Healthcare automation strategies for empowering patient and staff centricity

Good morning and welcome to the Health Leaders Revenue Cycle Leadership Now Online Summit. My name is Eric Wicklund. I'm Senior Editor for Innovation and Technology here at Health Leaders and I'm going to serve as your moderator for today's event. Uh, over the next few hours, we will be bringing you thoughtful, insightful and engaging content that will explore key areas that will be critical for the current and future success of your organization, organization, and these will be arranged in three successive panels.

Um, at this time, I want to thank each of our panel sponsors. Uh, Inval, Invalid, Optum and Waystar for making today's event possible. And to you in our audience for giving us your time and attention. Finally, I want to thank, uh, I want to move on to kick, I want to get this, uh, the whole day started with our morning summit.

So I'm going to be kicking off with, um, the first panel titled RCM Essentials for 2025,  Automation Strategies for Empowering Patient and Staff Centricity. And this one's sponsored by Optum. Uh, before we get started with this panel, I've got a few housekeeping details. Uh, this program will be 60 minutes in length.

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This, this is a question mark icon and it covers common technical issues. Now let's get on to this first session today. Um at this time, it's my pleasure to introduce our three panelists. We have savannah arsenault director of pre service and clinical And financial, uh clearance at oshner patrick mcdermott a client advisor for optima insights and interim vice president of rev cycle at lewiston Um lewiston, uh lewiston hospital and we have viviana belen senior director of front end revenue cycle for moffitt cancer center Thank you all three for for joining us today You Um, let's get right into the discussion.

What I want to do is have each of you tell us a little bit about yourselves and your organization. And I'm going to start with Hi, good morning. I'm Savannah arsenal with officer health. So I am the director of pre service and financial clearance. I have responsibility over some of our prior authorization or estimates and financial clearance teams.

Um, at Osher, we are a large integrated not for profit health system throughout the gulf south region Um, we have over about 46 hospitals that span throughout that region Um, and I do also always like to note that we are an epic shop.

Okay. Um, Vivian Yes, thank you. Good morning. I am Viviana Villan. I am the senior director front end revenue cycle at Moffitt Cancer Center. Uh, we are located in Tampa Bay, so you can imagine how crazy the last week has been here. So, um, we do. Um, like I said, we have a main hospital in Tampa. We had Five outpatient locations.

We have a majority of our business is outpatient. We see Uh last fiscal year also almost 700 000 outpatient appointments and we are on inpatient hospital with 320 beds I oversee I lead the teams the financial clearance unit every single step from new patient registration, authorizations, estimates, financial counseling, uh, peer to peers, and, um, front end denials.

And I have been with Moffitt for, uh, 10 years. Thank you. It's a pleasure to have you. Thank you very much, Patrick. Eric, thank you, and good morning all. Patrick McDermott, right now I'm the interim vice president of revenue cycle for Lawrence General. which is just north of Boston. It's a safety net hospital, very important to the community.

They are recovering from a cyber attack, not uncommon situation these days. So we're recovering our cash flow and they're right in the middle of acquiring Um, two hospitals. So very exciting time. I feel like we're in the epicenter of of health care excitement right now. And previously I've been the VP of revenue cycle at Resurrection Healthcare and also Sutter Health in California.

Okay, so we got all sorts of events going on here. This should be a lively discussion. Let's, let's jump into the first question here. How important is it to have a solid foundation of effective processes in place before implementing a new solution? Um, Viviana, let's start with you on this one. Sure. It's not an option.

It is a must, right? We need to understand before we implement any solution. We automate any process. We need to know what is working and what is not working. We need to get to have documented guidelines. We need to have clarity. Of what are our responsibilities and if we don't know how we're doing, how are we going to measure or to identify what is the solution that that we need?

I think it has been very important like we have in the financial clearance unit 56 of our operation is automated and we have done that within the last eight years. Um, so, um, But it was just, first of all, clear what are the processes. We are very strong on documentation, operational guidelines, and not only for us and our team, but we need to know all the stakeholders, everyone, all the ancillary departments, clinical teams, understand what we do is not only internally, um, clear communication, right?

There is no room for assumptions because when we're going to, uh, change, right, or implement the solution. Oh, is it going to happen? Is this happening this way or not? No, we need to understand what is affecting every area. If we don't know, part of that operational guidelines are our KPIs. We're super strong on measurement because if we don't know and we have not documented and the history that we have happened, we don't know how are we going to perform once we implement a solution.

Uh, Savannah.

Okay, thank you. Um, you know, I definitely agree with everything that was just said. I think ultimately, you know, it's important to have this solid foundation so that You can provide clarity and alignment for your staff when you're implementing something new. Like if you don't have that in place, you're not, um, you're not going to be successful with implementing a new process, especially if your team's not already comfortable.

Um, and really that kind of goes back to also, um, communication and creating that feedback loop. So internally with your team, but also externally with your stakeholders, like what was just mentioned, um, really important to work with your IS team, integrate your Epic team. Help them understand the why so that you guys are on the same page working towards the same goal.

Um, but really, like, this solid foundation is going to allow us to prioritize use cases, determine opportunities with our vendors, identify workflows that maybe we can develop in house. And when we implement these new solutions, we want to ensure they're reliable while we're prioritizing patient safety and also.

