Why Patient Access Is the Missing Link in the Revenue Cycle [PODCAST]

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Why Patient Access Is the Missing Link in the Revenue Cycle

In this episode, Jake McCarley, CEO & Co-Founder of Alluvium, discusses why patient access is the missing link in the revenue cycle.

Highlights of this episode include:

• Why leaders should see access as the first step in financial performance
• How front-end decisions around scheduling, provider availability and patient engagement do influence downstream revenue cycle outcomes
• What financial impacts health systems experience when patients face access barriers, missed appointments, or delays in getting care
• How improving front-end processes can help reduce denials, accelerate reimbursement, and create a more efficient revenue cycle
• What role AI and data play in helping health systems can better understand demand, optimize capacity, and improve patient access
• What steps healthcare leaders should take to better connect patient access, operational performance, and revenue cycle strategy

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Jake McCarley. Jake is the CEO and co-founder of Alluvium, the enterprise access and capacity performance platform, purpose-built for large health systems. With nearly a decade of experience working alongside some of the most complex health systems in the country, including HCA Healthcare, CommonSpirit Health, CHS, and Memorial Hermann. Jake has spent his career at the intersection of patient access, operational performance, and revenue cycle outcomes. Before founding Alluvium, formerly BlockIt, Jake identified a systemic gap: health systems were making billion-dollar capacity and access decisions with fragmented data, disconnected workflows, and reactive processes. His answer was to build a platform that gives health system leaders the ability to see where capacity and demand are misaligned, predict what’s coming, model scenarios collaboratively, and act with confidence.

Today, Jake is one of the most vocal advocates for using AI, not as a buzzword, but as a precision instrument, one that transforms raw access data into revenue cycle clarity, reduces over-reliance on expensive BI infrastructure, and helps health systems move from reactive scheduling to predictive access management.

In this episode, we’re discussing why patient access is the missing link in the revenue cycle. Welcome, and thank you for joining us, Jake.

Jake McCarley: Thanks for having me.

Kelly: Well, let’s go ahead and jump in. Patient access is often viewed as separate from revenue cycle. Why is that a mistake? And why should leaders see access as the first step in financial performance?

Jake: Yeah, we see this a lot where patient access is set off to the side or, at best, is kind of treated as a separate function to the overall revenue cycle of the hospital. And we would argue that that’s a mistake to look at it in that way because the patient access components of a health system are what ends up flowing into the revenue cycle process itself. If you look at revenue cycle, it’s kind of a captive thing. It’s what comes through. What are the patients that are showing up? Who are those people? What kinds of cases are those? Where are those cases? And so, a lot of the things that make up patient access end up becoming the material, if you will, that the revenue cycle teams are working on. And so a lot of times you’ll see revenue cycle folks who are optimizing and optimizing and trying to make that experience better within Rev Cycle, which are all really good things to do and thoughtful things to do, but they’re working with kind of a set group of things that they had no influence or impact on receiving. And so what we’ve done over time has helped organizations think about patient access not as a thing that we also do or a separate discipline, if you will, but something to think about alongside or within the same system as Rev Cycle so that the goals that you’re setting as an organization, whether that be a quality goal or a growth goal or [inaudible] goal or whatever the case may be, all of those actions actually sit up in the patient access space. So how do you shape user experiences that kind of create the kind of demand, the demand shaping that you’re looking to see as an organization, that you can then apply those really great disciplines from Rev Cycle on. And so, we really view them as part of the same interconnected system, versus viewing access as an entirely different function.

Kelly: Yeah, such an interesting perspective there. So how do front-end decisions around scheduling, provider availability and patient engagement influence downstream revenue cycle outcomes?

