Revenue Cycle Management Technology Adoption Model Guides RCM Digital Transformation

Introduction and Overview

Hello. I'm Jonathan Wiik, vice president of health care industry insights from FinThrive, and I'm joined by Miguel Vigo, the chief revenue cycle officer at University of California San Diego, UCSD, and we're here to talk about the Naham Conference. And as well, we're gonna talk through something called the revenue cycle management technology adoption model or the RCM TAM, and how that can help set strategy. Welcome, Mike.

Thank you, Jonathan. Great to be with you, and I'm excited to talk through the RCTAM product today.

That's awesome. Alright. We're gonna dive right in here. I'll, advance these slides and we'll, walk through.

Market Recovery and Trends

As I mentioned, we're gonna talk about the RCM TAM today, and, this presentation's April twenty fourth here in about, oh, a little under two weeks, but gonna or a little over a month, actually. We're gonna walk through, just where we're at with, some market things. I'll walk through that, and then we'll hear about Miguel's organization out there at UCSD and what they're doing. And then we'll talk through this RCM TAM, and then look at some KPIs some other things as we go.

I wanted to start and set the tone by recovery, not the Pacu type of recovery or surgery recovery, but just financially where the market's at. And I'll show some numbers and where we're at. I think last year was mostly a year recovery. We'll hear from Mike here in a minute about how California did in his organization.

But really, was a a year. I'm a big Kaufman Hall fan. This flash report comes out every month. You don't have to be an econ major to understand that it's gonna take you at least as long as your deficit to come out of it.

We've got kind of this propeller or windmill pattern here. If you look at this in aggregate, You know, we're running right around, break even now. I actually just pulled this report up for January, and it's running about one point eight percent in aggregate for most of twenty three. So finally outpacing a little bit of the deficit that we created I like to call that margin compression of, the result of what I call the three headed monster.

Impact of COVID-19 on Healthcare Volumes

The first pet of that monster really is patient volumes this isn't a strip from an EKG. It's actually emergency inpatient and outpatient volumes that we track here at FinThrive, and, they're there in those respective colors. And you could see, you know, the the trough that occurred about three years ago. Believe it or not. Here in a few short days, if not now, we're celebrating the four year birthday of COVID.

And, it it, you know, certainly caused a a large trough of activity in terms of just outpatient procedures and and lockdowns and those types of things. And then that leveled off in twenty one.

And then we had kind of the similar pattern occur over the holidays, Thanksgiving and Christmas to what those low troughs mean on the outpatient side. That makes sense. A lot of people don't go get surgery. Instead of turkey dinners or Christmas trees of those types of things.

Challenges with Inpatient and ED Volumes
Nonetheless, what I like to find interesting is that impatient ED has really stayed under normal. That zero percent mark there that's hatched out is below normal. We haven't seen inpatient and EDU volumes recover fully.

Inpatient's kind of peaked up just a little bit there. You can see, but that dark bar of ED bonds are there. And I we can get into a whole another talk about why we think that is, but I think, you know, telehealth and I think self care and and just, you know, basically outpatient type care, has kind of taken the the seat of that. But most hospitals I talk to We'll talk to Mike here in a minute too.

I've indicated that their volumes are mostly back, but ED is still a little bit low and as a function of that, so as impatient. We'll walk through as we go. What I like to call the alligator sort, chart. And this is a jolt survey.

Impact of Labor Turnover on Margins

Jolt stands for job opening labor turnover, and This comes from the Bureau labor statistics. I just like showing this to as the other head of the three headed monster, why margins are there. You know, during before COVID, we had relatively stable, you know, hiring and opening trends, that top bars openings that light blue, that orange is higher. And there's always kind of this delta of about five hundred thousand positions.

That makes sense. Right? If you look nationally, there's always gonna be more open positions than those that are actually hired. Well, COVID came disrupted that way to hire immediately, to kind of handle those spikes of the Delta and Omacron, and then kinda went back down to a normal level of hires.

But the openings kinda pla skyrocketed.

And and that gap has pretty much stayed there for the past two to three years. And it's a pretty big delta. One point three million open positions. And a lot of that I like to call her mic drop type positions as people that are just like, I'm out. I didn't sign up for this. I'm moving I'm switching careers.

Nursing and clinical positions were already somewhat fragile before COVID happened, and I think this was the straw that broke the Campbell's back. And even if you wanted to hire all of your positions, I think you're gonna start looking at technology and just different staffing models as we move forward. And I know that's the case that you see David or you see SD as well in San Diego there. Definitely different ways of delivering care than what we delivered four years ago, and we're having to be more efficient.

Challenges with Payers and Denials

We can't pay for contract labor, which was one of the main reasons labor was clinical labor is one of the main reasons why margins suffered so much as well as volume. And then, of course, our favorite, the payers, They, are are playing some really, really, really big games of hardball right now in terms of their activity.

Denials are running right around four percent right now. For write offs, very, very high. Staff time, in terms of complying with policies. This is an AHA survey.

