nThrive Files IPO Prospectus: Revolutionizing Healthcare Revenue Cycle Management with Integrated Analytics and End-to-End Solutions

In the healthcare sector, Revenue Cycle Management (RCM) is crucial for streamlining administrative operations for healthcare providers, particularly hospitals. The RCM process begins when a patient schedules an appointment and concludes when the healthcare provider receives payment. Any errors occurring during this process may result in delayed reimbursement or complete non-payment for services rendered.

With the emergence of new third-party payment methods and the healthcare industry’s shift from traditional fee-for-service to value-based care, particularly amid the transition of medical coding guidelines from ICD-9 to ICD-10, the management of medical billing has become increasingly complex. To liberate physicians from cumbersome billing administration and allow them to focus on patient care, a growing number of healthcare providers are outsourcing their revenue cycle management (RCM) operations to specialized RCM companies that leverage proprietary technology platforms to handle this intricate process.

RCM companies can provide outsourced services such as patient pre-registration, appointment scheduling, medical billing, and coding. Outsourcing models range from comprehensive end-to-end outsourcing to partial outsourcing under periodic contracts.

According to the “U.S. Revenue Cycle Management (RCM) Market Size Report, 2019–2025” released by Grand View Research, a U.S.-based market research and consulting firm, in January 2019, the U.S. RCM market size was estimated at $10.98 billion in 2017, with a projected compound annual growth rate (CAGR) of 11.2% during the forecast period.

Currently, the U.S. RCM market is highly competitive, with numerous participants, including industry giants such as 3M Health Information Systems (Salt Lake City), Adreima (Downers Grove, Illinois), Allscripts (Chicago), Epic Systems Corporation, Cerner (Missouri), and Change Healthcare (Nashville, Tennessee).

The RCM company mentioned in this article, nThrive, is a recently established entity formed through mergers. It has not only partnered with Epic Systems Corporation and Cerner in succession but also acquired Adreima.

It is worth noting that nThrive not only provides conventional RCM outsourcing services but also leverages its robust data analytics platform and team of experts to offer business consulting, analytics, and educational training services to healthcare providers. The latter constitutes its competitive advantage over peers.

Headquartered in Georgia, USA, nThrive is an analytics-driven, technology-enabled company that provides comprehensive revenue cycle management (RCM) outsourcing services to hospitals and other healthcare providers. nThrive was formed from the merger of three companies, with its predecessor being MedAssets-Precyse.

In June 1999, MedAssets, one of the predecessors of nThrive, was established. Initially a Group Purchasing Organization (GPO) for pharmaceuticals, MedAssets provided clients with discounts on medical supplies through large-scale orders. In 2007, MedAssets went public and gradually expanded its business lines, offering products that included cost and clinical resource management, procurement, revenue cycle solutions, change management consulting, and data-driven analytics software. By August 2014, MedAssets had grown to become the largest GPO in the United States.

In early 2016, private equity firm Pamplona Capital Management acquired MedAssets for $2.7 billion, selling the latter’s drug purchasing and consulting businesses to the VHA-UHC alliance (one of the largest GPO participants in the healthcare sector), and combining MedAssets’ revenue cycle management business with that of Precyse, a company Pamplona Capital Management had acquired in 2015.

MedAssets boasts robust front-end systems, such as patient access portals, and strong back-end capabilities, including charge capture, claims denial management, and accounts receivable functions. Prior to its acquisition, MedAssets’ CRM business performed well, managing over $450 billion in gross patient revenue and serving more than 2,700 healthcare organizations. Meanwhile, Precyse specializes in health information management, coding, case management, transcription, and clinical documentation improvement.

Following the merger of the two companies, the new entity was named MedAssets-Precyse, positioning itself as a leader in the market for end-to-end revenue cycle technology, outsourced services, and education. To ensure a smooth transition and business continuity in key areas, Pamplona Capital Management appointed J. Joel Hackney as Chief Executive Officer of MedAssets-Precyse, leveraging his expertise to drive the company’s continued growth.

Hackney has over 20 years of executive leadership experience, having held senior positions at General Electric, Nortel Networks in Montreal, Canada, Avaya in California, and AVINTIV in North Carolina. He possesses deep expertise in driving business transformation and profitable growth.

