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NextGen Healthcare Award Write Up


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NextGen Healthcare receives Frost & Sullivan's 2019 North American Ambulatory Revenue Cycle Management Services Enabling Technology Leadership Award

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NextGen Healthcare Award Write Up

  2. 2. BEST PRACTICES RESEARCH © Frost & Sullivan 2019 2 “We Accelerate Growth” Contents Background and Company Performance ........................................................................4 Industry Challenges..............................................................................................5 Technology Leverage and Customer Impact of NextGen Healthcare ............................5 Conclusion...........................................................................................................7 Significance of Enabling Technology Leadership .............................................................8 Understanding Enabling Technology Leadership .............................................................8 Key Benchmarking Criteria ....................................................................................9 Best Practices Recognition: 10 Steps to Researching, Identifying, and Recognizing Best Practices .................................................................................................................10 The Intersection between 360-Degree Research and Best Practices Awards.....................10 Research Methodology ........................................................................................10 About Frost & Sullivan ..............................................................................................10
  3. 3. BEST PRACTICES RESEARCH © Frost & Sullivan 2019 3 “We Accelerate Growth” Background and Company Performance Industry Challenges In the United States (US), the shift in population demographics coupled with the rise of value-based reimbursement (VBR) models drives the need for better prediction and management of revenue cycles, especially for high and at-risk patient populations. The move to value-based care alongside changing claim submission and reimbursement criteria, as well as a flurry of mergers, creates new challenges for healthcare providers. Providers are experiencing severe solvency concerns, resulting from increasing enrollment in high-deductible health plans and poor collection from patients with co-pay or self-pay arrangements. Reimbursement complexities that originate from participating in both fee- for-service (FFS) and VBR models drive the need for integrated financial management capabilities. At the same time, provider organizations struggle to maximize their revenue collection operations. Most US-based providers work with low operating margins due to poor accounts receivable (A/R) performance and high average denial volumes. Furthermore, the average cost to reprocess a claim is $25 and, in many cases, the projected loss due to claims denial surpasses the market capitalization of smaller physician practices.1 Finally, poor referral management incurs significant revenue loss for physician practices—spurring the need for robust revenue cycle management (RCM) solutions. Successful vendors must emphasize return on investment (ROI), particularly for small and medium-sized physician practices. Vendors demonstrating end-to-end capabilities such as patient access management, eligibility checking, claims pre-adjudication, denials management, and collections optimization services will enjoy increased relevancy in the market. Top vendors will deploy patient-centric solutions that support automated patient access management across the care continuum, digitize the claims submission process by sending machine-coded claims (based on physician-documented clinical records) to billing directly, and leverage built-in claims editing functionalities to optimize claims first-pass rate. Market participants must also contend with the fact that many smaller practices choose to manage their own billing operations rather than replacing long-standing relationships with employees in favor of information technology (IT) and business process outsourcing (BPO). In the foreseeable future, natural language processing (NLP) and artificial intelligence (AI) technology solutions will become essential components of all advanced RCM portfolios. Additionally, progressive market participants will offer codes supported by electronic health record (EHR)-integrated NLP solutions that allow comprehensive traceability of specific codes from the fully processed clinical documents. AI and machine learning should also be leveraged to select the right codes for complex diagnosis at the point of service. Hence, claims and coding platforms must interface seamlessly with providers’ underlying EHRs, payer IT systems, practice management solutions, and patient portals. 1 Graham, Tina. "You Might Be Losing Thousands of Dollars Per Month in ‘Unclean’ Claims.” Medical Group Management Association (MGMA) Connection Magazine, February 2014. resources/mgma-connection-plus/mgma-connection/2014/february-2014/you-might-be-losing-thousands-of- dollars-per-month-in-claims