It's showing a very, very difficult relations in there, and they're saying that it's getting worse Most of the hospitals I talked to. Mike joined us at our FinThrive Advisory Board here last month. There's just a raw disdain of hate for the parents right now. I haven't seen much love in that area.

And I think we'll get there someday, but it hasn't been good. As I mentioned, denials are running right around four and a half percent or five. This comes from Clarivate or HBI data. That's the write off rate gang too.

That's not the initial denial rate. I would have gotten fired when I was a chief revenue officer. I had a four point six percent, write off rate, you know, ten years ago. It seems to be the norm.

Now benchmark performance runs anywhere around, one percent, but gonna turn it over to make to Mike now just initial thoughts on what's going on in the market and then we'll talk about UCSD as well, Mike. But, what are your thoughts on those stats? Is that ringing true in California? Are there some other things going on there?

Insights from UCSD and San Diego Market

Or You know, it's, thank you, John.

I think, the one one thing we're seeing in San Diego a little bit, we might be, out of the common, I guess, Nomenclature here is our ED visits are still pulsing pretty high, but pretty much everything else, has definitely been there. I'm not sure. We don't have a silver bullet or full understanding on the EDE part, but all I know is we've got volume. We've got a good problem, and we gotta figure out enough are the right place to care for them. So good problems they have, good problems on the list. So yeah.

All the best slides for you, brother.

Yeah.

Very proud of being here, and thank you for having me. UC San Diego Health is a part of the UC Health Network.

Overview of UC San Diego Health

Based off the university system throughout the state of California.

We're fortunate that we offer pretty much every specialty and service out there, not just for patient care, but Obviously, being part of an academic center, we have a lot of school, education, and training, which we represent, either the fifty percent of what's offered in California or we're the biggest organization to offer that. So odds are it's a few degrees of separation from somebody to know that's either worked urban educated to the University of California system. So it's a really, really great system to be a part of. More specifically, the next slide, you'll see for, University of California, San Diego.

UCSD's Service Offering and Reach

We really have a three main hospital campuses now. That recent acquisition of, what used to be called, Alvarado, we call East Campus is part of our, our newest growth initiative, and we continue to reinvest in all of our current, facilities, including Shiley, our cardiovascular center, our family ortho, outpatient center, and our Mortise Cancer Center, just a few to note that we work with and provide care for Bharas on the leading edge research.

And we're based on the south, south part of California in the San Diego County, we pretty much go all the way from, what's commonly called North County kind of oceanside, Carlsbad, San Marcos, and we go all the way down pretty much right up to the Mexico border. And here's a little bit of a layout of where our main hospital campuses are with satellite locations through all. It's very important to note that outside of our medical and our healthcare practice, we really do have a mission, a mission vision, and culture to care for everybody every day, equally across our system.

Can't do so if we don't have the money and funding to do it. Right? There's have a beautiful mission statement. If you don't have the money to support the mission, then, it's a mission that will die pretty soon and fast. So about three point seven billion of our net patient service revenue and a lot of our statistics there. So we're fortunate to touch almost every life in the San Diego County region in one way or another.

Community Care and Financial Support

We don't do so without making sure that we take care of not just the everyone that has, the needs, but whether you have the right means financially to come to us or not, we wanna make sure we're taking care of our community in every way we can. Whether it's a, you know, a homeless patient, a patient that, just came into our community or into our country, or if it's somebody coming on hard times, I believe San Diego's recently rated by the US news and report as being the most expensive place to live hashtag, I could use a raise.

But, it is something that we make sure we reinvest in our communities and take care of our our population.

No matter what income or financial background you come from. So proud to be a part of that as well.

The other part that, makes us very special is that we continue to keep quality and patience safety top of mind.

Focus on Quality and Patient Safety

For the second year in row, we were rated number one in San Diego, beating out a lot of our competitors, but Also, we are recently ranked five stars from CMS and we're on the nation's honor roll meeting. We're in the top twenty hospitals in the country. So not just financially taking care of our patients and doing well for my revenue, but also making sure our quality goes alongside that as well. So I'm very proud of the organization. And the quality we bring to the communities.

So a little bit about revenue cycle, what are we doing to help support the mission, the vision, the value? So There's a number of pillars that go into any organization.

And as I kinda joke about earlier, but in a more true statement, we wanna make sure make sure we're supporting that mission. We have to have a strong financial foundation, and that financial stability and sustainability comes in a different few different ways cash and AR management being the biggest parts that I'm fortunate to oversee with my leadership team. I'm gonna show you a few things that we're doing to help support that part of the pillar in that form.

A little bit of how we do this, broken out our work chart. I have a fantastic team of folks here. But more importantly, we lead and break it up by what makes sense for our operations and our teams and our community. We continually review this.

Organizational Structure and Growth

I just mentioned we had an acquisition a few months ago, and we have another acquisition coming up again. So we are not afraid of tradition. We are not afraid of new and what's coming. We will shake things up to make sure that our teams are split up in a way that supports both the patient, the operation, but also our employees.