Data integrity. Okay. And Patrick. I think this is a really important question, especially now when we're going to all these conferences and the topic is artificial intelligence. I think this is very much a cart before the horse kind of dilemma that we're hearing about right now. Process redesign always has to precede any type of automation.

And, you know, just starting from all of our experience, probably all of us Um, in the audience and the panel, we've been involved in conversions, um, whether it's an EMR system, a billing system or any other software where it's gone poorly or a year from now, we're just not getting the benefits. And it's because the process redesign did not proceed the actual installation.

You know, it's, it's not, it's cliche to say you don't want to automate bad process, but, you know, that's happening more often than not. So I think the process redesign. Is not part of the conversation enough when we're talking about automation side that I think it's a very important question that's being asked about the foundation.

I do want to introduce just one lean concept that I learned when I was at Sutter for five years. We had a very much had a lean operation at our Sutter shared services and you know, we talked about always doing a SIPOC S I P O C. And that SIPOC was always a reminder when we look at process, we need to look at our supplies, suppliers, our inputs, our outputs, our process, and our customers.

That all adds up to SIPOC. You know, and I think the supply, the S is really important because so much of what we do in revenue cycle has to do with what contracts we're actually dealing with, right? And that's such a big problem in the industry, whether it's CMS or state Medicaid program or any number of contracts.

That's the supply that we have to really analyze before we before we, you know, redesign any kind of process. And then, most importantly, is the customers is are the are the needs of the customers currently being met right now? And what are future things we can do for our customers? So before we start automating things, We really need to go through some type of process redesign and SidePak's a good way to remind ourselves of how to go through that.

And you mentioned the, uh, the, the, the, the popular phrase, term, trend, whatever of the day, the year, the decade, AI. I'm sure AI will be a Weaved into all of this conversation today, but I wanted to veer off script just a little bit here. And we, you know, we mentioned, or we, we kind of laid the groundwork what to do before implementing a new solution.

I'll throw this out to all three of you. Can anyone give an example of a new solution that was recently implemented that that went according to plan or that worked out for you?

I can speak about one, not recently, uh, but it was like, uh, four, four years ago. But, uh, what we did RPA, um, for authorizations. So every single step that it was doing, it was done by a team member. We got bots and program them what to do. So we re we were, have been able to grow, uh, volumes, uh, you know, 10 percent increase on new patients and, you know, established patients without adding new team members within the authorization, within the authorization team.

Also what we did with this part of the, uh, RPA, you know, how they, you know, the, the denials are, you know, Classified, right? Could be medical necessity or could be, you know, lack of information in the past. We had team members identifying what type of denial it was and routing them accordingly when we implemented RPA that was done by the bot.

 So this is a medical necessity denial. It goes straight to our clinical team internally with the financial clearance unit to perform the peer to peer. And if it was just lack of information, it was routed to a work queue to one of the team members that will be able to add additional information. That translated immediately on patient satisfaction.

Why? Because in the past, they were asking, what happened to my authorization? Is it done? Well, no, it could be waiting for someone, a team member. to look into it. Now with our automation, say now has been the last four years. Um, uh, that was done. So patient satisfaction, provider satisfaction, uh, efficiencies cost, uh, you know, got reduced because of the F.

 D. Savings on as we continue to grow. Our next step right now that you mentioned AI is just to be able to predict that denial even before we submit, right? Or help the team members, uh, with the help of the AI read the information in the medical records. To be able to enter the key component to ensure that the authorizations are approved instead of getting that denial So it has been a journey but has been successful

Okay. Okay. Let's jump to the next question. Um Okay. How would you go about adding your revenue cycle operations to determine I'm sorry. Let me start over on that one. Coffee is just catching in right now. How would you go about auditing their revenue cycle operations determine the type of solution needed and where to implement it.

Um, then there's a second part of this question is how would how do you get your staff involved in this process? Uh, let us start with Patrick. Yeah, I was thinking about this. You know, I bet just this might be true of Savannah and also Viviana. But every time I've joined a new organization, you know, you ask a lot of questions.

And one question on the checklist is, have there been any consultants in this organization, in this business office, in this patient access department across the revenue cycle? Because I want to, I want to read the report and see what, what kind of opportunities they discovered. So every single time. I've joined a new organization.

There there's usually been one or two consultants who have audited the revenue cycle and it's interesting material, but it's usually up on a shelf kind of collecting dust. And the reason for that, this kind of goes to your question about auditing is that when you have a third party auditing your organization, you don't have as much ownership of those audit results.

So what I would suggest is the best thing. for us. Revenue [00:16:00] cycle leaders is to do our own audit and discover, go through discovery process using our own managers or own staff. Great learning process. Not only how to audit things, how to analyze things, but also imagine the ownership of the results. Now, certainly a consultant can help to facilitate and structure this type of audit.

But if we audit our own processes and technology and, you know, people and culture. We're going to really own those audit results and based on the opportunities we discover internally, we're going to be more apt to own it and want to make appropriate changes. So I think that's maybe something we can be doing differently in the future.

Yeah. And that brings up the interesting question is, you know, how do you decide whether to outsource the auditing or do it in in house? What are the resources that are needed? Um, Savannah, let's go to you next on this one.  Thank you so much, Patrick. I definitely think I agree with you, Patrick. I think, um, the internal ownership of auditing is super important, especially within the leadership in the team.