  4. 4. BEST PRACTICES RESEARCH © Frost & Sullivan 2019 4 “We Accelerate Growth” Finally, centralized financial reporting capabilities aided by sophisticated data analytics and visualization tools, dashboard-led financial benchmarking, and seamless collaboration between stakeholders—e.g., RCM IT vendors, in-house RCM service providers, and payer IT systems—will provide a holistic and high-demand revenue cycle workflow for smaller physician practices. Overall, EHR centricity, data interoperability, service scalability, price customizability, and ecosystem-level connectivity are the key features of an integrated financial management solution. Technology Leverage and Customer Impact of NextGen Healthcare Founded in 1976 and headquartered in Irvine, California, NextGen Healthcare (NextGen) designs cloud-based EHR and practice management solutions for ambulatory groups of all sizes. With a team of more than 3,000 EHR, Practice Management, and RCM experts delivering comprehensive ambulatory solutions, NextGen is one of the top five EHR vendors in the US. The company’s EHR solutions enable users to coordinate patient care while complying with healthcare reform demands, e.g., PHM, the Merit-based Incentive Payment System, and other value-based care requirements. With their Enterprise Solutions, NextGen also meets the needs of more sophisticated groups with differentiated capabilities in interoperability, patient engagement, regulatory compliance, and actionable intelligence delivered in-workflow. NextGen’s capabilities include detailed dashboards, analysis, and key metrics reporting, as well as drill-down data mining functionalities and peer comparisons. For example, superior medical records and data organization abilities allow users to view content—e.g., workflow, medications, and procedures—on one dashboard. Furthermore, the company’s proven A/R management processes help clients optimize financial performance. Currently, over 155,000 US providers use NextGen’s solutions to improve their practice management operations. In the RCM space, the company’s solutions consist of both services and software. Services include financial and clinical assessment and support, e.g., pre-adjudication, ICD-10 coding and clinical documentation, identifying revenue opportunities, and correcting operational inefficiencies. Other key service segments comprise patient eligibility checking, patient estimation, appeal and claim management, and performance analytics. Advanced software such as NextGen Connect offers state-of-the-art integration and interfacing with systems such as LabCorp, Quest, and immunization registries while Rosetta, a proprietary interface service, sends and receives HL7. Frost & Sullivan research reveals that digitizing the claims submission processes by sending machine-coded claims to billing directly and leveraging built-in claims editing functionalities to optimize claims first-pass rate is a priority. NextGen ensures expedited claims through a predictive rules engine that ensures 98% of claims acceptance after the first submission. As a result, medical practices can reduce costs, prevent errors, and increase productivity.
  5. 5. BEST PRACTICES RESEARCH © Frost & Sullivan 2019 5 “We Accelerate Growth” Furthermore, the company offers extensions to core capabilities with coveted features such as a mobile workflow app that allows clinicians real-time visibility into their schedule and patient information, facilitates clinical documentation, enables secure provider messaging and collaboration, and improves the clinician/patient interaction. NextGen’s HIPAA-compliant software has laboratory services functionality and referral management, allowing medical staff and providers to coordinate effective and efficient patient care delivery. Other innovative features include chronic disease management and health maintenance reminders. Providing Advanced RCM Applications Frost & Sullivan research shows that provider consolidation is accelerating due to the poor margins of many healthcare systems. Strategic deployment of a range of RCM IT and service solutions is necessary to address critical industry and VBR-related pain points. Frost & Sullivan notes that best-in-class RCM products will improve the:  Payment experience for patients: Through patient-portal connectivity (incumbent or external portal) that drives effective scheduling and built-in payment modules that facilitate informed financial decisions.  Care coordination for providers: Through centralized workforce management that eliminates front and back-office silos.  Cost management for all: Through point of service toolkits that provide accurate estimates concerning patient liability and propensity to pay. Furthermore, new and emerging vendors will introduce solutions that improve the efficiency of mature vendors’ legacy RCM platforms across all major service segments, including patient access (online appointment scheduling), coding (NLP and AI-based), billing (payer-mix prioritization based on patient-risk scores), and reporting (visualizing and benchmarking quality performance). NextGen’s cloud-based solutions meet these criteria, providing cost competitiveness and aiding interoperability, while its RCM services streamline incumbent workflows and correct inefficiencies. For example, its rules engine reviews 100% of charges at the front end of the process, thereby helping stem revenue leakage. Other best practices include digitized patient eligibility assessment, auto-highlighted claim errors, and managing denials via predictive analytics. Recently, NextGen expanded its RCM IT portfolio via its NextGen Financial Suite, an advanced RCM technology platform that includes advanced patient access technologies, industry leading rules engines, and clearinghouse solutions to streamline the entire RCM process and simplify medical billing. The software combines state-of-the-art medical billing technology with the support of practice economics experts, helping physicians increase revenue through robust analysis, efficient processing, and best-in-class consulting.