So love my team as my work chart here, but, as we continue to grow, we're always looking to redefine our team and how can we be even better.

So how do we do that? So we wanna make sure that we tie all the way from the top part in our mission vision values, our strategic goals for the year, that align from every single team, whether it's strategy, whether it's physician care, financial investment, whatever that is, and we wanna start cascading those down. How can we tie that together? So one way is making sure we're setting objectives. The other way is is how am I setting those objectives to make them measurable and obtainable.

Setting Objectives and Measurable Goals

What resources and tools am I giving my team? And then if I need to put a KPI or metric there, that we're doing that, so we're tracking it. I will say that at a director level, we set them at a level that's easily explainable to our non financial teams. We also break them down in the subset so that every team has a has a hat in the rank if you will.

They wanna make sure that they're contributing to it. And empowers them, makes them feel good, and then it supports that larger goal. That way you drive the engagement from the teams, and you give them some to look at every day. That they can achieve, measure, and know how well they're doing.

Metrics and KPIs for Financial Performance

So how do we break that out? We try to make as simple as we can. We talk about what can we what can we control internally? What's the process that we have that we can look at, whether it's ordering things or contracts, How are we spending our money and our budget and our resources?

If it comes to our financial perspective, how much cash are we getting in? What's our cost to collect? What can we do to add a few more codes and modifiers? How can we further support not just gross revenue, but not revenue? Make sure that we're moving forward and supporting the financial incentives.

Customer perspective, our patients are number one, our main customers, if you will, So we're always looking at employee, I'm sorry, patient experience and engagement scores to keep supporting them in the care mission. And then lastly, what am I reinvesting into my teams?

I say, lastly, in the management of order, not in the management of priorities.

What am I doing? Is that more town halls? Is that setting up safe to speak computer learning? Am I making sure that there are multiple outlets to work from and communicate with? We really want them to feel like they're empowered and they can get joy when they come to work and the work they produce.

Strategies for Financial Stability

Couple examples. These are kind of the high level executive examples that we report out are not collection rates. Essentially, all things, collected with our contract and repair I'm sorry, payer contracts and what we expect to collect. I am fortunate to report that, looking at mister Wicks at graphic a few minutes ago, I am just ever slightly belong, below the national average for write off on the hospital side. The physician side, the metrics a little different. They're a little bit tougher, but still doing better than most in, that national outreach. So very proud of that team, but definitely room to improve.

That denial rate unfortunately continues to be, something that increases as we're seeing across the nation. I'd love to say that we're getting closer in about seen Kumbaya, their payers, but I'm also a realist. So I'm gonna tell you that that's not true. So what can we do to get a better internal look of how we're doing so we can change things and get more efficient and continually and readily adapt with the changes that come. And then lastly, our age, I think, not gonna tell anybody here anything new. The older the account, the harder it is to collect. So that's always a metric going to bring down and get closer to have a fresher AR.

Technology and Process Optimization

How are we doing this? Well, Epic First, that's our EMR. We always wanna invest to get our features functionality, whatever we can do. There's any type of new development or, organizations who provide us on a test things out, part of being an we raise our hand first, we're not afraid to be the first person, the beta partner, alpha partner, do the research. We always wanna do that. So always looking at automations and EpicTech first.

AVN, we're one of the first organizations in the country where we actually have hard stop the AVNs all the way from ordering down. I can tell you that monthly, we are saving hundreds of thousands of dollars, and that is pretty new for us. And, yes, there were a lot of, folks blowing up my email and my voicemail, but we have worked with them. We've educated them, and we've handheld those departments, but we continue to do really, really well. As we roll out that ABN optimization.

Denials prevention team. Nothing new there. Just looking at different ways and in taking data, how can we slice this? Differently reprioritize accounts.

Vendor Contracts

Our vendor contracts is pretty interesting. I've only been at UCSD for about a year and a half, but a lot of opportunity there And, I think when you start sitting down and talking with your partners about how can we really drive what's best and get top of license, performance out of both? Your real partners will stand up. They will meet you there, whether that's a rate discussion, a cap discussion, accountability discussion.

That's something that really is important. And you really find out who your best partners are there. So that's a big learning curve for me here with our partners at UCSD, but it's also been one of the most, educational, as I've learned a lot about how it can perform even better.

Financial Experience Improvement

Financial experience is number one. How can we make it easier for patients to pay their bills? Make it easier to understand. And it also works on the vendor side too.

How can we streamline this? So I'm not spending x amount of FTE's researching invoices. So make that entire financial experience, both external and internal, a bit easier and better and streamlined for all parties involved. And the last part, it's I'm kinda repeating automation, but this is really external.

How can I use either my own internal software designers or my partners to push further so that I have these automation solutions, even if my EMR is not there?