I think also it's really important to make sure that we're looking for solutions to our identified challenges rather than being enamored by all of the shiny options that vendors want to provide to us. Um, so, you know, at Osher, we try to stay disciplined when we're setting these priorities. We are very excited that technology has come so far and it, you know, it's working to help us move the needle more efficiently within revenue cycle.

Um, and we have focused on automation within revenue cycle for many years. So you know, our primary focus initially was with eligibility checks, authorizations, patient estimates, um, scanning documents within our E. M. R. Um, and we've really expanded that throughout the years. Um, like, for example, [00:18:00] we've recently went live with automation of Our emergency department coding, and I know we briefly touched on a I, but we are looking at implementing a I within our pre service authorizations and denial similar to how to what they'd be on a mentioned.

So, really, our areas of focus are, are chosen by looking at our workflows. Where we have an issue or a need that we're trying to solve for Um, and then looking at how likely Is the automation to solve for that issue and is the lift of installing it versus solving it with automation? Um, you know, looking at that, obviously, also the return on investment is also a key part on that.

And I know we have a second part of this question. Are we going to touch on that? No, certainly you can. I mean, I'm bouncing around here. I'll ask questions that aren't on the list as well. Just to, you know, just to keep guys, you know, loose. And as I said, the coffee is just starting to kick in now. Yeah, I'll [00:19:00]

I think, um, you know, when you, when you talk about. Having your staff involved, um, you know, where the tools may be more mature, you have to invest in the human capital to design what's going to be best for your workflows. So there's really no plug and play with automation. If you want the most benefit. Um, and we need our staff to implement these processes.

We know that they're the subject matter experts. You know, we have our senior reps or leaders are high performing team members working closely with our, our vendors, our Epic team. And if we're implementing something internally, um, And something that I did want to share that our clinical innovation officer, Dr Jason Hill, recently said, um, that I loved is that when you're implementing AI and automation, they serve as the co pilot.

So, what that means is we still need our staff to pilot these workflows and to validate the information when we're utilizing automation and AI. So I know I stole that one. I'll pass it on now. Viviana. No, no, and I completely agree with Savannah. And, like, the way that we do is two options. One, what we need to fix, right?

So we look at reports, we meet with our team members. How We are fans here of skip levels, right? Skip, skip, skip level. What is working? What is not working? How can we make your day easier? And then when we started looking at the data, the reports, okay, how can we improve this? So then that will be an option to look for a solution.

Then the other piece is, we're doing it right. It's fine, right? We're meeting the goal, the standards, the objectives. How can we do it better? Then we look at those other options to select a tool Then actually we get us a group right in front in mid, uh front mid and back end and we say okay Which one is the priority and not because we are not ready.

We are ready to implement But we know we need the IT involvement. We also need, you know, to make sure that we have the the money to, uh, to implement all those, um, new tools. So we decide as a team, which one is going to be a quick win? What is going to have, like Savannah said, the biggest, uh, you know, return on investment?

How are we going? Which one is going to benefit our patients as well? And, and then One more thing, we are all very involved in the details and we also have a lot of support from our clinical teams, right? It has been like a huge difference from, you know, 5, years that it were two worlds, right? Clinical team, finance team, not anymore, right?

So, Even every, every decision that is made in the clinical team, they are mindful of how it's going to affect our finance, right? Um, you know, and the opposite, how are we going to help our patients? How are we going to help our providers? So I would say, you know, quick wins and, and how Again, thinking of the mission.

What is the mission? What are we here, right? Yeah, we're here to to to cure cancer So what is the tool that is going to get us there? Uh First not um, you know, that's how come how we kind of decide how to to choose. Okay, great Yeah, and that's a topic i'm going to get back to um later on certainly want to talk more about how How you integrate clinical and, and rough cycle.

Um, as you say, it's, it's, it's always kind of been separate. And how do you want to get your doctors and nurses interested in what you guys are doing at the back end and, and, and vice versa? Um, Patrick, I wanted to go back to you on this one. Cause you had mentioned, uh, the idea of auditing in house instead of, uh, hiring someone to do that.

How, how heavy of a lift is it for a hospital or health system to decide to audit on, by, on their own? I think it's a. heavier lift than maybe they've been used to. Um, but there's a philosophy that our job should be to do the work and to improve the work. And we've got to spend a little bit of time. And you know what?

Cubby calls the quadrant two, which is the important but not urgent. We can't be spending all of our time in a reactive mode in a crisis mode. It seems like that's there's always a crisis around the corner and 2024 was no exception. So there is a crisis around the corner, but we have, the leadership has to help the management team and the staff allocate some of their time to important and not urgent activities such as process redesign, continuous improvement.

So in a lean organization, what you do is you have events and these events are called RIEs or rapid improvement events. And these rapid improvement events can be. you know, anywhere from an afternoon to three days and you go through the nine boxes of the lean methodology, starting, starting with, you know, what are we trying to solve?

 Okay, what's, what's our cause? That's box one. And you move through the boxes, which is mapping out current state, trying to, you know, envision what the future state and so forth. We really do need to spend some time, um, doing some type of continuous improvement activity like a rapid improvement event. And most importantly, is getting the line staff involved.