  6. 6. BEST PRACTICES RESEARCH © Frost & Sullivan 2019 6 “We Accelerate Growth” The NextGen Financial Suite Plus assigns professionals to manage clients’ insurance A/R, alleviating tedious staff duties like combating denials. A dedicated expert team aggressively analyzes unpaid and underpaid claims, follows up with insurance companies, monitors A/R aging, reworks denied claims, maintains contact with insurance companies to ensure rapid claim settlement, and oversees insurance credits and refunds. The NextGen Financial Suite Pro offers billing and collections services to help improve the patient experience by providing patient responsibility clarity and convenience. Knowledgeable, courteous billing professionals answer all inbound calls, respond to questions, and prompt payment when appropriate. The company also provides appointment and balance due reminders, an easy-to-access patient portal, and convenient eStatements and online payments. As a result, NextGen can help its clients effectively navigate regulatory changes, reduce administrative burdens, and optimize financial performance. Additional best-in-class RCM practices include decision support, patient self-service capabilities, and industry-leading features, such as an exceptionally user-friendly layout. The company’s strategic mergers and/or partnerships with providers of specialized, niche capabilities allow for continuous evolution of the portfolio. As NextGen adds third-party capabilities to the core platform, in-workflow integration through high-fidelity APIs remains the key to adoption and success. Frost & Sullivan appreciates that NextGen helps drive adoption of advanced RCM solutions in the US via its superior ability to provide comprehensive regulatory compliance and financial risk mitigation, accomplished through revenue cycle workflow customization while reducing operational expenses attributed to claims processing. Finally, real-time reporting of financial and operational performance alongside the automatic identification of claim denial root causes help practices optimize payment collections, rebates, and incentives for patient services—thereby increasing revenue, improving margins, and ultimately helping small practices remain sustainable in an increasingly challenging reimbursement climate. Conclusion The successful implementation of value-based reimbursement roadmaps requires robust and cross-functional revenue cycle management (RCM). NextGen Healthcare (NextGen) leverages innovative and holistic financial solutions to help providers identify revenue cycle gaps, develop risk-based premiums, and simplify operations. The company’s proven expertise in error-free claims preparation, clinical documentation, automated billing workflows, and robust RCM analytics helps practices benefit from a powerful financial ecosystem to help them thrive in the current healthcare environment. With its client- centric offerings, technical excellence, and commitment to innovation, NextGen earns Frost & Sullivan’s 2019 Enabling Technology Leadership Award in the North America ambulatory revenue cycle management services market.
  7. 7. BEST PRACTICES RESEARCH © Frost & Sullivan 2019 7 “We Accelerate Growth” Significance of Enabling Technology Leadership Ultimately, growth in any organization depends upon customers purchasing from a company and then making the decision to return time and again. In a sense, then, everything is truly about the customer—and making those customers happy is the cornerstone of any long-term successful growth strategy. To achieve these goals through enabling technology leadership, an organization must be best-in-class in three key areas: understanding demand, nurturing the brand, and differentiating from the competition. Understanding Enabling Technology Leadership Product quality (driven by innovative technology) is the foundation of delivering customer value. When complemented by an equally rigorous focus on the customer, companies can begin to differentiate themselves from the competition. From awareness, to consideration, to purchase, to follow-up support, best-practice organizations deliver a unique and enjoyable experience that gives customers confidence in the company, its products, and its integrity.