In early June 2016, MedAssets-Precyse acquired Equation, a healthcare analytics and consulting firm. Equation’s cloud-based intelligent analytics platform, DataRiver™, transforms healthcare data into actionable insights. Following the acquisition, Equation’s technology and data analytics capabilities enhanced the functionality of MedAssets-Precyse’s existing analytics platform.

Less than a month after MedAssets-Precyse acquired Equation, in late June of the same year, MedAssets-Precyse was renamed nThrive, marking the birth of the new company.

By integrating the operations of companies such as MedAssets, Precyse, and Equation, the new company nThrive focuses on revenue cycle management, primarily offering software, managed services, business consulting, and analytics solutions.

Chris Skiffington, President of Solutions at nThrive, stated that there is no significant overlap among the three companies’ products. MedAssets offers robust revenue cycle management software, including front-end patient registration applications, mid-end chargemaster components for price management, and back-end solutions focused on claims and collections processes. The company also provides revenue cycle consulting and management services. Precyse specializes in health information management and the conversion of clinical documentation into medical billing. Equation fills the final gap in revenue cycle management analytics.

The newly synthesized nThrive integrated the strengths of three companies, yet it did not stop there; instead, it chose to continue expanding its capabilities. Strategic acquisitions of top-tier players and collaborations with industry giants have become key means for nThrive to enhance its business scope and market influence, thereby achieving rapid expansion.

In the revenue cycle management process, patient registration and insurance eligibility verification constitute the first step. To help administrators quickly verify patients’ insurance eligibility and retrieve their benefit information within healthcare providers’ Patient Accounting System (PAS), nThrive has partnered with EHR giant Epic to create an add-on module integrated with the Patient Access Suite.

“By partnering with Epic, users no longer need to access external insurance verification systems or re-enter personal and insurance information, as the required data is automatically integrated when initiating eligibility requests,” said Jit Sivalogan, Head of Product Management for nThrive’s Patient Access Solutions.

Claims processing is a critical factor in the revenue cycle process that affects payment speed. To alleviate the complexity of claims processing and reduce the probability of claim denials, nThrive has partnered with both Epic and Cerner™ to create compatible claims coordination systems, thereby increasing the likelihood of identifying and resolving issues during the claims process.

Furthermore, nThrive acquired two companies that are leaders in their respective fields: Adreima and e4e Healthcare Services.

In November 2016, nThrive acquired Adreima, an Illinois-based provider of clinically integrated revenue cycle services. Adreima delivers patient-centric, clinically integrated revenue cycle solutions that assist patients in identifying appropriate health insurance plans and fulfilling their financial obligations, while collaborating with healthcare providers to optimize revenue cycle performance.

“Adreima adds new strategic capabilities to nThrive’s portfolio, including patient insurance eligibility determination and registration services. These services enhance healthcare providers’ ability to identify appropriate insurance plans, thereby enabling them to better care for and assist patients,” the company stated in its acquisition announcement.

In April 2017, nThrive acquired e4e Healthcare Services, a healthcare services company headquartered in the United States and India. With 20 years of experience in healthcare business process outsourcing (BPO) serving healthcare providers and payers, e4e also offers value-added solutions including software, technology, help desk support, and analytics.

Following the acquisition, e4e’s physician billing and coding solutions became a key component of nThrive’s ambulatory product offerings, enriching nThrive’s patient-to-payer portfolio. Meanwhile, the acquisition of e4e also strengthened nThrive’s global presence, particularly in the Indian market.

Mergers, acquisitions, partnerships... In less than three years since its formation, nThrive has been actively recruiting talent and expanding its capabilities, rapidly accumulating a wealth of human resources, technology, and products. This has enabled the company to build a comprehensive suite of CRM services covering the front-end, mid-cycle, and back-end of revenue cycle management, and even extending to analytics, consulting, and education after the completion of the revenue cycle process.

The Full Suite of RCM Services Provided by nThrive (Screenshot from nThrive’s Official Website)

This integrated industry chain enables patients to focus on their medical consultations and physicians to concentrate on patient care, transforming healthcare service providers into high-performance engines capable of sustainable operation. The following outlines nThrive’s comprehensive end-to-end service offerings:

Patient Access Solution (Frontend):This solution aims to improve patients’ experience throughout the care journey. nThrive provides services ranging from insurance eligibility verification to the collection of various documentation, including point-of-service (POS) data, while preventing patient registration errors that could lead to claim denials by payers.