And I would like to add something. Sometimes we don't have a choice, right? Sometimes legislation comes through and then we need to be reactive, right? I know a couple of years ago, PRINCE Transparency was just to give an example. So sometimes we don't have an option. It's just. Trying to choose the solution right more like the vendor instead of what what will be the the the option there Yep.

Yeah, and it certainly seems like there are so many more crisis events nowadays than there used to be All right. Next question. Okay. Here's a good one Um, what does the learning curve look like for staff during the rollout of a new solution? And how are troubleshooting issues handled? I think this is perfect for the whole A.

I. Conversation because there are so many A. I. Is such a fast moving, uh, technology and there's so much hype around it that it's, you know, you've got to figure out whether your staff understands what they're doing before you actually put a solution like that in place. Um, I want to start with Savannah on this one so much.

Yeah. So I think we all know the beginning of, you know, a new new automation or a new solution. Yeah. It's, it's probably gonna, you know, cause some resistance from the team. Definitely a lot of questions. Um, we all know that change is hard. And so I think it's important to, you know, explain the why early get their buy in.

Um, it's been really helpful for us when we've implemented new automation to complete shadow sessions with both the vendor and our frontline staff. They've recorded those. We've done those with multiple teams, multiple leaders. Um, we've also, you know, created tip sheets and S. O. P. S. for the team so that they can really gain that basic understanding and really begin to use what we're trying to implement.

Um, and as leaders, you know, because it's a new process for us to week, so we have to ensure that we're holding the team accountable to actually using the solutions. Obviously, you know, I know, and kind of going back to the resistance part in the beginning, um, I jumped ahead. Sorry. Also, if we can Having my coffee still, um, you know, when we've implemented new automation, we've gotten up so much, a lot of hesitation from the team questions, like, is this going to replace my job?

Um, and we've had to reassure them each time that we still need them there to validate, and that kind of goes back to that co pilot pilot thing, right? So AI and automation is just our co pilot. We still need that human there, um, to validate and for the, those more difficult workflows. So really helping them understand that they're not going away.

We still need them to get these processes moving, helping them gain that basic understanding, holding them accountable, um, so that they can become proficient, right? Because if they're not comfortable using the tool, they're not going to use it. Um, and then ultimately, when they do become proficient, that's going to optimize our workflows.

That's going to allow them to become more engaged and recognize maybe other areas that we can automate. Or maybe we've automated some payers and some service lines, you know, for for certain. Um, let's say, for example, prior authorization, and they've started noticing a trend where for, you know, this 1 service and 1 pair.

They're consistently no prior off, right? That's work that we can begin to automate because it's we know that we don't need that human there. Um, and so And then going back to also incorporating metrics That's super important those kpis and really making the team a part of that showing them. Um, You know the progress that we've made so we share that with our team in their monthly meetings And we help them understand like the impact that The automation is making but also their their help with the automation and truly just painting that picture um, we collaborate very closely with our is and and our Our epic team when we are rolling out automation with an epic because I will say that we do try to look internally within our ehr before going externally to vendors and Um, we've you know been piloting a lot of new, um, applications for epic, for example, pair platform.

So that lets you, um, there's a couple of different applications within pair platform. One of them is electronic medical prior off so we can connect directly from epic to the payer. Our team doesn't have to go to the pair website or call. They can upload clinical data. Um, So in scenarios like that, we've had to really maintain those close relationships so that when issues arise, we can address them really quickly.

Um, we have weekly touch bases and then we have also additional methods for them to escalate as necessary. So, um, you got to handle those troubleshooting issues quickly so that you can keep the project moving forward. Nice. Yeah. And, um, yeah, I like the second part of this question because we learn so much when something goes wrong.

The lessons learned are, are very helpful. What happens when something goes wrong? How do you troubleshoot, uh, uh, uh, an issue? You know, really, I think when something goes wrong, we what we like to say is we fail fast. Right? So I think we kind of need to find that what's truly important is figuring out the root cause of where it went wrong.

That may involve, you know, looping in some of those other stakeholders, your vendor or your IS team to really dig into that. Um, but obviously, you know, To really minimize those troubleshooting issues. We like to do a lot of testing. So we, we ha we do have a long testing phase, um, before we go live. So I think that's really kind of, so you know what to anticipate.

So you're not troubleshooting as much as really, um, going through all of that before you're go live and scoping out that, that time and not rushing through that, I think it's really trying to prevent those nice. Okay. Um, maybe I'm reactive. Sorry. No, certainly. Yeah. Okay. Viviana, same question. Yes. No, uh, you know, agree with Savannah communication, give the team members the why.

And in addition to that is the career development, right? Uh, like a few years ago when we were doing manually say Medicaid authorizations, right? What a waste of time. So then when those were automated, we were able to reclass those positions to financial counselors, right, to, um,um, copy assistance, uh, enrollment patients helping that they we couldn't automate that that part because we need to have the conversation and explain the patients, you know, cancer patients, they're going to use the entire out of pocket, the deductible, how can we help them enroll in on these programs that are over in the market.