Jake: Yeah, it mainly relates to what is the makeup of the patients that we’re going to see directly comes from those front-end decisions. Some of it has to do with data and what you’re able to see. Some of it has to do with the user experience. Some of it has to do with accessibility. But scheduling as the front-end component of how a patient enters into that health system is extremely important to the revenue cycle equation. It’s most basic. It’s the efficiency of that, the data collection of that, the elements that are a part of that process that are going to contribute to a more effective revenue cycle process later on. A lot of times, work that revenue cycle teams are doing are going back and fixing things that were happening in the upfront patient access component. So that’s part of it. Provider availability and just the engagement of the patient in general is also super important. And so, providers, they’re very particular about their schedules. They’re very particular about the way their day goes. And we continue to think about these as interconnected systems. So, the way that that provider experiences their day is directly related to how their schedule is shaped, which is directly related to how the patient experiences their in-office visit. And so, all of these things are connected. And so, the tighter those things are and the more aligned they are, both in terms of the efficiency of that experience and the shape of that experience so that you’re getting the right patient to the right place at the right time is good for everyone. It’s good for the provider. It’s good for the staff. It’s good for the patient. And when you put that level of discipline into the front-end process that generally is called patient access, the downstream revenue cycle impact is high.

You get a higher follow-through rate, you get a higher return rate, you get a higher referral capture rate, you get lower leakage, you get higher provider satisfaction because the experience of their day is better because it’s been more thoughtful in terms of how those patients end up landing in the clinic. The data collection is better. So, to me, kind of back to the idea of it being one interconnected system, those front-end decisions have such an impact. If you step back and think about anyone with Rev Cycle experience, a lot of the things they’re fixing are because that wasn’t true in their environment and those front-end decisions were made independently of the collective goal of the health system, which is, how do we provide great patient care? And eventually collect the dollars necessary to continue that mission.

Kelly: Yeah, no, it makes a lot of sense, Jake. So, what financial impact do health systems experience when patients face access barriers, missed appointments, or delays in getting care?

Jake: Well, I mean, we’re still in a pretty big fee-for-service arena. People generally get paid for what they do. I would say even in the situations where you have a captive or you have an ACO oriented financial instrument, this still has an impact on the financial health of the organization in some way or another. If a patient– even if you’re collecting to manage their care, if that care is not done from a proactive standpoint or they’re not following up on the basic things that they need to do, it’s very easy for that to escalate into something that has a higher acuity, which has a higher cost. And so regardless of whether fee-for-service and you’re getting paid when they show up, or whether you’re managing their care, the financial impact’s pretty significant. The challenge in healthcare world is that these providers schedules, or if you’re in an acute setting, the beds or the ORs or whatever the care delivery mechanism is, they’re finite resources. So, if you don’t use them, you lose them. If a patient doesn’t show up or you have a really high cancellation rate in the clinic, those slots are gone. That’s capacity you could have used to see another patient or to move a patient up who was scheduled later. If you have an OR that sits empty on Saturday and Sunday because the logistics aren’t worked out on how the health system could make the case for opening those ORs on the weekends, then that’s lost capacity. It’s like a plane sitting on a tarmac with no passengers in it, waiting for Monday to come around, right? And so all of these things that are happening within the capacity of the health systems on both the acute and the ambulatory side have significant financial impact just because those resources expire, those slots, those beds, those ORs that you can’t reuse something that you missed. And so having a really tight system where that’s managed really well from a supply and demand standpoint has a pretty significant impact on the financial health of the system.

Kelly: Yeah, I mean, it does seem like the financial impact here is quite significant. So why do many organizations still overlook patient access as a revenue driver? And what prevents them from making it a strategic priority?

Jake: I think a big part of it, from what we’ve seen, is purely the visibility into how the system works. I mean, anyone who has worked within a health system, or I would say a delivery network, doesn’t have to be a health system. It’s true on the payer side as well. It’s really foggy. And maybe it’s the word to use. It’s foggy. You can’t really see what is happening on– what capacity do we have? How are the different patients coming in through what channels, and what’s happening within each of those channels? So, these supply and demand dynamics that have been solved in other industries for a very long time are really foggy in these environments. And I think when you have organizations or you have environments where these complexities create this fogginess, where leaders are just not able to see what is happening and how those systems connect and be able to predict from there like, “Okay, we can now see it.” If we made these changes, what would happen to our capacity if we hired these 10 people, or what would happen if we opened these ORs on the weekend? If they’re not able to see it and then predict it and use some of the modern tech to be able to make those decisions, then you don’t know what you don’t know. You feel it doesn’t work and it doesn’t feel right and you know something could be better, but you’re not quite able to connect those dots because you can’t see the system. And that’s what we find in a lot of organizations is patient access has kind of sat in its own department for a very long time, and rev cycles set in its department. And there just hasn’t been enough visibility to say, “Oh, if I optimize this within the access strategy, that’s going to have these impacts on the rev cycle strategy.” And these are actually the same goal. So how do we actually align incentives and create a unified operating system where we can see those things?