  8. 8. BEST PRACTICES RESEARCH © Frost & Sullivan 2019 8 “We Accelerate Growth” Key Benchmarking Criteria For the Enabling Technology Leadership Award, Frost & Sullivan analysts independently evaluated two key factors—Technology Leverage and Customer Impact—according to the criteria identified below. Technology Leverage Criterion 1: Commitment to Innovation Criterion 2: Commitment to Creativity Criterion 3: Stage Gate Efficiency Criterion 4: Commercialization Success Criterion 5: Application Diversity Customer Impact Criterion 1: Price/Performance Value Criterion 2: Customer Purchase Experience Criterion 3: Customer Ownership Experience Criterion 4: Customer Service Experience Criterion 5: Brand Equity
  9. 9. BEST PRACTICES RESEARCH © Frost & Sullivan 2019 9 “We Accelerate Growth” Best Practices Recognition: 10 Steps to Researching, Identifying, and Recognizing Best Practices Frost & Sullivan analysts follow a 10-step process to evaluate Award candidates and assess their fit with select best practice criteria. The reputation and integrity of the Awards are based on close adherence to this process. STEP OBJECTIVE KEY ACTIVITIES OUTPUT 1 Monitor, target, and screen Identify Award recipient candidates from around the globe  Conduct in-depth industry research  Identify emerging sectors  Scan multiple geographies Pipeline of candidates who potentially meet all best- practice criteria 2 Perform 360-degree research Perform comprehensive, 360-degree research on all candidates in the pipeline  Interview thought leaders and industry practitioners  Assess candidates’ fit with best-practice criteria  Rank all candidates Matrix positioning of all candidates’ performance relative to one another 3 Invite thought leadership in best practices Perform in-depth examination of all candidates  Confirm best-practice criteria  Examine eligibility of all candidates  Identify any information gaps Detailed profiles of all ranked candidates 4 Initiate research director review Conduct an unbiased evaluation of all candidate profiles  Brainstorm ranking options  Invite multiple perspectives on candidates’ performance  Update candidate profiles Final prioritization of all eligible candidates and companion best-practice positioning paper 5 Assemble panel of industry experts Present findings to an expert panel of industry thought leaders  Share findings  Strengthen cases for candidate eligibility  Prioritize candidates Refined list of prioritized Award candidates 6 Conduct global industry review Build consensus on Award candidates’ eligibility  Hold global team meeting to review all candidates  Pressure-test fit with criteria  Confirm inclusion of all eligible candidates Final list of eligible Award candidates, representing success stories worldwide 7 Perform quality check Develop official Award consideration materials  Perform final performance benchmarking activities  Write nominations  Perform quality review High-quality, accurate, and creative presentation of nominees’ successes 8 Reconnect with panel of industry experts Finalize the selection of the best-practice Award recipient  Review analysis with panel  Build consensus  Select recipient Decision on which company performs best against all best-practice criteria 9 Communicate recognition Inform Award recipient of Award recognition  Present Award to the CEO  Inspire the organization for continued success  Celebrate the recipient’s performance Announcement of Award and plan for how recipient can use the Award to enhance the brand 10 Take strategic action Upon licensing, company is able to share Award news with stakeholders and customers  Coordinate media outreach  Design a marketing plan  Assess Award’s role in future strategic planning Widespread awareness of recipient’s Award status among investors, media personnel, and employees
  10. 10. BEST PRACTICES RESEARCH © Frost & Sullivan 2019 10 “We Accelerate Growth” The Intersection between 360-Degree Research and Best Practices Awards Research Methodology Frost & Sullivan’s 360-degree research methodology represents the analytical rigor of our research process. It offers a 360-degree-view of industry challenges, trends, and issues by integrating all 7 of Frost & Sullivan's research methodologies. Too often companies make important growth decisions based on a narrow understanding of their environment, leading to errors of both omission and commission. Successful growth strategies are founded on a thorough understanding of market, technical, economic, financial, customer, best practices, and demographic analyses. The integration of these research disciplines into the 360- degree research methodology provides an evaluation platform for benchmarking industry participants and for identifying those performing at best-in-class levels. About Frost & Sullivan Frost & Sullivan, the Growth Partnership Company, enables clients to accelerate growth and achieve best-in-class positions in growth, innovation and leadership. The company's Growth Partnership Service provides the CEO and the CEO's Growth Team with disciplined research and best practice models to drive the generation, evaluation and implementation of powerful growth strategies. Frost & Sullivan leverages more than 50 years of experience in partnering with Global 1000 companies, emerging businesses, and the investment community from 45 offices on six continents. To join our Growth Partnership, please visit 360-DEGREE RESEARCH: SEEING ORDER IN THE CHAOS