a winning revenue cycle strategy

Case Study | Sharp HealthCare | San Diego, CA
  • Male nurse practitioner African American

    2,700 affiliated physicians

  • Hospital bed and IV drip

    1,322 beds

  • PatientChart

    9,000 patients seen each day

  • female employee purple hair pink shirt

    18,000 employees

  • ILLO_MoneyBags_Purple_DGT%20%281%29

    $3.8B net revenue in FY 2018


  • Difficult to motivate and reward revenue cycle employees
  • Limited ability to drive desired work performance across varying levels of experience
  • Needed to establish accountability for following gold standard revenue cycle workflows
  • Higher millennial turnover
  • Managers struggled to obtain real-time feedback on performance


  • athenahealth Gamify


  • 31% increase in credit balance productivity
  • 21% increase in customer service productivity
  • 18% increase in hold bills productivity
  • 10% reduction in task lag
  • Reduced staff turnover rate to less than 5%

  • 100% real-time visibility into employee and team performance

Sharp HealthCare, one of San Diego’s largest hospital networks, has a long history of success with its revenue cycle management service to optimize performance across the enterprise. Last year, Sharp decided to try something new. The health system partnered with its revenue cycle vendor to apply gaming concepts to the revenue cycle workflow to boost employee productivity, create a culture of transparency, and get deep insight into staff performance.

Like most health systems, Sharp traditionally conducted financial and employee performance reporting weekly and monthly. That didn’t allow for real-time interventions, nor did it ensure that employees were adhering to gold standard revenue cycle workflows.

“We are in an environment that is productivity-centric, but we didn’t have great tools for monitoring productivity in real time,” says Gerilynn Sevenikar, VP of hospital revenue.

In addition, Sharp was challenged to keep billing staff motivated due to the sometimes monotonous nature of the work. “We wanted to differentiate Sharp HealthCare and attract the digital generation,” says Sevenikar. “We wanted the best and the brightest to see us as an engaging, fun place to work.”

Gamification motivates employees to follow gold standard workflows

athenahealth Gamify is a cloud-based game application that sits on top of Sharp’s revenue cycle workflows. It uses real-time analytics to underpin a “game” that employees play as they work on tasks.

Sharp hoped that adding elements of game play while providing near real-time feedback on performance would help employees enjoy their work while increasing productivity. They saw the potential for gamification to provide transparency for managers and employees that would drive better quality and accuracy for revenue cycle outcomes, and introduce a culture of recognizing and rewarding high performance.

Starting small ensures a smooth launch

Sharp first implemented gamification in a group that works on discrete tasks. “We deployed first in the pre-billing area, where we receive the patient account information postdischarge and prep it for release to the payer,” says Sevenikar. “We can easily measure whether tasks were completed successfully or not.” As a result, the new “game” was seen as fair and was widely accepted.

It helps that employees can personalize their experience by setting up their own gaming profile. “One of the things that is most fun for the employees is creating their avatar,” says Sevenikar. “Their avatar appears on the leaderboard, so everybody can see their creation.”

There were some questions, at first, about whether the gaming approach would appeal to all age groups. “There was a bit of a worry out of the gate that this is something that would only be attractive to a millennial population,” says Sevenikar. “That isn’t the case. This is a great way for every employee, no matter what their age, to be rewarded for the work they’re doing.”

Productivity gets a serious boost

Sharp collaborated with employees to figure out how high performers would be rewarded. Per employees’ request, “We offer badges, recognitions, and leveling up in the game when they accrue points,” says Sevenikar. And those rewards have proven highly motivating.

Friendly competition has empowered the group to achieve an 11 percent improvement in productivity, while maintaining and, in some cases, improving accuracy. That’s because the game is designed to reward those who follow best practices in revenue cycle workflow, rather than the claim payment outcome.

“One of the things we can see on the leaderboard is how you are performing in relation to other employees,” says Sevenikar. “So employees watch their scores. They get that little nudge if somebody is only 20 points behind them.”

Employees are so engaged with the game system that when positions in the department recently became vacant, they requested permission to take over those potential “points” instead of filling the position. “Employees didn’t want to let those additional points go to someone else,” says Sevenikar. “They wanted to take over the additional worklists.”

Employees have also asked to manage a wider variety of tasks. “At least two different employees have asked for cross-training,” says Sevenikar. “Instead of saying they’re done for the day, now they’re saying, ‘I need to learn how to do workers’ comp follow-up, because I’m running out of work on some days and I want to continue working.”

Real-time feedback leads to proactive management and collaboration on best practices

A data-driven approach to workflow provides deep insight into performance. “I can break down performance by employee, hour of day, day of the week, and team,” says Sevenikar. This helps pinpoint trends and proactively manage any dips in productivity.

This approach has transformed the way the department approaches employee performance. “For example, if there is a rep who is touching an account four times, but another rep is only touching it once,” explains Sevenikar, “what’s happening differently between these two reps?” Managers can use the analytics to drill into workflow differences and have a dialogue about the best way to handle a particular book of business. What’s more, it allows for constructive employee engagement. Sevenikar points out that “employees like it when they know what’s going on.”

Employees are eager to share best practices and help one another with work. “Now, employees share insights about how they can do better in the game, which didn’t necessarily happen in the past,” says Sevenikar.

Creating a culture of transparency and accountability

In one of the most significant developments, the department’s culture is now based on 100 percent transparency. That has created a renewed sense of equality. “The numbers are what they are. They’re refreshed every 15 minutes,” says Sevenikar. “There can be no suspicions about who is doing what. Everybody is completely comfortable with what they see.”

Work expectations have shifted towards rewarding high performers and creating accountability. “The goal is to reward employees for improving performance. This isn’t about shaming somebody for being at the bottom of the list,” says Sevenikar. “Each employee can see exactly where they are on their own screen, learn how far they are from the next person, and make changes.”

Attracting “the next generation employee”

In addition to enhancing revenue and efficiency, Gamify has helped stabilize turnover, make employees feel valued, and create an appealing place to work. In fact, the turnover rate plummeted from 6% to 1.8%.

“In healthcare finance, people are always looking for ways to reward and recognize their employees,” says Sevenikar. “Until we started with gamification, I struggled to get good metrics for my employees. Now, I can give people real-time information they can take action on.”

Sevenikar also points out, “Doing something like this attracts the next generation employee. Gamification has enticed people to work here that potentially would have gone someplace else.”

Gerilynn Sevenikar, VP of hospital revenue

These results reflect the experience of one particular organization and are not necessarily what every athenahealth customer should expect.

* Data reflects first six months of use