Valley Health Case Study
CASE STUDY
Valley Health Exceeds
First-Year Financial Goals
End-to-end RCM partnership drives rapid increase in cash collections and net revenue
SNAPSHOT
As part of their mission to provide high quality, accessible, affordable healthcare in their community, Valley Health partnered with Ensemble to optimize revenue cycle operations. By rapidly integrating advanced technology with existing systems, filling staffing gaps and implementing best practice processes, Ensemble exceeded Valley Health’s year-one cash collection goal and increased net revenue by $20 million while helping strengthen the patient experience.
PROFILE
- Nonprofit health system
- $1.3B NPR
- Virginia; West Virginia
- End-to-end RCM partner since Jan. 2023
Challenges
Valley Health’s rapid growth and escalating administrative demands from payers outpaced its ability to maintain strong financial performance with existing in-house staff and technology resources. With a pending electronic health record system conversion, they recognized the need for specialized expertise to optimize operations, ensure a smooth transition to Epic and fuel future growth.
Solutions
After evaluating various revenue cycle companies and capabilities, Valley Health selected Ensemble as their end-to-end partner to manage acute and physician-based revenue cycle operations.
“We are confident that Ensemble’s infusion of new technology and customer service will create efficiencies and also improve the patient experience,” said Valley Health President and CEO Mark Nantz. “Our strategic partnership supports Valley Health’s mission to serve our community by improving health through high quality, accessible, affordable healthcare.”
After a thorough assessment, Ensemble customized and implemented a plan to meet the unique needs of Valley Health and deliver rapid results. Within 60 days of contract execution, Ensemble successfully transitioned nearly 400 associates to its organization and began complete day-to-day management of revenue cycle operations across six hospitals and 70+ practices.
Our transition with Ensemble was seamless. It was clear that practice makes perfect, and that Ensemble has done this so many times the process has been refined.
Ensemble quickly filled gaps in staff and technology and implemented best practice processes, including:
- Implementing a new telephony system and remote work force model, which enabled nationwide talent acquisition and increased existing staff's capacity to financially clear patients and validate authorizations for specialty services
- Enhancing the underpayment recovery process, leveraging proprietary AI software, and strategically implemented front-end edits to drive improved clean claim rate and reduce overall denial percentage
- Delivering market-wide insights into payer behavior and facilitating claim-level reviews to accelerate issue resolution and improve contract negotiations with major payers
- Providing robust Epic go-live support via pre-conversion appointment reconciliation, charge monitoring, testing and hospital staff training to ensure revenue was back to baseline within one week post-go-live
- Facilitating thorough staff training for 70+ practices to support best practice adoption and process-based root cause analysis across scheduling, registration and charge submission workflows
“The great work that our revenue cycle operators perform connects directly to the positive outcomes for patients and communities,” said Shannon White, Chief Operating Officer of Ensemble. “Valley Health, along with the Ensemble team, shares a strong commitment to creating excellent patient experiences. It is a privilege to serve as their trusted strategic revenue cycle partner.”
Year-One Results
percent of net revenue