Mid-Term Revenue Cycle Solutions (Mid-Range):Chargemaster Safety Net provides services such as medical charge item updates, compliance, and defensible pricing, while also preventing healthcare providers from undercharging, overcharging, and generating incorrect coding.

Patient Financial Solutions (Backend):The back end of the revenue cycle is a critical component for healthcare providers to generate funds and drive growth. nThrive helps healthcare providers increase revenue by managing claims, contracts, and billing collections, optimizing the patient claims processing workflow, reducing underpayments, shortening days in accounts receivable, lowering collection costs, and accelerating cash flow.

Value-Based Care Solutions (Backend):Help healthcare providers identify factors affecting costs, quality, and care decisions, and assist them in resolving issues from multiple perspectives through consulting services, on-demand education, and analytical tools.

Healthcare Advisory Services:nThrive’s expert advisory team provides end-to-end guidance to help healthcare providers identify issues impacting financial and operational performance, and deliver solutions that increase revenue, reduce costs, and improve patient and employee satisfaction, ultimately enabling them to achieve a high-performing, patient-centered revenue cycle.

Healthcare Analytics Services:nThrive helps healthcare providers identify areas for improvement, make data-driven clinical decisions, quantify physician value, enhance daily operational efficiency, and achieve growth objectives by integrating and analyzing disparate datasets within 30 days through a streamlined data ingestion process.

Healthcare Education Services:nThrive Education provides tailored online education, performance management, and benchmarking solutions, enabling healthcare providers to implement structured, personalized training programs for medical coders, insurance specialists, clinical documentation specialists, physicians, and other staff, thereby helping their teams enhance skills, resilience, and competitiveness.

Today, nThrive has attracted more than 1,350 hospitals and other healthcare institutions to partner with it through its comprehensive CRM services. The company has established offices in multiple countries worldwide, with over 6,000 employees generating an average annual revenue of $600 million.

Certainly, with the growing emphasis on electronic health records (EHRs) across the healthcare sector, the transition to value-based care, and the ongoing need to curb rising medical expenditures, the RCM market holds significant growth potential, positioning companies like nThrive for a promising future.

In China, due to differences in the medical environments at home and abroad, no true CRM companies have yet emerged. However, platforms dedicated to improving healthcare processes and patient experience are beginning to gain prominence, such as Yiguo Doctor. VCBeat has previously published an article titled “The “Meituan-Dianping” of High-End Healthcare: How Yuguo Doctor Is Transforming the Medical Experience for Millions of Middle-Class Patients” as its title, it analyzed the Yiguo Doctor model.

Yuguo Doctor has established a service network covering users, commercial healthcare institutions, and insurance providers, with a focus on serving upper-middle-income and high-net-worth individuals. By connecting premium private healthcare facilities with insurance companies, it offers services such as curated selection of high-end private medical institutions, physician credential verification, and consultation discounts, thereby empowering users to make more informed healthcare decisions. Yuguo Doctor’s business model shares many similarities with “Meituan-Dianping,” particularly in the areas of medical information accessibility and patient experience reviews.

Although Yiguo Doctor differs slightly from CRM companies in the strict sense, with the continuous introduction of domestic healthcare reform policies and the ongoing improvement of the commercial medical insurance system, China’s healthcare industry is poised for a period of significant transformation. In the future, the CRM model is likely to be implemented in China in a manner tailored to the unique characteristics of the Chinese healthcare environment.

Reference Link:

https://www.nthrive.com

https://www.modernhealthcare.com/article/20160627/NEWS/160629938/medassets-precyse-gets-new-name-nthrive

https://www.prnewswire.com/news-releases/equation-acquired-by-medassets-precyse-300277829.html

https://www.modernhealthcare.com/article/20151102/NEWS/151109998/2-7-billion-medassets-sale-shakes-up-healthcare-group-purchasing-market

https://en.wikipedia.org/wiki/Revenue_cycle_management

https://www.beckershospitalreview.com/finance/pamplona-capital-names-ceo-for-combined-medassets-precyse-enterprise.html