Project Management and Accountability

How do we do this? How do we track? This sounds like a lot. Trust me. This is only a snippet of what we've got. It's probably a thirteen or four seen a megabyte document that we run, but we've got a great leadership team and a project management team that helps us keep folks accountable to how we're doing. And a gantt chart throughout the fiscal year, what's at risk, what resources are needed if we need to reprioritize.

And we do that with some internal scoring, but it's a very detailed map that we keep, and we politely, but aggressively keep everybody accountable. And we meet every two weeks to go over this project document. And make sure that if anybody needs anything, they can voice that out, they ask the questions, and we get them what they need, or I'll be real with you, as I mentioned, we will reprioritize or decide. Maybe that was a priority in October.

Mission Alignment

It's not so much anymore because we bought a hospital. So we continue to look at this. We don't push things just to push them. Really do do a lot of deep breath checks to say, does this still make sense for our mission?

Does this still make sense for our strategy road map? And if not, we're not afraid to cut it. If we fail at something, we learn from it, we move on, but a little snippet of what we're looking at, this fiscal year.

So how do we get better? I think that's the one thing with rev cycle. Right? It's a circle.

So we're always being asked kind of the same questions. How can we continually be better? Well, We'd love to and we do this well. We would love to be better.

Contract Negotiations

We partner with our contracting team. Right now, we've been kinda put to the limit twice with terminations with Aetna and Anthem.

Two of our top four biggest pairs blue or Anthem Blue Cross being our top one. We took it all the way to the, poker table all the way to pretty much the final hand. And let's say that, we called the bluff and we won that. Right? So in an area where it's very tested, I can tell you that trust me there are some winning cards up to sleeve from a provider standpoint. It's on how you plan. Unfortunately, when we don't always win them, there's arbitration and litigation.

Contract Management Challenges

I really hope a lot of you have not gone through this as much as, maybe we have. But it is a realistic strategy. You need to start thinking through and putting together. You can plan all day long and you might have a contract black and white That does not mean that they're gonna abide by.

I'm not telling you anything new. So you really gotta think about how you wanna approach that internal external, and your data's gotta be solid gold, order to move forward with whatever strategy you put forward with. Another items are payer mix, Medicare rate in increases if you call them that have not been the most profitable or at least beneficial to us. So we gotta think about different ways to cut our costs.

Cost Control and Efficiency

And the last part is those are things we can't control. There's things we cannot control. Inflation, economy, California just had a wonderful law come through that makes the minimum wage in health care twenty five dollars an hour. That was not in our budget two years ago.

It is in our budget now. But those are things that we really are outside of our control. We have nothing to do, but we have to figure out how can we continue to be more efficient use automation and technology because that cost cutting is, it's never gonna stop. Right?

And rev cycles usually one of the top areas they look for. Just thinking outside the box with some of these things.

So what have we done?

Market Analysis and Partnerships

Oh, good. Sorry.

So what have we, what what have we done from a market standpoint to look at how can we get some information, get some partnerships. So we're not acting in a silo but we're also looking to take a real self health check of how are we doing? We're our biggest opportunities, and where do we really need to invest our time and resources. So We had a need, and luckily FinThrive was right there. So mister Wiik, I'll toss it back to you.

You bet. Thank you, sir.

We're gonna walk into just some specific things for revenue cycle. This has a a a QR code here. You're welcome to click on it. It will launch the twenty twenty four transformative trends survey, that talked through about ninety two executives like Mike here, and their perceptions. And we asked pretty simple questions just to understand what's going on the market. What are your priorities?

Market Priorities and Technology Investment

If that is a priority, how are you gonna tackle that priority?

What technologies are you gonna invest in and those types of things? And this shows really some interesting statistics just between last year and and this year, just revenue as as as became you know, somewhat more important than it was. I think it's always important as you heard from as you heard from Mike. Patient experience switched positions.

It used to be in kind of the third position, under cost. And, you know, based off those statistics I showed you earlier, there. A lot of organizations, including those in California, we're really in a spot of cost control. I think you're always there, but that dial kinda gets turned up and turned back down, depending on how you're doing financially and how those margins are performing.

Payer Negotiations and Revenue Capture

Once you get your volumes back, You you play some good poker hands. Like Mike said, in terms of your payer negotiations, you manage your denials and maybe, get some more revenue captured through your ABN and Medicare. Processes and and and things like that. That allows for you to maybe put patient experience back up.

I think it's all these are always important goals. It's just important how they they stack rank them.

What's important now is financial leaders are absolutely looking for a way to to chart their course forward. They have health systems are contracted with more than forty vendors as they go forward. And this footprint really, you know, examines, what all those things are. This was something that certainly had when I was a revenue cycle leader, I'm gonna allow me to kinda understand what solutions I had and when I when I didn't before we even had an RCM technology adoption model.

Revenue Cycle Technology Adoption Model

It was more of just a a a checker board, if you will. And do I have that? Do I need that? Can we invest in that?

