The RCM Maturity Framework: A Path to Digital Transformation and Operational Excellence

By Eric McGuire

November 9, 2023

Healthcare organizations are facing unprecedented financial stress, with many experiencing negative margins due to a surge in expenses and revenue loss that was further exacerbated by the COVID-19 pandemic. Amid this challenging environment, healthcare finance leaders are seeking ways to accelerate cash flow, reduce expenses, and increase profitability, with many turning to outsourcing and technology.

Achieving a high-performing revenue cycle requires a strategic roadmap that is customized to an organization's unique needs. This is where the RCM Maturity Framework comes in. This powerful diagnostic tool helps organizations optimize and digitally transform their revenue cycle performance. It is based on a practical approach to RCM transformation that can help future-proof operations through a hybrid model of in-house management, outsourced services, advanced technologies, and actionable analytics.

The Framework consists of four stages: emerging, foundational, advanced, and high performing. An organization's stage is determined by its level of maturity across three pillars: service delivery, technology and interoperability, and analytics. Knowing the organization's stage of maturity and where it falls short within each pillar provides the directional clues needed to continue advancing toward operational goals.

AGS RCM Maturity Spectrum Diagram 1

The RCM Framework allows leaders to benchmark their current maturation level and create a customized roadmap for navigating their organization’s unique journey toward operational maturity and enhanced revenue cycle performance by answering questions such as:

  • What level of revenue cycle management maturity has your organization achieved?
  • Are you aware of how high-performing organizations are achieving advanced maturity?
  • Do you know what’s needed to accelerate the maturation of your organization’s RCM?
  • Have you determined the intended destination for your journey?
  • Does your team have the necessary skills and experience to take your revenue cycle operations to the next level?

The RCM maturity journey typically involves a five-step process.

  1. Evaluate the maturity of the current state operations.
  2. Identify a realistic long-term maturity target.
  3. Develop iterative annual goals to achieve the long-term maturity target.
  4. Cultivate an alliance partner ecosystem to accelerate growth.
  5. Conduct annual reviews focused on iterative goals and re-focusing as needed for the long term.

To help navigate the journey, healthcare organizations can seek the support of an experienced advisor to understand their current state of maturity and what steps are needed to help advance. The right advisor should have expertise in RCM and be committed to the organization's long-term well-being. They should be able to assess the current state of RCM operations and offer practical solutions for sustained financial health. It's important that the advisor becomes part of the organization's team, working on-site where applicable, to gain a deeper understanding of the operations, culture, and strategic growth plans.

To learn more about the RCM Maturity Framework and how it can help your organization achieve digital transformation and operational excellence, download our whitepaper, “The RCM Maturity Framework: A 4-Stage Journey to Digital Transformation and Operational Excellence.” It provides a detailed explanation of the Framework and its four stages, as well as actionable insights and best practices for each stage to create a roadmap for a strategic approach to maturation.

Eric McGuire

Eric McGuire, CRCR, PgMP, PMP, LSSGB