Despite pandemic-driven limitations, health systems can still find ways to optimize revenue cycle and generate income. When health systems improve and prioritize patient access through a patient-centered access center, they can improve the revenue cycle performance through decreased referral leakage, better patient trust, and optimum communication across hospital departments. Rather than relying on traditional revenue cycle improvement tactics, health systems should consider three ways a patient-centered access center can positively impact revenue cycle performance: Advance access. Optimize resources. Engage stakeholders.

1. How to Optimize the
Healthcare Revenue
Cycle with Improved
Patient Access
Health Catalyst Editors

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Jennifer Livermore, MSIHM
Director, Access Operations,
ProHealth Care
This report is based on a 2020 Healthcare Analytics Summit (HAS 20 Virtual)
presentation by Jennifer Livermore, MSIHM, Director of Access Operations,
ProHealth Care, titled, “Improving Revenue Cycle Performance with a
Patient-Centered Access Center.”
How to Optimize the Healthcare Revenue Cycle

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How to Optimize the Healthcare Revenue Cycle
In a fraught healthcare landscape, health
system leaders learn to operate on thin
margins with limited resources.
However, some leaders overlook the
value that better patient access can have
for an organization’s financial well-being,
especially when unprecedented changes,
such as COVID-19, compromise access
in new ways.

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How to Optimize the Healthcare Revenue Cycle
Patient access is the foundation for
optimal revenue cycle performance
because providing care is the primary
income source for health systems.
Therefore, if patients can’t easily
access care, hospitals can’t deliver that
care, nor generate income because
patients will seek care elsewhere.

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How to Optimize the Healthcare Revenue Cycle
Establishing a patient-centered access
center, one place (or source of truth) for all
patient inquiries, requests, and referrals,
can help health systems optimize patient
access and, thus, improve the healthcare
revenue cycle.

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The Relationship Between Healthcare
Revenue Cycle and Patient Access
Too often, health systems only focus on
healthcare revenue cycle management
and fail to realize the revenue cycle
opportunities that come with improving
patient access.
To improve the revenue cycle through
patient access, health systems must first
understand the relationship between
revenue and access.

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The Relationship Between Healthcare
Revenue Cycle and Patient Access
If patients can’t access care at a health
system, the organization cannot generate
income from their care or procedure.
No part of the revenue cycle—including
billing and insurance, payment, and
financial clearance to determine which
patients are likely to pay (also a
safeguard to prevent bad debt)—can
occur unless a health system cares
for patients.

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The Relationship Between Healthcare
Revenue Cycle and Patient Access
Effective patient access also helps health
systems respond more rapidly to COVID-19.
For example, with virtual access in place,
health systems can seamlessly convert in-
person visits to video and telephonic visits,
reserving limited hospital beds for patients
with COVID-19 without forgoing patient visits.

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Three Methods to Establish a
Patient-Centered Access Center
Health systems have always faced barriers
to patient access but connecting patients
with care is even more challenging in a
global pandemic.
To improve patient access and positively
impact the revenue cycle, health systems
should consider the benefits of a patient-
centered access center—a navigation
infrastructure that creates new access points,
deepens patient trust, and supports patients
throughout the care journey.

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Three Methods to Establish a
Patient-Centered Access Center
Three core methods behind a patient-centered
access center enhance patient access and
improve the healthcare revenue cycle:
1. Advance Access
2. Optimize Resources
3. Engage Stakeholders

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Three Methods to Establish a
Patient-Centered Access Center
Method #1: Advance Access
Advancing patient access is complex,
but there are many ways organizations
can achieve better access.
Centralizing ownership of referrals and
orders through a patient-centered
access center and training access
center staff to provide patients with a
consistent experience, no matter
where they receive care throughout
the system have a positive impact
on access.

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Three Methods to Establish a
Patient-Centered Access Center
Method #1: Advance Access
A decentralized approach often fails
to hold team members accountable
for sending referrals and orders to
the right place.
Historically, health systems have
taken a decentralized patient
access approach (Figure 1).

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Three Methods to Establish a
Patient-Centered Access Center
Method #1: Advance Access
Inconsistent Access
Clinic vs. Hospital
Figure 1: A historical, decentralized approach to patient referrals and appointment requests.
Source: Jennifer Livermore, MSIHM, Director of Access Operations, ProHealth Care

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Three Methods to Establish a
Patient-Centered Access Center
Method #1: Advance Access
This scattered approach makes it difficult
for team members to follow referrals,
ensure the referral makes it to the correct
destination, and identify the process gap
that sends a referral to the wrong place.
Inconsistent responsiveness (e.g., in a
decentralized call center) leads to patient
confusion and dissatisfaction, increasing
the likelihood that a patient will seek care
elsewhere.

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Three Methods to Establish a
Patient-Centered Access Center
Method #1: Advance Access
Centralizing referrals in one place
(e.g., a patient-centered access
center) ensures responsiveness to
service requests and matches
patients to the optimal service,
provider, and location, leading to
better access and satisfaction.
These small changes result in higher
efficiency (because team members
refer patients to the right place the
first time), more procedures, and,
therefore, more revenue.