So, but it was an increase in pay. It was an increase, um, on, on the roll, a better role for the team members. And then when you are honest. I mean, it was. You need to be honest. It's like, yes, this role is not going to exist, but this is what is going to happen. You are going to grow with the organization, um, within the organization.

Then it has helped us with retention. Um, I can say that, um, Our tenure in the revenue cycle is, uh, the average tenure is eight years and you know how that, you know, COVID affected, uh, you know, four years ago. So, but why? Because of that opportunity to grow. And to the second question, Um, I think once you start a solution is implement a solution is communication, follow up, talk to you, to the final user, right?

Because we can see the report, well, it looks fine. Then when you talk to the team member who is on the phone and they, and you have to do extra work, well, it's not working. So I think having the, um, making the decision, if you need to stop and do more work, it is fine. Right? Not because we implemented we're going to move forward.

No, having the, the making the decision is fine. If something didn't go as planned. Okay. And Patrick, same question. What's the learning curve for a new solution when you get rolled out and what happens when it all goes south? Yeah. And we're really talking about the learning curve for the staff in this question and I loved I love Savannah's fast fail reference.

I want to build on that a little bit and Viviana's remarks. But you know, when I think about installing automation and we, you know, we previously talked about how the process design is critical predecessor event to that, but in any kind of install, you've got the pre go live, you've got the go live and then you've got the post go live.

So the way I think about this question, there should be learning in each of the three phases, learning in the pre in the go live and in the post go live. But the learning how how we learn and how the staff learn is going to be different. So in the pre go live, it's all about training. It's all about understanding what is this new machine going to look like?

What modules am I responsible for that? I need to become an expert. So it's training, training, training. And then, you know, Savannah mentioned testing, too. Having the staff, having the operational staff, you know, whether it's a registrar or a insurance verifier or a biller actually involved in the, in the testing of how it impacts, you know, the claim or the registration screen or ultimately, you know, the 8 35 output, having them involved in this testing is really critical to having a great go live.

And it's kind of, you know, it's kind of like go live. Beware. If you don't get your staff involved in the pretty go live, you're You're likely going to have problems in the go live and it's it's going to be my fault. So then in the go live You really want the staff auditing everything going on hour to hour by hour, especially in that the first five days of the go live Because they're going to they're at the ground level and they're going to learn About what's gone wrong with the build, and we can we could quickly fix this then on the on the post go live.

There's gonna be a number of lessons. So that's where we need to step back management and staff and really just ask the question. How did the go live go? You know what broke? What's not working as we planned it or designed it? 

Document those lessons, learn, fail fast and then get better. But I think learning can be You know, institutionalized and structured into The course of the project plan.

Very good. And I think one. Yes, sir. One thing that is important. Our world changes every day. Correct. Today we may have a biosimilar that is not available tomorrow. So, as we roll out a solution, it's important to plan to for a process to identify things that may change and be able to react fast. We may be thinking when we launched the solution.

Is working we tested is working something changes with the payers with insurance Then we need to react fast. Certainly. Yes, and and with the introduction of new well, not only biosimilars but new technologies, uh coming into the marketplace That's your all of your your RCM programs are evolving and again with something we will get into.

Um, Okay, next question. Um, okay. Here's a good one You would you would all kind of mention this early on and this is a good way to to really dig into this conversation What are some of the KPIs you look for? to determine the success of a solution. How do you know they're just working? Patrick, let's start with you.

This is a very important question. And you know, I'm going to focus on on baseline. So before we spend the money and spend the aggravation and all the change management on new technology, whether it's, you know, replacing our E. M. R. or putting in a new eligibility system or any other software that helps us automate.

We've got it. We've got it. We've got to determine what the baseline performance is to the best of our ability. Now, if we have some really good reporting in place, that's gonna be easier. Now, if we don't have really good reporting in place, then we're gonna have to do some sampling. Okay, so, for example, let's say we're putting in technology to help us improve point of service collection in the E.

But in this example, you know, we just didn't report very well on point of service collection. It just wasn't a priority in this in this example, so we can sample. Five days of collections in the ER and at least get a baseline. So no matter where you are in the maturity scale of reporting, you can always get some baseline because you want to be able to then put the solution in place, put the automation in place and then measure against that baseline.

Now, you're not just measuring against the baseline to make sure you have a return on investment. You know, as Viviana mentioned earlier, you want that return on investment, but it's also a great way to celebrate the success and the fact that you're doing things more efficiently. Now, the only thing [00:38:00] other I'd add on KPIs is, you know, we need to measure the net patient revenue effect, of course.

And, you know, that includes things like air days, cash collections, reduction of avoidable write offs and everything. But let's not forget about the cost. Also, patient experience and the employee experience. So I think there's four kind of buckets that we need to be thinking about when we're baselining performance.

And they are net patient revenue, cost, patient experience, and the employee experience. I like that patient experience, uh, angle. It's, it's something you don't normally consider in an RCM or finance. Yeah, the patient experience, you know, might be measured formally in the organization, you know, through a patient satisfaction survey, you know, like prescany, you know, really mastered, you know, really help organizations in the past.

Or if if we're not using a patient experience survey [00:39:00] at the hospital, then, you know, we can do some, we can do some spot surveys. We could do a focus group with a number of different types of patients. and do a focus group before. And then that will that will also inform the design of the solution that we're trying.