What's that plan look like and it's a range kind of front middle back. We call this kind of a placemat, but it's not unlikely to have, you know, a couple dozen, if not three or four dozen different solutions that are either embedded within the electronic medical record or they're a third party bolt on solution or you know, an end to end platform like FinThrive that allows you to manage your revenue in a way that, not leading any dollars on the table. Common concerns from folks like Mike and others or, you know, what is inside my core EMR? What what do I have from Epic or Cerner or Metatech or Allscripts?

Evaluation of Technology Solutions

What technology do I have on that placemat today as you transition organizations or any different organizations? What is my total cost? What am I spending? What's the yield? From these solutions. How are they doing end to end in my organization

How much am I driving my IT department nuts? They were my best friends when I was a revenue cycle leader. Because I constantly had to ask them, you know, for new secure portals or new VPNs and and, get their teams together in terms of making sure we had the data and things that we needed. What is my path?

How can I automate? You heard Mike mention that as well. How many vendors do I really need? The performance has been difficult to measure spent there to maintain and I would argue duplicative in offerings in the past.

Revenue Cycle Technology Strategy

And at every hospital, you heard it from Mike and his strategic objectives. They absolutely are looking at what's core within Epic, what are some automation technologies they need to have to manage my denials, my other other, contract management, insurance, discover all of those things that that I need to do to capture revenue. We're gonna talk about the revenue cycle technology adoption model here. Mike and I are gonna kinda go back and forth a little bit on his results specifically.

This is another QR code that you could click on that actually will launch the survey for you. And you could take that as Michael elaborate on here in a little bit. Sometimes it's good to just set time to do this with your team. So you're you you certainly could take it alone, but if you my recommendation of what we've seen kind of as a best practice is, you know, click on this QR code and set a half hour, hour meeting with your team and walk through because you'll learn as you go that it gets pretty granular in terms of what's there, and it's nice to have some of your experts that are over those parts of the department help fill it out.

Survey Participation and Impact

How the model worked or where it came from is we really went and surveyed a hundred organizations. What I want you to remember about the RCM TAM are two things. Is the technology valuable in the market? We used a five point likert scale.

We'll go over that in a minute. And is it is it something that's really not useful or it's mission critical? And and that really helped us establish, you know, what technologies are valued in the market right now from a use standpoint. And then secondarily, okay, that's great.

And Michael tell you this too. You, like, we all wish we had a billion dollar budget. Right?

Organizational Technology Representation

There's technologies that are out there that you absolutely think are valuable, but you may not them now depending on your financial position and what your budget looks like. You met Mike mentioned the cost pressures that he's having from labor because of California statutes and those things. It's in the budget now it wasn't. And as much technology and resources and people that you wanna invest in, there's always seems to be this gap just like that app I showed you between hires and postings, in terms of what you want and what you can have and what are nice to haves and what are need to have.

We wanted to represent all the the EMR, which you could see there. We also wanted to represent different sizes of organizations, in terms of beds and their net patient revenue.

Assessment of Technology Value

So as I mentioned, there's two things that we really we we measured in here. Was was the technology mission critical or was it of no value? We removed the things that were below, moderate, low, or no value from the model and just kept the mission critical and high value. That'll be a theme that we walk through here. And then we looked at stages of these into five different levels in terms of is this in place in more than sixty, seventy, eighty percent, and so on of organizations. And as you'll see the model here in a minute, it walks through that.

Revenue Cycle Technology Adoption Model Details
So this is the model, and we'll get into Mike's results here in just a minute. And, you know, basically, you know, talks through broad, high, moderate, and emerging adoption levels. And you could see those color coatings of that four or five mission critical or high value types of levels there. Obviously, things like eligibility, claims.

 

I would argue estimation Some of those things are absolutely things that you have to have that are mission critical in any revenue cycle that are there. You'll see different levels of penetration as we go forward here. But to move from one level to the next, really need to have this seventy, sixty, sixty percent, you know, level of of adoption to move in stage by stage. As we looked at those stages, we saw a v shaped type presentation come back.

Stages of Technology Adoption

So five stages presented about forty three percent of the markets at stage one. They've got fifty, sixty percent of those mission critical or high value solutions that we talked about, about a third or so are in stage two, eight percent there in stage three, and then four or five earlier kind of these aspirational levels. If you remember the EMR adoption model that came out during meaningful use from hims, This model kinda took some of those things from that and wanted to really look at, you know, that one has a seven stage model, if I recall. And if you recall, like, you know, stage seven might be that you are sharing data between facilities across states as patients transition to different levels of care or maybe travel and those things and maybe stage one or two had com computerized physician order entry or maybe electronic charting, those types of things.

Comparison with EMR Adoption Model
There were federal dollars attached to this. Don't we all wish the federal dollar attached to some of our revenue cycle technologies.

Nonetheless, it's a five stage model. And, certainly the breath of technology is more, saturated as you go through those those levels.

Here are the stages.

And, in a minute, we're gonna go over what Mike had. But as I mentioned, one, two, three, and five, and you could see, as I mentioned, forty three percent were there at stage one, and and and so on as you go left to right.

