (RCM) market?

The hospital revenue cycle process was not immune to the many changes COVID-19 brought to the US healthcare provider ecosystem, causing health systems to significantly shift operations to survive.

Challenges such as financial pressure, regulatory changes, the quality care and patient experience focus, and digital penetration pushed health systems – who traditionally prefer to keep operations in-house – to look outside for support. This drove more than 10% year-over-year growth in sourcing in the RCM market in 2021, and the strong contracting activity continues to gain traction this year.

Several health systems, including MarinHealth, Baptist Health, SSM Health, and Bassett Healthcare, have entered into outsourcing agreements with third-party vendors. However, unlike most past arrangements when sole-source was the dominant sourcing model, RFP-led sourcing is now the preferred model for healthcare providers in the post-pandemic world.

Exhibit 1: Split of new Revenue Cycle Management (RCM) services deals in 2021 – sole-sourced versus RFP-led

Picture1

Source: Everest Group’s coverage of 32 major RCM services outsourcing providers

Why do healthcare providers prefer RFPs?

Key factors driving health systems towards a competitive route over sole-sourced are:

  1. Unlike the pre-COVID era, when outsourcing was, typically, limited to a revenue cycle function or segment, the new deals coming in the Revenue Cycle Management (RCM) market are broad-based and many times encompass the end-to-end revenue cycle needs of healthcare providers. Given the size and scale of such deals, healthcare providers prefer the competitive route to get the best possible deal
  2. While cost used to be the primary decision-making driver, health systems are now emphasizing deal aspects such as innovative pricing (wanting third-party providers to have skin in the game) and offering diversified delivery network, innovation pool commitment, and compatibility with existing infrastructure, including experience of working with platforms such as Epic
  3. With hundreds of outsourcing providers in the RCM market, health systems know they can shop around to get the best deal

Key decision-making parameters for health systems in a competitive bid

Healthcare provider enterprises are looking for service providers who can provide end-to-end services covering the entire gamut of Revenue Cycle Management (RCM), rather than discrete, siloed services.

From a decision-making perspective, below are some of the key parameters that enterprises look for when selecting a potential service provider, along with their relative importance rated on a scale of 1 to 10:

Exhibit 2: Level of importance of key buyer decision-making parameters for outsourcing Revenue Cycle Management (2021)

Picture2

Source: Everest Group’s coverage of major Revenue Cycle Management (RCM) providing enterprises

Service providers need to pay special attention to how they position themselves effectively in the extremely competitive RCM market. The two main levers determining a winning proposal are:

  1. High-quality, well-structured proposals that demonstrate a deep understanding of the client’s needs
  2. Commercial proposals that are well aligned with the client’s budget and offer flexible payment terms

 

As competitive RFPs rise in the RCM market, providers who can create a differentiated value proposition and align their strategies with the enterprise’s vision will succeed in securing these lucrative deals.

To discuss Revenue Cycle Management (RCM) reach out to us at [email protected], [email protected], or contact us.

Learn more about RCM operations in the healthcare industry in our video, Revenue Cycle Management RCM Operations – Emerging Opportunities & Strategies.

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