"Analytics allows you to look at how you're making your money, where your money is coming from and going, whether your clinical care is delivering the value it needs to deliver – but at the same time it also helps you understand where your expenses are, where your revenue is, and how to balance and optimize that."

Healthcare as a whole has "been in a fee-for-service mindset for so long," says Gaston. "Organizations are entrenched in that process. There are certainly some leaders and exceptional organizations out there that do a good job with it, but very few understand how to negotiate or contract or bundle outside of that fee for service model." 

Once upon a time, Gaston worked at Blue Cross Blue Shield. Even then, he said, "when we would talk about bundling things, everything was based around the concept of an individual claim, rolling up the claims and managing the claims."

This despite the fact that "claims are, in theory, irrelevant to managed care, bundled care, accountable care, where you're responsible for a population," he says. "It's just a way to track the individual episode: the receipt."

And speaking of the "individual episode," there's another wildcard for revenue cycle: ICD-10. Now that (as of this writing, at least) there's still no firm date set for conversion, a whole lot of planning has been thrown into flux.

"The vendors have done the work to retrofit," says Hoyt. "It may have been hard as hell, and it may slow down the system because we're now dealing with three times more codes, and I'm sure the vendors would like the opportunity to rewrite and redesign using the new code set, but they had to retrofit. 

"There's a point where they've got to get the clients on a new version," he adds. "Because it's such old technology. And we're gluing pieces on like ICD-10. It's just another nail in the coffin of old systems." 

Just like Y2K was an opportunity for some vendors draw a line in the sand and cease support for some outmoded pieces of technology – "an opportunity to shoot some (old) products," so might ICD-10, whenever it may arrive, be the opportunity for vendors to mark the pivot point toward a new era.

"Are these (current) systems ready for payment reform and ACOs and bing responsible for a population? The answer is fundamentally no," says Hoyt. "People are just hiring analysts and building spreadsheets and maintaining separate databases. There's a point at which we all get sick of this and replace the systems.

"But the CFOs today have their eye on getting checks in the mail for meaningful use," he says. "Once that's over, I've got to believe they're going to start ripping out old systems to get ready for a new one."