Technology Adoption Results

And we looked at those results and also measured KPI. I think with something that's very, very important. These key performance indicators, these aren't all of them, but Big five. He saw some of these similarities to some of the things that Mike was measuring.

Quencers collections, AR over ninety with something denials right with something he was measuring. Cost to collect and bad debt. Those that had a higher level of technology had a higher level of performance against these KPIs. And that makes sense.

Right? I mean, as an organization, you invested in this technology, you shouldn't be paying for it. Or continue to pay for it. If it isn't moving the needle across some of these KPIs or all these KPIs in the organization.

Financial Performance Comparison

So the purpose of kinda showing you this is those that did invest had better financially performing revenue cycles than those that did not. So this is my here and and compared to your peers, you know, where did you show up? And UCSD, you know, basically, before he even took the survey, Mike said, yeah, but we're in the middle. And and, Mike, do you have thoughts on this side?

You know, and when you when you first saw the survey, what were your initial impressions?

Yeah. I think, it it was thinking I was right about in the middle. I'm not gonna lie. I think, we'll get into a little bit. I thought we're a little bit further along in some areas than we were, but, nothing, nothing, resets you like the truth. So, after going through the model and and going through the questions and talking with the team, it really did bring a lot of reality in resetting a priority for us.

You bet.

Results Summary and Future Progress
This is Mike's results. And and, he came out, I believe, as a stage one if I recall.

And, and that's the majority of the organizations and, and, he's gonna, I think quickly move into stage two based off of some of those investments and even into three. And it doesn't take a lot to get there. And the idea isn't necessarily to advance through all the stages as fast as you can as we're looking at this, this is just to expose you to the model. There wasn't one.

As we started with when we were talking about revenue cycle market approach, there really isn't a model until now. We've partnered with HFMA on this model. It's on their website as well. And when you clicked on that link before, it should take you there.

HFMA's Assessment

And And HfMA has looked at this. Sean stacks, a colleague of mine over there is looked at it as well, and he thinks this is great. It allows you to kinda understand what pieces of technology are out there first and foremost. Secondly, what the rest of the market thinks they are from a value standpoint and then also allows you to see from a deployment standpoint where you're at.

You can see where Mike check boxes and x things. And one of the things I remember, Mike, when you first did this is that you filled it out and then you met with your team because there were some differences in what your team felt you had from a footprint standpoint and what you felt you had. Do you wanna elaborate on that a little?

Reality Check

Yeah. So I had mentioned my time with UCSDB in about a year and a half. So came in, did initial discovery, kind of exploratory work, had some great impressions, looked at some data, and that happened to be the time I took the initial assessment or intake and was walking away feeling pretty good. Definitely feeling like I was two going into three, if you will. And then, was able to circle back with my team, had them walk through and complete the same steps. And that was a bit of a reality check, meaning that my perception of where we were at from a tech standpoint was further along than we actually were.

Resetting Expectations

Now that doesn't mean that everything was on fire, but it definitely helped me reset and re understand where we were, where we had maybe done an initial investment, but hadn't seen it through. Or the Jonathan's point in the couple areas, We had made some investments, and it was not getting the ROI, the expectations we had assumed or thought. So definitely reset reality for myself and my teams and helped, you know, maybe a, a beneficiary of this tool and the expected outcomes, but it really brought us together and have a use it as a platform, a lot of discussions that we were not having.

Impact on Team Engagement

Because others were seeing their realities, come to light as well, whether perceptions be reset and allowed for a lot more engagement or collaboration not just with myself, but, with loud and the leaders as well. Cool.

That's the one thing.

Oh, go ahead. I'm sorry. Yep. Go ahead.

No. No. Go ahead.

Yeah. One thing I I think was interesting here too, Mike. Well, sir, expensive time on this slide is and this is one of my favorite parts, and I remember when I was a revenue cycle leader, and I know you're a a a a revenue cycle. I like calling ourselves gurus instead of geek or nerds, but, like, we really love numbers.

Right? And I love to be able to see, like, am I is this a we problem or a me problem and being under being able to understand where we are. And one of the beauties of this is it's a database that's learning. So as more people fill out the survey and do an assessment, these These KPIs that are attested in there start to get hardened and and and more concrete by each level.

Comparing Performance Against Other Organizations

And you could see how you performed as an organization against maybe a stage four or above organization to that point I showed earlier about how investments in technology really should drive an ROI. And, Mike, I'm gonna ask you some questions here, but, you know, really Doing well in areas like point of service collections, AR days, denials, as you mentioned, cost to collect days cash, those are some opportunities that looks like in terms of, for your organization, clean claims and bad debt.

Identifying Opportunities for Improvement

Look like, some areas that that you might have some opportunity as well.

But what was your thoughts as you're looking at these KPIs and understanding where you're at and what are some areas of folks Yeah.

Really just more of real time or front end. Assistance.

Yeah.