Those those patient experience outcomes were after and and then we can do surveys afterwards to measure if we had the intended effect. Okay. Um, Viviana, same question. Well, how do you determine whether a new, uh, new solution is working for you? Yes. So we are, um, like Patrick mentioned, we are very, uh, financial driven.

So like the entire organization is measured by EBITDA. Right. How, how we every day in a fiscal year now in the department and revenue cycle when we did automation and you know, most of the, these are new solutions. Ft savings. Correct. So our cost to collect how much money with customers to collect every single dollar and the volume, the volume increase versus growing expenses, uh, quality.

Correct. If we're doing, Correct. Uh, automation. We continue doing our monthly quality controls. We are auditing the bots. We're auditing the process productivity. So those are basically cost to collect productivity quality on the F. T. F. T. Savings. Those are the ones that we have been using. Plus, yes, we do.

 Press gain is another indicator for the entire organization. Okay? Uh, Savannah. Same question. Yeah, so I think obviously everything that was just mentioned by Vivian and Patrick was great ways. Um, you know, to measure these really, the only thing that I have to add, in addition to measuring that patient satisfaction, that's a little bit different than what was said is we've started a consumerism group within our revenue cycle, um, to kind of help measure that patient satisfaction when rolling out.

Um, you know, opening that digital, that digital front door to our patients, right? And rolling out anything that's maybe automated on our end, but also impacting them, um, whether that's within their, um, their, their app to log in, you know, that's connected to our EHR. Um, but that's something that we're consistently looking at.

We meet biweekly and anytime we roll. something out. We're looking at how it impacts the patients. We're looking at the messaging that we're putting out to the patients. Is it compassionate? Um, and so I think that's been, um, really impactful because, like you said, looking at the patient experience hasn't always historically been something that we've focused on within revenue cycle.

So Seeing the patients as consumers and seeing how all of these things impact them and getting that input because we also have had patient, um, survey  groups where we've gotten data back from them to really to get their input and what they want. That's been very impactful for us, and it's been helpful.

We created actually a consumerism dashboard recently. So looking at our top metrics, like, How many of our estimates were automated? How many of our patients get self scheduled? Um, how many of our insurance within our EHR were created automatically by the system and not by a user? How many of our authorizations were not touched by a user?

Um, so, you know, we're tracking all those things and the impact of the patient. That's brilliant. I think it is. Yes. Yeah. And I think it's interesting as we, uh, you know, as we, as we embrace what is called patient centered care, that even the revenue cycle management aspect of the hospital health system is interested in what the patient is thinking and whether the patient is, is satisfied with the services provided.

And that's, it certainly goes a long way toward that other Popular catchphrase of value based care. So as we move forward now, we are, we are, let's see, we are about 18 minutes left on the hour. And I do want to encourage our audience again. Any questions, please post them for our Q and a portion, which we will be getting to very soon.

Now, I'm going to ask, okay, this kind of segues right into this question, uh, what we were talking about, um, how have automated solutions for patient facing tasks in the front end made things easier for processes down the line? Um, let's go with Viviana on this one. Wow. Yes. A hundred percent. I'm just trying to think some, um, Processes that we have implemented say, uh, you know, out of network has been usually, uh, like, uh, a challenge for patients and for providers.

Right? So something that we implemented that has helped in the back end is the fight. Just from new patient registration. If a patient is out of network, right? And sending the notification. And if we can have that conversation, how that has helped. Well, patient is informed. They know they will have to pay, you know, additional out of pocket that if they were to network or they have the option to, you know, change insurance.

In the past, we didn't have that automation. So at the end, it was our business office, you know, trying to explain to the patient it was too late. The patient couldn't make the decision, the informed decision, uh, if wanted to pay the out of, out of pocket, right? Or same for the other network, right? Medicaid enrollment that is going to start.

Well, we send automated messages to the patients informing them, well, enrollment is coming up. These are, you know, please visit our website. Uh, we didn't have that in the past, where we didn't have the, uh, the ability to send messages. Um, immediately. You know, t has reduced by death. It has increased patient satisfaction instead of been dealing with a bill, you know, 3456 months later, uh, denials.

The reduction in denials has been incredible with all different processes and automations that we have implemented. I could go on and on and on with all of them, but I think I think it's fascinating to you are a Moffitt's a little bit different than Lawrence General and Oshner and then you're focused on cancer care.

So the relationship with the patient is a little bit different. The treatments, certainly are more complex and more costly is that do you see a difference. Is there a difference in how you you work with patients on this. Yes. Completely. I came from acute centers to cancer center and you think it's the same?

No. When you get a new patient at Moffitt and the patient is diagnosed with cancer, that patient is going to use the entire out of pocket and more, right? Depending on the time, right? If it's December, you're going to be responsible for average 7, 000 for fiscal year 24, for calendar year 24, and another 7, 000.

Uh, so, and they come, there were patients come, once, twice a week, right? So, the registration process changes, the authorization process changes. Um, we have to be creative, right? We used to check authoriz eligibility. Every single time the patient was coming when we were able to automate like no really, you know, the 80 20 rule I mean if you're going to is going to be eligible on December 1st, we're going to have the same on eligibility on December 15 I know some exceptions.