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Three Methods to Establish a
Patient-Centered Access Center
Method #2: Optimize Resources
Common patient access resource challenges
include differing schedule management
practices by department and a lack of clarity
around patient cancellations and no-shows.
To tackle scheduling management
differences, health systems can better
optimize resources by creating and
distributing standard templates and
protocol guidelines.

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Three Methods to Establish a
Patient-Centered Access Center
Method #2: Optimize Resources
When every team member at the patient access
center follows the same (or similar) workflow,
different access center teams don’t have to
waste energy recreating workflows, allowing
health systems to optimize the limited
resources they have.
Another way to optimize limited, and sometimes
overworked, staff is to define schedule manage-
ment best-practices and unify them across
departments by training template owners on
applying scheduling standards.

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Three Methods to Establish a
Patient-Centered Access Center
Method #2: Optimize Resources
Health systems can also optimize
resources by cross-training staff so
that all team members at the access
center can handle every type of
patient access request, rather than
transferring patients to other teams.

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Three Methods to Establish a
Patient-Centered Access Center
Method #2: Optimize Resources
For example, to overcome cancellations
and no-shows, leaders can train all access
center team members about the correct
workflow to fill empty patient slots, giving
patients every opportunity to schedule and
keep an appointment.
When a patient-centered access center
provides every opportunity for a patient to
receive care, the health system has the
chance to generate revenue from those
appointments instead of losing revenue
from canceled or missed appointments.

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Three Methods to Establish a
Patient-Centered Access Center
Method #3: Engage Stakeholders
Effecting change in any organization is
challenging, especially in a health system—
where disparate departments spearhead
initiatives, and leadership support is already
spread thin.
However, stakeholder engagement (or
leadership support) is critical in improving
patient access.

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Three Methods to Establish a
Patient-Centered Access Center
Method #3: Engage Stakeholders
Health systems can increase stakeholder
engagement around a patient-centered
access center by creating collaborative
governance structures that drive design,
goals, and performance evaluation and
issue resolution tactics.
With a clinical and administrative leadership
perspective, health systems can also help
evaluate referral and demand processes
and patterns and ways to improve them.

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Three Methods to Establish a
Patient-Centered Access Center
Method #3: Engage Stakeholders
Regularly engaging leadership in the details
of a patient-centered access center and how
to improve it will increase buy-in and
dedicated resources around the access
center and other access-focused initiatives.
In addition, when leaders and providers are
committed to advancing access, they will
find ways to improve access within their
respective disciplines.

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A Patient-Centered Access Center Drives Better
Healthcare Revenue Cycle Performance
In a challenging time with limitations from
COVID-19, organizations can still generate
income and improve revenue cycle
performance through a patient-centered
access center.
Advancing access through responsiveness
and consistency, optimizing resources to
reflect availability accurately, and engaging
stakeholders in problem-solving access
issues leads to an effective patient-centered
access center where a health system can
review, understand, and track all patient
access entry points.

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A Patient-Centered Access Center Drives Better
Healthcare Revenue Cycle Performance
When health systems prioritize patient
access, they can improve the healthcare
revenue cycle through decreased referral
leakage, improved communication across
different departments, and getting patients
to the right place the first time.

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For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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More about this topic
Link to original article for a more in-depth discussion.
What Health Systems Need to Know About COVID-19 Relief Funding
Activity-Based Costing in Healthcare During COVID-19: Meeting Four Critical Needs
Bob Alexander, Implementation Services, Sr. Director
How to Scale Telehealth Solutions to Increase Patient Access During COVID-19
Ed Corbett, MD, Medical Officer
How Data Transforms the Hospital Command Center to Pandemic Proportions
David Grauer, MBA, MHSA, SVP, Professional Services;
David Gardiner, MBA, MHA, MPH, SVP and Executive Advisor
Restarting Ambulatory Care and Elective Procedures: Analytics Guide Safe, Pragmatic Decisions
Health Catalyst Editors
Health Systems Share COVID-19 Financial Recovery Strategies in First Client Huddle
Health Catalyst Editors

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Jennifer Livermore is the Director of Access Operations with ProHealth Care,
Waukesha. In her role, Jennifer is responsible for clinical and business operations
of Care Access and Patient Access, developing strategies for future access
functions and integrating services for patient scheduling, patient engagement,
physician referral, answering service, telephone nurse triage, patient registration,
referral and order management, and insurance verification and authorization
functions. Her team resides with the Revenue Cycle team of ProHealth Care.
She earned a bachelor’s degree in Journalism from University of Wisconsin, Eau Claire and a
master’s degree in Integrated Healthcare Management from Western Governors University. Jennifer
enjoys volunteering for local organizations and served as a Board Member for the Wisconsin Chapter
of the American Association of Healthcare Management.
Other Clinical Quality Improvement Resources
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Jennifer Livermore, MSIHM

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Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
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