So point of service is an easy one, but, of course, clean claims falls into that. A lot of the AR work. I think we spent a lot of time touching accounts, longer than we should or retouching them. I also think that we probably deprioritize a large subset of accounts because we're like, oh, those leads, I'll get to them later.

Using Technology for Improvement

Yeah. And on those categories, I definitely saw this tool highlighted. Opportunities where we could use tech or some sort of hybrid combination, not that they're not important because to argue the point, they probably are the most time sensitive or more complex, but if there's a technology that can accelerate those, automate those, or batch job and whatever the scenario is, then why are we not doing that? So those are a couple areas where, yes, we can work them.

Yes. Our overall net collection rate's good, but like you were saying cash is still important. How about we get that cash ten, twenty, thirty days sooner instead of having to touch it multiple times or we're just putting it on the back burner. So That was something that really came out from the results and seeing not just the stage win, but if we really progressed through the stages, immediate cash benefits and acceleration.

Visual Representation of Work Streams

Awesome.

Then this is what I like to call a jelly bean document. I think the business has a different opinion, but I I like call it that because it does look like a box of junkies, but it but it it it really is nice. On the left and navy there, you see the work streams.

And then, there's a color coding of things that are mission critical or of high value you could see there in the upper right corner from the legend that the the the kind of blue and the light blue. And then things in gray are things that you already have. And so I love this because it's kind of an at a glance. Okay.

Prioritization and Direction Setting

If there's a lot of color on this, there are things that I need to look at. If there's a lot of gray on this, there's a lot of things that I already have. And there's kind of a combination here, isn't there, Mike? It it looks like there's some things that, you can kinda look at the work streams and understand ones you wanna prioritize or not, which we'll get to in the next slide.

But do you like this view or what are your thoughts here?

No. Like, it's great. It actually takes, kind of a generalities last update I gave was a bit more of a exact high level. The next layer of that is, well, how are you gonna do that? And I think that's where this one really steps in and says, these are the key areas that we need to focus on. And this is kind of that direction setting with your management, your leadership team.

We need so solutions or a hybrid approach or some sort of strategy to attack these colored items because these are the ones that are gonna help drive where our KPIs are not meeting.

Focus Areas for Improvement

Nice.

And then it allows some some some areas of priority. Right? And so you had already mentioned this, but scheduling and pre reg there got shaded. I'm gonna look at, you know, optimizing that the strong work that you've already created foundation at ABM, but adding some tech there to help insurance discovery. I know is something that we're working on with UCSD FinThrive level in terms of just finding other coverage that's out there and piloting that at one of your sites that's that you recently acquired. And then expanding that out to others and, of course, everyone's favorite prior off. And then denials and automated appeals was something else you wanted to focus on and You had mentioned some of the areas that that were priorities for you, but, the technology here is something that's gonna benefit UCSD and How do you how do you feel this helps when you're looking at investments to understand where you're prioritizing?

Timelines for Implementing Solutions

Yeah. I think couple things. One is, the immediate the the cash impact timeline is important to measure as you go through it. But more importantly, we have some issues where you know, how are the timelines to get these solutions in place, not just the cash timeline, but, for example, an authorization automated prior authorization.

Super critical. Super important. You do not wanna rush that. The plan level, tying and mapping super important. A lot of time, long road there. Remittance manager, maybe some claim statusing.

Not that those aren't important, but that road map is a lot shorter, everyone. So that's one that you kinda wanna get all the plates spinning at the same time, if you will, but understand what resources are needed here and which ones can I schedule so that I'm continually having these cash influxes or at least the projects that are supposed to lead to those in sequential order so that you're continually having success and you're not overextending your resources and your team, whether that's operational or it's your IT EMR partners?

Awesome.

Budgeting and Revenue Targets

Yeah, this gets at that timetable. I think I like this view as well. Nothing would make my CFO or my finance team happier than having this, you know, from me in granular detail, you know, on a month to month basis. Right?

You just don't have the time to do it. But from a technology standpoint, it's nice because you can budget off of this. You could set revenue targets or goals. And I know UCSD is a very metric based organization based off what you showed Mike, but I love this because it allows you to see, okay, these are mission critical things.

These are high value things. These are the years we're gonna work on them and you could, one, hold us accountable. A partner and you hold yourselves accountable to to delivering on the technology to move those KPIs as you talked about.

Long-term Timeline and Progress

This has about a twelve to eighteen to thirty six month time table. And, how are things going here? You've started some of these. Right?

Yeah. We have. Well, things are going pretty well. I think the AVN Medical necessity one has been a little bit of an immediate, keeping cash in our pockets, if you will.

We're definitely doing some claim status and charge capture reviews. Lot of opportunity there. However, that one takes a lot more manicuring or curating, if you will, especially at an academic institution, but A lot of the, what I'll call, lower hanging fruit, the claim statusing, some of the scrubbing of the accounts for additional coverage, are we looking we have a lot of data to your point. Are we slicing that looking that in the right way and putting it through the right partner's engines to see what opportunities there So so far, those all of this is going really well.

