Luke Gale

Highmark Health’s data-driven gold-carding program reduces clinician burnout, improves revenue cycle efficiency for eligible providers, and establishes a framework for national scalability. Prior authorization requirements are a major pain point for clinicians and revenue cycle leaders alike. While payers have made multiple attempts to establish gold-carding programs, these past efforts have led to mixed results and have mostly failed to gain meaningful traction.

As Medicaid enrollments decline, health systems must break down operational silos and ramp up monitoring to protect their 340B eligibility. For hospitals relying on the 340B revenue, declines in Medicaid enrollment are forcing health systems to more carefully monitor DSH percentages maintain eligibility. During the recent HFMA Region 1 Annual Conference, a panel of pharmacy and revenue cycle experts warned that surviving that protecting 340B revenue would require some operational shifts.

To maximize yield and maintain healthy revenue cycles, health systems must align managed care and revenue cycle operations into a unified framework. It's easy for health system leaders to lay blame on revenue cycle teams when cash flow drops. But more and more health systems are beginning to recognize that poor revenue cycle performance is just the symptom of broader and systemic faults.