Build, Buy, or Partner? How Providers Can Level the Playing Field with Payers

As artificial intelligence (AI) continues to revolutionize the healthcare industry, leaders in revenue cycle management (RCM) face a critical decision: should they build their own AI-solution, buy an existing one, or partner with an experienced vendor? This choice can significantly affect a healthcare provider’s bottom line, including efficiency, cost-effectiveness, and overall success in managing denials.

Let’s explore the pros and cons of each approach.

Building an In-House AI Platform

Pros:

1. Customization: Developing an in-house AI system allows for complete customization to fit specific organizational needs.
2. Control: Healthcare organizations maintain full control over the development process and the final product.
3. Intellectual Property: The AI platform becomes a proprietary asset of the organization.

Cons:

1. Resource Intensive: Building an AI-accelerated platform requires significant time, money, and specialized expertise.
2. Longer Time to Market: Development and implementation can take years, potentially delaying benefits.
3. Ongoing Maintenance: In-house solutions require continuous updates and maintenance, which can be costly and time-consuming.

According to a Deloitte survey, 63% of healthcare organizations developing AI solutions in-house reported challenges in hiring AI talent. This highlights the difficulty in assembling and maintaining the necessary expertise for an in-house AI project.

Buying an Existing AI Platform

Pros:

1. Faster Implementation: Off-the-shelf software can be implemented relatively quickly.
2. Proven Technology: Existing platforms have often been tested and refined in real-world scenarios.
3. Lower Initial Investment: Buying a platform typically requires less upfront capital than building one.

Cons:

1. Limited Customization: Healthcare revenue cycle is unique and pre-built platforms may not perfectly align with a provider’s specific needs.
2. Ongoing Costs: Licensing fees and potential integration costs can add up over time.

A report by Gartner suggests that by 2025, 80% of executives will be using automation in some form within their workflows. This indicates a growing trend toward adoption of AI solutions in healthcare finance.

Partnering with an Experienced Vendor

Pros:

1. Expertise and Experience: Vendors bring specialized knowledge of data scientists and software engineers, as well as proven track records in healthcare AI.
2. Continuous Innovation: Partners typically stay at the forefront of AI advancements, continuously improving their offerings.
3. Scalability: Vendor partner services can often scale more easily with organizational growth.
4. Cost-Effective: Partnerships can offer a balance between customization and cost-effectiveness.
5. Time Saved: By relying on the vendor to implement its own platform with its own data scientists to manage a health system’s RCM workflows, providers can spend more of their time on patient care.

Cons:

1. Less Direct Control: Organizations must rely on the partner for certain aspects of the AI journey.
2. Potential for Misalignment: If not carefully chosen, a partner’s goals may not perfectly align with the organization’s goals.

When addressing RCM challenges, hospital leaders typically consider those three referenced primary options: build, buy, or partner. Building an in-house technology platform offers more control, but may strain resources, while buying a pre-built solution can be faster, but expensive and potentially limiting. The third option, partnering with an experienced vendor like Aspirion, presents a compelling alternative by offering a balanced service that integrates specialized expertise with innovative technology to achieve successful implementations. By relying on a vendor’s proven AI-powered platform run by its own data scientists to manage a hospital’s RCM workflows, hospital leaders can free up time to concentrate on other areas, like patient care.

The right partnership can ease the burden on healthcare leaders, addressing multiple challenges simultaneously. It eliminates the need to constantly keep pace with rapidly evolving AI technology and automation advancements by letting the vendor handle that. Additionally, it resolves the ongoing struggle of recruiting and retaining specialized talent. Perhaps most critically, it alleviates the financial strain on providers who are already operating within tight margins, offering a cost-effective solution to complex RCM challenges.

Why Partnering Is Often the Best Choice

For most hospitals and health systems, partnering with an experienced vendor for denials management and complex claims, like motor vehicle accident, workers’ compensation, Veterans Affairs or TRICARE, and out-of-state Medicaid, is often the most advantageous approach. Here’s why:

1. Specialized Expertise: Healthcare RCM is complex and constantly evolving. Experienced vendors have deep, specialized knowledge that most providers would struggle to develop in-house.
2. Cost-Effectiveness: Partnerships often provide a more balanced cost structure compared to the high upfront costs of building or the ongoing expenses of buying
3. Faster Time to Value: Vendor partners can typically implement solutions more quickly than in-house development, allowing providers to see benefits sooner
4. Continuous Improvement: Good partners stay on top of industry trends and continuously update their solutions, ensuring that hospitals and health systems always have access to the latest in AI technologies and automation
5. Focus on Core Competencies: By partnering for RCM, such as complex claims and denials management, providers can focus more resources on their primary mission: patient care
6. Scalability and Flexibility: Vendor services are often designed to scale with organizational growth and adapt to changing needs more easily than in-house solutions
7. Regulatory Compliance: Experienced vendors stay up-to-date with healthcare regulations, helping organizations maintain compliance
8. Risk Mitigation: Partnerships can help distribute the risks associated with technology implementation and maintenance

A survey by Healthcare IT Leaders found that 66% of hospitals and health systems plan increased AI spending. This underscores the growing recognition of AI’s importance in healthcare finance.

Cutting-edge AI Tech and Experience Without the Headache

While building an in-house AI solution or buying an existing one can be appropriate in certain circumstances, partnering with an experienced vendor that has already developed an AI-accelerated platform and recruited top data scientists often provides the best balance of expertise, advanced technologies, cost-effectiveness, and flexibility for most hospitals and health systems in their RCM and denials management workflows.

As healthcare RCM continues to evolve and financial pressures mount, leveraging the expertise and innovative services of a trusted partner with a built-in, experienced team can help hospitals and health systems keep pace with payers, who are ahead of the technology curve. By choosing the right partner, healthcare leaders can focus on their core mission of providing excellent patient care while ensuring their financial operations are optimized through cutting-edge AI technologies and automation.

Ready to finally level the playing field with payers who have a financial and technological head start on providers?

A partnership with us includes taking advantage of our pioneering, AI-powered RCM platform, along with our expansive and experienced team of data scientists, legal experts, and clinicians. We do the heavy lifting, so you don’t have to. Let us boost your revenue recovery fast and efficiently. Contact us today!