And so, visibility, I think, is probably the primary reason why these things have continued to exist in isolation. Once people can actually see how they’re connected, it’s impossible to go back because you understand how these steps end up downstream effective on care or outcome or financial metrics or whatever. So, we see visibility as really the primary. It’s too foggy for them to see it. And so there hasn’t been a strong driver to drive that alignment historically.

Kelly: No, I mean, it makes sense. I mean, they’re still way too siloed. I totally get where you’re coming from there. How can improving front-end processes help reduce denials, accelerate reimbursement, and create a more efficient revenue cycle?

Jake: Yeah, this is back to the idea of simplifying those processes and aligning those experiences with the goals of the revenue cycle process itself. And every health system, every delivery environment is set up a little different in terms of kind of what they’re going after. And if your front-end process isn’t set up to deliver what that back-end process on the rev cycle side needs for it to be efficient, then that’s going to trigger a lot of work that someone has to go and fix later on. And what we see a lot of times is now you’re seeing AI being used, the agent process to go and resolve that, which is great. It’s efficient because you’re not having a human do it. What we would challenge is, let’s fix that so it’s not a problem at all, right? I’m glad that we’re using AI agents to automate that work. But what if we didn’t have to do that work in the first place? So, I think having the right leaders around the table who are unified on their goal– and incentive alignment is a huge thing within leadership teams, where often we’ll find within these two groups, and even within the groups, that the incentives are not actually aligned in such a way that everyone’s working together. So you have a fogginess against you, you have an incentive misalignment against you. And so then people just become frustrated and can’t quite name that frustration. I’ve experienced that in my own work. And so that’s generally what we’re encouraging when looking at that from an efficiency standpoint, is let’s try to solve things where we don’t have to do them rather than repeating the same workflows in a more efficient manner that shouldn’t have been there to begin with.

Kelly: Right. Yeah. Seems like improving those front-end processes are key. So, what role can AI and data play in helping health systems better understand demand, optimize capacity, and improve patient access?

Jake: Yeah, this is a crazy thing. So, AI is only as useful as the environment it’s sitting on top of. And what we find over and over again is people that are experimenting with AI and pulling data out of context and putting it into ChatGPT or whatever, a large language model and getting a data point or an outcome. And that’s good exploration, but AI has to be thought of in a more holistic sense. And the usefulness of AI is only as useful as the comprehensiveness of what it’s sitting on top of. And so being able to take the data environment within an organization and to apply healthcare domain expertise within that data environment to shape that in such a way and to align the AI through the lens of healthcare expertise to deliver insights and bottlenecks and things like that are really key to setting up an operating system that leaders can actually benefit from. The data is there. The challenge is not, is there enough data to do it? Getting at the data historically has been very hard. A lot of that’s been solved. It’s more how do you construct the right data and how do you construct the right shape of AI? AI is a very big word, a very general word…

Kelly: It is.

