Prevention is the cure for your revenue cycle too

Not long after the champagne toast is completed, resolutions set, and the Times Square Ball has settled into its home for the next 365 days, a reminder pops up in my calendar that it’s time to schedule my annual medical appointments.  

So begins the task of scheduling my physical and blood work, calling my dermatologist for my annual skin check, getting in to see my eye doctor for my annual vision test, and getting squeezed in for my annual mammogram, pun intended. 

I am diligent with my preventative care as I know that prevention is the key to longevity, and I want to be around for a while. It’s well documented that preventive care can lead to early detection of problems that, in turn, can lead to better outcomes for patients and not to mention a longer life.  

Preventive care allows your healthcare providers to identify potential diseases and conditions when both are in their earliest stages, leading to interventions and more effective treatment.  

In addition, preventive care helps manage the overall cost of healthcare. This is why payors incentivize patients to seek this proactive care by eliminating co-pays for annual wellness checks. In fact, it is estimated that every $1 that’s invested in prevention returns up to $45 in savings, depending on the intervention. (1)   

Afterall, an ounce of prevention is worth a pound of cure. However, despite all the reasons that support patients seeking preventive care, studies estimate that more than a quarter of the population in the United States is not listening to this logic. (2)    

Now, sure this lack of prevention is happening in the clinical setting. But what about in other areas of the healthcare delivery system like finance and revenue cycle? Surely with the introduction of artificial intelligence into the industry lately and all the hundreds, maybe thousands of vendors out there serving the industry, these efforts are focused on prevention, right?  

Wrong.  

Kodiak recently surveyed a group of customers in the revenue cycle space and asked two questions. First, what percentage of their teams’ time was spent on activities to fix problems or errors that were created upstream in the revenue cycle? The average response was 78%.  

The second question asked them to look at their overall budget for their department and to estimate what percentage of their budgets was spent on areas that focus on prevention. The answer was 5%.  

In addition, despite widespread claims of AI and analytics, the revenue cycle market remains overwhelmingly reactive. Fewer than 10% to 15% of vendors operate with a prevention‑first model grounded in predictive insight and operational intervention. (However, I am happy to say that Kodiak is one of them.)  

An ounce of prevention is worth a pound of cure on the business side of healthcare, too. Kodiak estimates that every 1% shift from reactive spend to proactive prevention will yield up to a 20% reduction in an organization’s denial volume, improve the clean claim rate by over 5%, and reduce cost to collect by up to a half of a percent.   

So, why then do we see such a low percentage of focus in the prevention areas by both the provider departments and vendors? Well, the vendor’s answer is simple. The incentives are not aligned. 

The majority of vendors in the revenue cycle space are getting paid to fix the problem, not prevent the problem. In the current environment, the departments within the healthcare organization simply do not have the time or resources to focus efforts on prevention. They are putting out fire after fire after fire each day, never able to get out of that vicious cycle.  The saying goes that the definition of insanity is doing the same thing over and over again and expecting different results. That so accurately defines what’s happening in most revenue cycles.   

We have to operate differently. I was asked recently what I believe the revenue cycle of the future looks like. My answer was simple.  The revenue cycle of the future is going to focus on prevention rather than correction.  

However, an organization cannot simply decide to become preventative overnight. It‘s a process, and it requires a diligent, deliberate plan that focuses resources, both in personnel and budget, to an environment of prevention.  

Some organizations are on their way. There are health systems who have robust revenue integrity functions in place that can spend their time diagnosing small issues and intervening before they become big issues. There are organizations that are performing in the top decile across all pertinent revenue cycle KPIs and that can maintain that level of performance because they did what was necessary to get there in the first place.  Those are the organizations that are ready to take on the future with a prevention mindset. But for most organizations, there is much work to be done.  

Now for the part where I give you my advice.  

First, as a patient, get your screenings. If because of that screening there is a finding, your physician will diagnose the condition, come up with a treatment plan, discuss the necessary interventions, and then monitor you following the completion of your treatment plan to ensure that there is no recurrence. Remember all the benefits from prevention.  

Not surprisingly, the work to be done in revenue cycle follows the same steps. First, the main issues must be diagnosed. The big rock items need to be identified. Luckily, to diagnose these issues, it doesn’t take a long, drawn-out assessment. The data within the Kodiak Platform can quickly highlight where focus and attention is required. 

Once you have the diagnosis, a treatment plan needs to be developed. The treatment plan will then inform the interventions necessary and the timing of each. During this step, don’t get frustrated. Trust the process. This will take some time. It could even take a couple years, depending on the severity of the diagnosis.  

Also, do not be surprised if additional issues arise during that time. This is normal and expected. What is most important is the resolution of each of the items on the treatment plan as well as the continual monitoring of those results.   

Once there is stability across all areas and a monitoring function is in place, the team can focus efforts on prevention. During this process, the organization should also look at the vendors that they’re using for each of the functions. If any of the vendors are incentivized by correcting errors without providing proactive measures to be implemented, I strongly suggest reconsidering the relationship just like you would reconsider a doctor who doesn’t advise you on how to avoid a malady in the first place.  

In both healthcare and the revenue cycle, the value of prevention cannot be overstated. Whether it is scheduling annual screenings or proactively managing operational challenges, a prevention-first approach leads to better outcomes, lower costs, and greater long-term stability. As we look ahead, organizations and individuals alike must commit to shifting their focus from reactive solutions to proactive strategies. By aligning incentives, investing in preventive measures, and embracing diligent processes, we can transform our approach and ensure a healthier, more efficient future for all. 

(1) TFAH ROIExecSumm02:TFAH ROIExecSumm02 

(2) New Poll Shows a Large Number of Patients Are Not Getting Health Screenings