So that, uh, push us to change our process. It does facilitate somehow automation, uh, because we had so many patients, recurring patients. Now, um, Savannah, as I, as I ask you this question, how have automated solutions for patient facing tasks and the front end made things easier? I'm going to incorporate the question we just got in is how do you use patient engagement to make service quality better?

as well as improve your financials. Yeah. So, you know, automation, some of the tasks I mentioned earlier, automating on the front end. Um, obviously when it's done right and it's been tested, it allows for less errors and it frees the team up for higher, higher value activities. Um, and so an example of this, um, you know, when we talk about automating eligibility checks, We know that payers can have multiple plans, um, and it can be confusing for our front end users.

And sometimes they might, you know, get the insurance card and the system will allow them to upload a plan that doesn't actually, that the patient doesn't actually have. It's still the same payer, but it's a different plan. Um, and so we've been able to automate this by, you know, telling the system when we're sending those queries to the payers, To identify that correct plan and automatically create it so that users not having to do it.

And that's allowing for less errors, registration related errors down the line so that the claims can build cleanly and also less. eligibility denials, right? Um, when we talk about, let's see, let me go to the question that was asked when we talk about engaging our patients to improve our financials. Um, you know, I think that really goes back to opening that digital front door and engaging those patients in those aspects if we can.

When we have that engagement, that's when we can really identify how things are working. So that will, will allow us to look at the quality of things. Um, but also when we have that patient engagement in terms of financials, um, you know, they can see what their upcoming responsibility is going to be for a visit.

They can see their benefits in real time. And that puts the responsibility back on the patient to take ownership of that, you know, health financial journey, and it does get them engaged in their health care. They end up having more questions. They call, they want to know what the charges mean, what the contracted rates mean.

 And so that does allow, you know, fostering that, um, communication with the patients and, um, and ultimately giving that better service quality. Okay. Uh, Patrick, same question. You know, uh, automated solutions for patient facing tasks. Yeah, I'm gonna focus on the patient facing, you know, a couple words. And, you know, who, who in this room has not walked into a doctor's office or occupational health office and just, and been asked to, you know, fill out, you know, three pages of forms and you're like, are you serious?

It's the app. It's the opposite of delighting the patient. So when we think about like low tech technology that we can implement all of our physician offices, occupational health centers, urgent care centers, and more and more, the revenue cycle leader and the front end leaders were in charge of both the hospital and the ambulatory sides of the business.

We need to make sure, you know, number one, you know, they've got iPads where they can be doing, um, where they can type their information into the, into the forms and there's no paper and pen forms anymore. Secondly, you know, we needed, we can use these things to scan in their insurance cards, their photo ID.

So they're readily available downstream when we're trying to double verify why this, why this particular insurance had a coordination of benefits denial and handheld cashiering. You know, we love it when the, the waiter, the waitress comes to the table and just swipes our card and we just, you know, do the transaction, the table.

They don't have to walk back and forth. It's very efficient. We need it. We need to also have handheld cash sharing, um, in our places where we can collect that co pay. Or that deductible certainly. And, um, we, uh, recently concluded our mastermind program on Ralph's cycle and finance operations. And one of the most interesting ideas that came out of that was the idea of using AI, uh, so early on to, to understand a patient's, uh, financial concerns and, and help predict or help the patient pay.

You can use AI all the way back at the beginning before they even come in to kind of understand where they stand. Um, and then you're, you're pulling in social determinants of health. Can a patient pay? Are there other factors affecting whether that patient can pay? And work together with the patient to create a program where they're, where, where, where those, those bills can be met.

It's, it's an interesting, um, it's an interesting evolution to patient management. patient facing financials that I think we'll see a lot of work in, in the, in the, in the near future. Um, okay. We have, uh, that one kind of crept on me by surprise. We are into the question, Q&A format here. Um, I'm gonna, I'm gonna read this one off and, and, and invite you all to comment on this.

Uh, it just came in following our conversation. Um, sometimes claims are recouped after a year during an audit due to the patient being inactive or because The coordination of benefits has not updated. Uh, do you, you know, what do you think, how do you work with that? Or how do you understand how that can happen?

Well, just, uh, I can share a process that we actually implemented, uh, last year and Using the technology, the automation, we, every single patient, correct? Medicare patient, and there is a, a couple more insurance companies that actually require the patients to, the end release, to confirm, call and confirm that they do not have a secondary, uh, secondary insurance.

We send notifications. to the, all the patients based on their upcoming appointments said, please ensure that you are going to contact your insurance to confirm that, uh, you know, secondary, if you have a, you know, a coordination to do the coordination of benefits. And I can say with that practice, we saw a reduction on those type of denials.

We also have. The denials due to coordination of benefits come back to the financial clearance unit. So they don't go to the, um, back end with revenue cycle. They stay with us. And the reason is if we check the eligibility, we are the experts, so we need to fix it. So that also says we made that change. We see, um, uh, really, uh, an improvement on those type of denials.

That's so smart.

Okay. Um, let's see. What else do we have here? Okay. Um, here's another interesting. Yeah. Here's another interesting idea here. Uh, patient eligibility, um, but patient eligibility benefits is never 100 percent assured. So what is the best way to automate that process?