Jake: …but often, yeah, the most impactful AI use cases are different combinations of models and different ways that deliver a specific outcome. And so that’s what we’ve been working with groups on and have found it to be pretty successful, is you have to be able to see the environment; you need to be able to predict and to model what’s going to happen. And that’s kind of been the challenge with existing business intelligence, is business intelligence is really great at telling you what happened. It’ll give you a metric or a static or the number of appointments or the number of beds that were filled, right. It gives you a historical view. And what leaders end up being challenged by is like, “Great, I’ve got this historical view.” They then have to take their goals, which are kind of in their head or on a PowerPoint slide and these ideas that they have, and those things have to converge. So, I have to take what I think is happening with what I want to happen, and then I have to find a way for those two things to play those things out. So, I have this idea, I want to do this, I want to do that. How do I figure out what’s going to happen? Or how do I know what’s going to happen? That’s what happened historically, but what’s going to happen in two months? Am I going to have enough capacity in two months to be able to hit my goals? When is it going to break? So, all of these forward-looking things are at the end of the day, what leaders want. It’s what I want as CEO of a company. I need to understand what’s going to happen. I need to understand what I could do today that’s going to affect that. I want my leaders to be aligned on what those actions are. I want to be able to track the outcome of the actions that we’re taking, and I want that system to learn and be a constant learning loop so that we’re continually moving towards the goals that we set as an organization, which is to help health systems get what they should be out of their delivery network. And so that’s all to say like optimizing capacity, improving access demand. These are all really– the shape of those problems are all really the same.

And what we’ve found is being able to craft that into an operating model where leaders can see, they can predict, they can derive insights and action those things. If you have insights without action, then that’s just slightly more useful than not having insights, right? You have to actually do something with that, right? And so, how can these models help us action that? And yes, use AI agents when it’s possible to do that, but how could we make it easier for the staff when necessary to have to take a human-oriented action? How can we make that process easier? So, AI plays a big role. It just has to be very thoughtful. It has to be through the lens of healthcare domain expertise for it to be able to work because you’re dealing with a people dynamic that generalized AI can’t really overcome in and of itself.

Kelly: No, I love what you said there. It has to be insights with action, so that’s the key piece I pulled out there. So, what steps should healthcare leaders take to better connect patient access, operational performance, and revenue cycle strategy?

Jake: Yeah, the first step is getting the right leaders around the table. This is usually not in an annual retreat or not a once-a-year thing, but when we think about the entire patient experience, who are the key leaders that represent that value chain and getting them around the table and doing the hard work, this is what we find. We do a lot of people work before we ever apply technology. Understanding like, okay, these are the people. These are the steps. These are the things that need to come together. What are the incentives? How are people coming to the table and thinking about that? What does good look like to them? There’s a lot of people-oriented work of aligning that leadership team before you can start to think about what’s the model operating system that would make that better. So, I think the first step is what is that journey? Who are those leaders and aligning on the people part before you get into the tech side. Second is taking the environment and creating an operating model where you can actually see it. And if you can’t see the environment, it’s very difficult to make decisions. Right. You can guess, you can wait and see what happens, but you can’t really make data-informed decisions if you don’t have an operating system that gives you visibility into that. And so, that leadership team being able to connect the dots on here, here’s the model that would work. Here’s the data that supports that model to give you visibility into that. And then, from there, setting the goals that all of the leaders are aligned on and being able to use the advanced modeling to help derive actions that can be taken, to use those AI models for insights, and to have a regular cadence where that’s being reoriented and reorienting. What we find often is people don’t do the people leadership upfront, and then they don’t do the people oriented stuff after the fact. And just being a human, this happens to me personally in my work and my personal life, we have to constantly reorient, reorient. What are we doing? What is good? Where are we in that process?

And thinking of it in terms of, hey, we’re going to get together once a quarter or once a month is really not the same thing as reorienting. And so, these models have to not only give visibility, drive insights, help you action it, but they should be something that your leadership team can use asynchronously and together to be able to constantly reorient to why we’re here, where we’re at, what I need to do, what I need to sacrifice maybe for Kelly to be able to do her step, right? It’s that reorientation. So, it’s people, then tech, then people again, that then informs process and outcomes, I think.

Kelly: Yeah, no, that makes a ton of sense. Well, thank you so much, Jake, for sharing your insights with us on why patient access is the missing link in the revenue cycle. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

Jake: Yeah, a couple of different ways. Our website is alluviumhealth.com. That’s an easy way. But honestly, if something struck a chord, you want to chat, love to do that. I’m very easy to get hold of. Email address, I’ll just give you my email address. My email address is jake@alluviumhealth.com and would love to chat and hear the challenges that you’re facing on some of these operational decisions and share anything that we’ve learned that would be helpful to what you’re doing in your environment.

Kelly: Awesome. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

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