Improving the future of healthcare, no matter how that might be perceived or interpreted, is a wildly daunting task. Think about it. Our Healthcare system includes private and public clinics, hospitals, Academic Medical Centers, and entire ecosystems that include patient health information and data. The environment we’re talking about is a highly complex one, given all this data, but what complicates healthcare more are the other effects impacting the state of healthcare today. These include, but are not limited to, regulations and best-practices in terms of CDI (clinical documentation improvement), quality of care, compliance, reimbursement, new technology that can be implemented, and hospital operations including staff structures and patient throughput.

This level of complexity cannot be understated, and quite frankly it is giving health organizations all across the nation an unbelievably multifarious challenge that extends to all facets of business, including hardline revenue and patient well-being in general.

Venanzio Arquilla, Chairman of Claro Healthcare and Kaufman Hall Managing Director, put it aptly by saying that, “We are looking at many issues here. Issue one is that there’s a labor shortage. If you have outside resources, that could be three or four times that amount of pay so that’s been a budget buster for health systems. The second issue is technology. There’s an arms race happening where everyone is trying to utilize the developing technology, but it’s not as simple and straightforward as it seems. The third issue is data. What do health systems and hospitals do with this data? There must be a way to utilize that data to their advantage and analyze it and make changes to business. The fourth issue combines everything and that’s reimbursement and revenue cycle.”

Claro Healthcare began as a company specializing in Clinical Documentation Improvement (CDI) focusing on inpatient care. “We started that work and so we fortunately have become the market leader in inpatient CDI. Claro Healthcare’s focus expanded as the landscape changed. Soon, outpatient CDI became a priority, covering services that occur on a same day basis inside the hospital, including surgeries, emergency room and diagnostic tests.

Understandably, outpatient CDI offers a very different population with new challenges. Quantitively speaking, the volume of data is huge, but Claro Healthcare makes it a point of trying to understand the public data as well as the client data that can lead to changes made in actual operations.

Claro Healthcare finds the opportunity around public data and consolidates that for the client. Now, the newest area that Claro Healthcare is revolutionizing is professional fee CDI, meaning there’s another component of the revenue cycle that can be completely impacted. “For all of these health systems that have either hired or purchased physician practices, those are all losing between $80,000 and $200,000 a year per physician. We’ve understood that whether it’s paid on the value-based risk model or the fee for service model, there’s still a great deal of opportunity for the health systems,” says Arquilla.

There’s more ground that is covered within the revenue cycle itself, and Claro Healthcare has executed on all components of the revenue cycle to deliver insights and net revenue improvement. The data leads to opportunity discovery, whether it deals with CDI or delves into other areas such as patient status, denials prevention, and pharmacy. Since healthcare is based around quality scores and compliance, current data from a healthcare organization will tell all it needs to tell in terms of the areas that need improvement, and the areas that are offering more opportunity than the client realizes.

Claro Healthcare understands how to fill in these gaps. “We’ve built a number of offerings around all these opportunity areas. We have a technology tool, knowledge and data management system, and then we can work with our clients to educate them in these areas, their physicians, executive team, nurses, and a variety of others in their organization. We’re helping clients capture an additional $80, $90, $100 million and improving quality scores so that’s 15 and 20% impact which is a  major impact,” Arquilla says.

Claro Healthcare’s approach can be summarized with this explanation: first it’s about accessing the public data, examining their practices, and performing analysis. “The data is very compelling because it tells you the opportunity from a financial as well as a quality standpoint, but then not only are you compared to national benchmarks, but we also compare you to your peers,” Arquilla explains. Analyzing current operations is comprised of many touchpoints. “We come in and we look at the most current data, their actual data, we look at their actual medical records, we talk to their physicians, we talk to their nurses, we understand what the executives are doing, we understand what technology they use, what processes they have in place. All of it,” says Arquilla.

The second part is about planning. “Number two is to convince everyone in the organization that there is an opportunity and there’s a need for action.” And the last part is about further education and training for all healthcare staff on being able to optimize their results and put into place practices that will continue to improve their operations.

Because Claro Healthcare is comprised of experts in healthcare, healthcare technology, and data and analytics, they have the unique and diverse resources to make substantial and sustainable impacts. It’s this type of expertise and approach that gives Claro Healthcare an added edge over competitors and the ability to truly transform an organization’s operations.

For instance, when a very prominent health system client engaged Claro Healthcare a few years ago (one of the top health systems in the United States), Claro Healthcare was able to first transform all areas of CDI in their flagship hospital and then also bring those solutions to each of their community hospitals. This meant that, though this health system was performing well in their metrics to begin with, they became even higher ranked compared to their peers as the number one hospital in the US out of a very competitive field of academic medical centers.

“We took them to an even higher level of performance and national quality metric,” Arquilla says. It’s something that no other healthcare consulting provider could do. Claro Healthcare’s success hinges on the fact that they’re able to deliver quality insights that address opportunities in all areas.

Though these types of strategic implementations provided by Claro Healthcare have a huge impact on results.

“At the end of the day, the goal is to improve healthcare from the bottom up, for the betterment of all patients everywhere.” Arqullia concludes, “When Claro Healthcare can help health systems in the country perform better, more citizens can be provided quality healthcare from systems that aren’t stressed or underfunded, but instead that are thriving in their own abilities to provide the best care possible.”