I'll add a little bit. Um, it is, it, you know, based on the current technology offerings around eligibility. Um, and there's many companies that do this. Um, it's also good to supplement that technology with some form of insurance discovery check. So you're making sure you've you've discovered not only the right primary, but also secondaries that might have been missed, especially for self pay.

before we would ever assign a self pay account, uninsured account to a bad debt collection. It should go through some type of final insurance discovery because we don't want our patients to go to bad debt unnecessarily. So I think that is a good supplemental technology on top of, you know, what is very good integrated eligibility offerings out there.

And I can add just like Savannah mentioned earlier, right? We, we have within our system, a mechanism to identify based on the payer, based on the plan, based on the person. Uh, prefix of the plan. If what type of, uh, you know, what type of plan matches our, our, you know, our database. And then we have a separate list by So, we need to make sure that we have a plan, which ones we can trust the eligibility response and the ones that we cannot, that need additional verification.

So for those, we also always need to make an extra phone call or we need to send a fax and wait for those. So, for us, it has been very helpful to have that in a database for our new patient registration team to determine what is in network and what is not. Okay. Oh, we have five minutes left. Sorry, I was just really quick to add the only other thing is that's been really helpful is you know patients they have are payers they have Different service types for every type of benefit service type for every type of service that you can offer And depending on the service type, so, you know, mrict diagnostic x ray, but or diagnostic medical You know, you could have your ultrasound in one category your x rays in one category You And every single plan and payer is different.

So we've done a lot of work and identifying how all of our services map to those benefit service types. Um, we've even have payers where the deductible applies for the hospital charges and the coplay applies for the provider. So I think just really doing that research to identify where those scenarios might exist is also very helpful to ensure that you're a hundred percent accurate in the benefits you're providing.

Nice. Okay. We just we got just about three minutes left, and I wanted to get one more question in. Um, excuse me. Uh, we mentioned every now and then, um, payers, um, certainly a key element to the whole process, and I just wanted to kind of give you a general question to serve as the final, you know, final words on this.

Um, how does automation, AI, how does that improve your relationship with your payers? And Savannah, I'm going to start with you on that one. Yeah, so I think that's kind of a tricky one. And it's definitely dependent on the payer. Um, and really how far and willing that they've been able to invest in, in automation and in those establishing those connections.

I will say that, you know, we are a big payer for us at Osher and Louisiana's Blue Cross Blue Shield of Louisiana. And they have recently or in Q4, they are adopting the application that I, I spoke to earlier, um, payer platform where they will be able to connect directly, you know, with them and their system into Epic so that our team can submit those prior authorizations.

And that's going to be a huge lift for us. Um, you know, I, I will say like we've try turning on other connections with some of our other payers and pair platform for different things. And it's really dependent on the payer. Some of them are great to work with and super easy. And some of them, it's been a little bit harder to, to make that contact.

We have a really great managed care team though, who's helped us when we, we have needed to identify who to contact and get those conversations going. Um, but, you know, I think from a provider perspective, a lot of us were ready to go right to make these connections and automation with the payers. And it's really just, you know, we're waiting on them to to also make that jump for in a lot of scenarios.

Nice. Okay. Um, uh, Viviana, same question. Yes. Um, we, we, we went live, uh, I believe three years ago with Entelipath. So we are live with automated authorization request for our radiology procedures, uh, with, uh, with three of the, uh, of our payers. So I'm saying we're continuing conversations with other, we know we're a, we're a certain millennials, sorry, on financials, So, um, I know that it's a lot of work also done with, with Epic directly with the payers.

So anything that comes, we, we are willing to, I'm happy to work with the payers. Same as Savannah said, we have a really good relationship with them. And our Payor Strategist team supports all type of automation working with the payers. It's a win win. Yes. Nice. Okay, Patrick, you get the last word on this.

Yeah, just a general comment on this. This is the most. This is the biggest opportunity in, in revenue cycle today is the, you know, the exchange of information in a frictionless way between the payers and the revenue cycle. There's no doubt that that's where all the waste is, that's where all the cost to collect is, and we need to make much more headway.

And while it's working well in some respects, like integrated eligibility is working well, um, claims. Claim submission's working well, remittance advice posting, it's working well. But you know, as Viviana mentioned, um, pre-auth, there's so much more work to do. So that's a, that's a really high opportunity.

And I would also just say appeals, um, moving away from paper-based PE appeals. And just having a a way to just website right into the pair with the appeal. It's pre populated Um, it's it's easier to appeal. That's certainly yeah Okay, I thank you all For a wonderful conversation today That is all the time we have for questions Um, and in closing, I want to note that if you registered for the next panel of this summit, which is titled how AI is transforming the future of health care, RCM, I mean, we're going to segue right into that shortly.

Um, a live clickable link will appear at the close of this session. If you've not registered for that program and wish to attend, you'll need to click the link and fill out the registration form to gain access. I want to thank our three panelists, uh, Savannah, Viviana, and Patrick for a wonderful conversation, an excellent discussion.

Um, and I want to thank again, our session sponsor Optum for making this program possible. Uh, finally, I want to thank you in our audience for participating today. We hope you enjoyed this session and we, you know, we look forward to seeing you during future the, the next couple of panels and future health leaders events.

Thank you very much.