By Scott Robertson
Ballad Health and Ensemble Health Partners announced last Thursday morning a partnership that will bring up to 500 new jobs to the region in the next five years. Around 1,100 Ballad employees in the areas of revenue cycle management will become employees of Ensemble, which has committed to building (or occupying an existing property to house) a service hub in which to expand.
Ensemble will assist Ballad in its transition to the EPIC electronic health records system through October, and will train the 1,100 former Ballad employees to better handle revenue cycle management, with Ballad as their primary customer.
Ensemble, which employs around 5,000 and has hubs in Ohio and North Carolina, is in the process of discussing options for the location of the hub with economic developers from Tennessee and Virginia.
The primary benefit for Ballad in the arrangement is the expected across the board improvement in revenue cycle performance, said Alan Levine, Ballad chairman and CEO. “There’s something to be said, with something in an area that’s as technical as revenue cycle, for having somebody for whom that’s what they do every day from start to finish. This is what Ensemble does. They are experts in how to have a highly productive revenue cycle function.”
That cycle begins with the first person who greets patients when they walk in the door and begin providing data, Levine said. “The revenue cycle starts when you register a patient. It involves physician documentation throughout the hospitalization, making sure that you’re capturing all of the data so that you can assemble the charges, calculate what’s the patient portion versus the insurance, get the authorizations, and get the bill out the door.
“Done properly, your patients will know what to expect, and then you’re making sure the processes within the hospital – and this goes all the way into the patient care units – you’re making sure this process supports what you told the patients on the front end, so when the patient leaves and they get a bill, it’s everything they expect. It’s transparent. It’s understandable. They know who to call and what the process is, and you have consistency in that process.”
Levine readily admits it has been a problem area for Ballad in the past. “Our revenue cycle functions literally have not evolved. We have the same revenue cycle processes that we had 20 years ago, basically.”
With Ballad transitioning from Siemens Soarian to the EPIC system between now and October, this was the perfect time to strengthen the bonds between Ballad and Ensemble, the nation’s leading expert on EPIC transitions, Levine said. “A lot of systems, when they have gone live on EPIC, had major cash flow hits after they converted. All of that stuff I mentioned earlier, typically when you convert to a new IT system, there are a lot of nuances that can affect your cash flow. Some of the best health systems in the country see this happening.”
Ensemble, Levine said, has the experience of having led several successful EPIC transitions. “You want to have a partner who already knows all the different places your revenue cycle is going to be impacted by the conversion, and you want to get ahead of those things so you minimize the experience.
“We looked at Ensemble’s success rate – the hospitals where they had been involved versus regular EPIC conversions without them. Whereas the trend line for hospitals that converted without them all showed a dip in revenue, the systems they advised or where they were managing the revenue cycle, those systems saw no change; in fact, there was an improvement.”
As for the 1,100 employees who will shift to Ensemble’s payroll, Levine said there will be significant benefits. “Part of that is, they will not just be serving Ballad. Their universe will have grown dramatically. So, it’s added job security, their benefits program is actually better, and their incentive programs are better.”
The benefit to Ballad comes through the improved training that the people who handle their revenue cycle functions will have. “Ensemble knows where the weak points are and how to work through those.”
That improvement in institutional knowledge will improve Ballad’s balance sheet by increasing the efficiency of the company’s efforts to collect from insurance companies. “We’re leaving a lot of money on the table with the third-party payors because of the way they are extremely sophisticated about the way they do down-coding, the way they will prior-authorize something and then deny it after we provide the service. So, a lot of this is designed around using Ensemble’s expertise to help us improve our documentation and improve our engagement with the insurance carriers so we properly collect what we’re owed.”
Ensemble will pass the direct costs back through to Ballad, Levine said, but then Ensemble will be incentivized to help Ballad improve its performance based on metrics from patient satisfaction to denial rates to compliance with documentation standards.
“Ensemble has full-time in-house analytics, so they’re looking at insurance company behavior,” Levine said. “If an insurance company starts doing denials for a certain type of procedure, typically they don’t tell us they’re going to do that. They just do it, and we don’t know until we’ve already lost tons of revenue. Ensemble has visibility to almost all of that. So early on, they can come back to us and say, ‘you need to make sure you’re capturing these datapoints in the upstream documentation or you’re going to get denied at the tail end.’”
Levine declined to state what a net benefit to Ballad might be in terms of either dollars or percentages over the course of the deal with Ensemble. “It’s hard to predict right now, because I don’t even know what our volumes are going to be. Once we get a new normal on what volumes are, then we can start making projections as to what the dollars are going to be.”