To be honest with you, Jonathan, I just wish I had more hands on deck to help provide me with the slicing. But that goes back to the budgeting thing, and I don't know if we wanna talk more about that.

Yeah. Don't we all? Yeah. So this is your slide, Mike. I'll turn it over to you, but, these are general impressions that you have from the model. So I'll let you walk through these bullets, and then we'll sum it up here.

Impressions from the Model

Yeah. I think it's important to to point out. I'm not sure if you're gonna talk about this in a second, but it really was an unbiased, un there was no input in terms of you know, swaying the conversation one way or another, really was just an intake, and it was easy to understand, easy to walk through was not a huge time suck at all. And the questions that, were a part of this and the steps made it easy to understand.

And we you almost as you're answering them, know that, wow, this is asking very direct questions that you might get some version of them and other assessments or conversations with consultants, but it's not really getting at what your problem is. As a provider, we know what our problems are. We need help in how do we attack it. So the questions that came through the tool immediately got my attention.

So I was excited from day one. I think I talked a little bit about being surprised a little bit with the results I came through after the team were engaged and involved.

Team Collaboration and Impact

I think what it did, as I mentioned, kinda, level set us, but what kinda happened after we got going and putting all the data in from all the team and doing that second review was there was a moment where I went to go talk and somebody spoke over me, and then I was gonna respond to that and somebody spoke over me again. And instead of being an ego, which I'm not, instead of, like, my ego get to me, I just sat back and I took a deep breath and I watched the leadership team come together. I watch them to have subgroups and let's do this and I can do that. And what about that?

Let's grab coffee on this. And as a leader, especially in reps, like, especially in the day we're in, it was one of the sexiest things I've ever seen because my team was taking this tool using as a platform, not only for metrics and strategy resetting as I talked about, but it started bringing them together of how they're gonna tackle things and how they're gonna measure their success of as they move forward with whatever those solutions and those next step were. So This tool was not something that just enabled me to have a better landscape of what's happening and how to move the pawns of the chessboard forward so we can get to a success.

But I didn't have to do that. My teams are doing a lot of that. And I think at the end of the day, that's really what we want because it yes. My name is on the end of it, but I don't succeed without them, and they're the ones who are accountable for it.

And this tool provided that transparency in that collaboration. So that dialogue, that accountability that came from that, That's something we all want. We all push for, but we rarely ever get consistently, and this tool set that platform. So I was a massive I was very impressed at the beginning.

And I walked away from it, with way more positives and wins than I thought I would. Awesome.

Embracing Disruption

Well, I'll wrap us up here. You know, need to embrace disruption. I think Mike has mentioned that with his team. The volumes, you know, are there in California, but I would argue the country. California's kind of its own unique market, especially the San Diego area.

You know, negative margins are still present. I think we're gonna continue to see continued cost pressures and, supply pressures and and pay our relations. Financial leaders will need to establish a vision. And you see that from for Mike and his team at UCSD, and I think it's great.

New market entrants are competing for patient volumes. Mike mentioned his competition in California, probably one of the most competitive markets in country. New entrants are compare are competing for patient loyalty. You heard the focus that he's gonna have on the front end to try to provide that frictionless experience also make sure things are financially cleared as they go through.

Focus on Patient Experience

Self service tools are seen as a win win. Innovative leaders are looking for those, patient payment, virtual intake and others. Really, it's gonna be a self-service market. I I like to complain a little bit about health care sometimes in that.

It's the only place where There really are long lines, telephones, and fax machines, and things. And you're starting to see places like UCSD and other organizations really understand that that's not okay and that they need to apply technology and have people kinda self serve. Like you can book a plane ticket or hotel reservation or an Uber, you should be able to onboard to your health care that way as well. This model allows you to understand where those blind spots are and understand where you can invest.

Optimization from Technology

It's an optima optimization from technology allows revenue and cost to be, managed in a better way. Adapt of the technology designed to to automate resolution for prior auth. That's an investment that Mike is making, and platform players are enabling this transition through consolidation. Also, allows me to to see your footprint and where you're at.

You're at. As Mike mentioned, this is a vendor agnostic, very simple tool to use. And really go use it. I think that's what Mike and I are saying.

Go get it taken. Go do a certain assessment, re back out to us and see what we're here. And if you guys have questions, you know how to get a hold of Mike and I, our contacts are here, and really wanna thank you today. And Mike, thank you so much for spending time as we come to the top of the hour here and and, appreciate your time today.

Conclusion and Call to Action

Any final thoughts, sir?

No. I just wanna thank you for allowing me to be a part of this journey. At the very early onset. And, if I could ever make a plug for a tool that'll definitely help make our jobs easier in a very complex world. This really is a win win and a no brainer.

There's nothing to be lost, but investing just a few minutes here, help you level set whatever your priorities are and give you more clarity in a world that only gets murkier. So no. Just honor to be a part of this from the beginning, and thanks for the opportunity.

You bet. Thank you.