Healthcare Rethink - Episode 113
Healthcare Revenue Management: Breakthrough Conversation with FinThrive and CeraCore
Discover real insights from industry leaders Jonathan Wiik, Vice President of Health Insights at FinThrive, and Phil Sobel, Chief Commercial Officer at CeraCore. In this engaging dialogue, they explore the Revenue Cycle Management Technology Adoption Model (RCM-TAM) that is transforming how healthcare providers manage their financial operations.
Episode Transcript
Jonathan Wiik:
Hi, I am Jonathan Wiik. I'm the Vice President of Health Insights at FinThrive. I'm joined today by the illustrious Phil Sobol from CereCore, we're partnered together on the RCMTAM or the Revenue Cycle Management Technology Adoption Model. We're going to chat about what CereCore is up to, what you've been up to, and just what's going on at HIMSS in the industry. Very casual, but Phil, welcome sir.
Phil Sobol:
Thank you. Pleasure to be here.
Jonathan Wiik:
Yeah, cool. Let's talk first about you, your role, and you're chief commercial officer there at CereCore, who CereCore is what you guys are up to. Let's do that.
Phil Sobol:
Absolutely. So as you mentioned, chief Commercial officer with CereCore, so I get the privilege of working with all of our operational leaders to make sure that the services that we bring from an IT perspective to hospitals and health systems actually add value. And so that's what we're all about.
Jonathan Wiik:
That's cool. I love it. Short and sweet, actually add value. Is it actually adding value? How is it adding value?
Phil Sobol:
Absolutely. So there's so much technical need inside of hospitals and health systems. Really, we partner and come alongside our clients, really as almost as an extension of their team. So whether it's project-based work, whether it's managed service-based work, to really help them fulfill their ultimate mission, which is patient care for their communities.
Jonathan Wiik:
That's awesome. So the Revenue Cycle Technology Adoption Model was something that we put together with HFMA, kind of like HIMSS' big brother I guess I'd call it, and we're using that with your customers and your interactions with your team in the revenue cycle arm to help them understand their tech stack, their maturity level and their impacts. Walk us through that.
Phil Sobol:
Yes, so honestly, when you all rolled out the RCMTAM model, it was one of those aha moments for the industry, because it was one of those areas, there was a gap that wasn't being served. And so you had the HIMSS models and the stages and everyone knew from a clinical standpoint where they were. They didn't have that on the revenue cycle side of things, and there was a big disparity. And so a lot of the work that we do is coming in and doing assessments for organizations, whether it be their tech stack, whether it be how they're using their applications, whether it be application rationalization, and this falls into that category because people need to understand where they are, where their blind spots are, and then where those areas of opportunity are for an organization. And RCMTAM fits that bill and that mode for revenue cycle.
Jonathan Wiik:
That's great to hear. It was like having a child for lack of a better way of putting it.
Phil Sobol:
Exactly.
Jonathan Wiik:
There wasn't a model that was out there, there wasn't anything that we were doing as an industry. We're at HIMSS, they came up with what I like to refer to as meaningless use. They had this EMRAM model, they called it the EMR Adoption Model that had Stage 5, 7, or 6 and 7. I was in the keynote today and heard from a hospital in Seoul, Korea that's stage seven. The physicians are just walking around and delivering care and the system's listening and ordering autonomously. Now, RCMTAM's not quite there yet, but maybe someday it'll autonomously find the cash.
Phil Sobol:
Wouldn't that be great? Wouldn't that be great?
Jonathan Wiik:
What types of things is CereCore finding when you deploy it? Are there certain spots that are hot or other areas within revenue cycle or?
Phil Sobol:
Yeah, I think it really varies on the organization. So I can't really put my finger on any one because our clients range from small rural community hospitals all the way up to organizations that have 50, 60, 70 hospitals plus all of the ambulatory side of things. So it really just depends on the maturity, but everyone needs it. Everyone needs that assessment, whether they're small, big, whether they're less sophisticated, more sophisticated, because sometimes the more sophisticated you get you grew through merger acquisition, you might have three, four, five solutions doing the same thing, and so the revenue cycle and have no idea about it. So being able to squish that down makes a big difference.
Jonathan Wiik:
Yeah, I see that a lot when I'm on site is this consolidation effort. You don't really know your inventory until you start measuring it. It's that old mantra from when we went to business school, you can't manage what you don't measure, so understanding that footprint. I was in a hospital in Florida that had three different eligibility systems and it made sense, which was weird. We took one away, or they did when we looked at it, one was looking at professional eligibility, not employed physicians. The other one was looking at the acute care stuff, and then they had a third one for a backup system because the payer mix wasn't quite right so that they could get complete responses.It's very, very interesting to me.
Phil Sobol:
But until you do the assessment and ask the why, you really don't know. And many times the organization doesn't remember it. And so having that documented, it makes all the difference in the world.
Jonathan Wiik:
It does. We're through about 150, 200 hospitals today. I'm so excited for CereCore to get it into everyone. I think everybody should do an RCMTAM. Super huge. It's quick, it's fast. We'll have a link to this podcast afterwards and we'll show how folks can get it and get it done.
Phil Sobol:
I agree. It just makes a lot of sense. And honestly, every single time we've walked one of our clients through it, there's a return on investment.
Jonathan Wiik:
Yeah, that's awesome.
Phil Sobol:
There's a return on investment and we help them prioritize.
Jonathan Wiik:
You bet.
Phil Sobol:
Because we know them, we know where they are and what those hot points are. And so it may look, hey, this one has a stronger return, however, given the community, given whatever, maybe you need to start here.
Jonathan Wiik:
You bet.
Phil Sobol:
We help them do that.
Jonathan Wiik:
You bet. Now I forget where you hail from. Where do you live? Do you live in Nashville?
Phil Sobol:
I live in Nashville, Tennessee.
Jonathan Wiik:
Very cool. So healthcare, that's like healthcare's granddaddy, for lack of a better way of putting it. A lot of stuff started there. What was your start? Where did you come from and how did that work?
Phil Sobol:
Yeah, so I actually grew up in the ERP space.
Jonathan Wiik:
Very cool.
Phil Sobol:
And then got into healthcare through that, and really been in healthcare full time for about 15 years.
Jonathan Wiik:
Wow, that's awesome.
Phil Sobol:
And so it was one of those things where I had exposure to a lot of other industries and saw that, but at the end of the day, as I looked and decided where do I want to be, kind of the, quote, unquote, "tail end of my career," I wanted to be in an industry that was meaningful and where we could make a true impact and healthcare was it
Jonathan Wiik:
Today in the keynote ... sorry to interrupt you. Today in the keynote, they talked about dedicated people caring for people, which I have not heard that put quite that way before. It was awesome. What are you seeing in Nashville? And we can get into federal discussions a little bit too, which are interesting right now, but what do you see for US healthcare? What's driving you nuts? What are you excited about? What do you think we should look at?
Phil Sobol:
I think there's a number of things, certainly lots of topics. There's a lot of uncertainty right now around regulation. What's going to happen, what's not going to happen. And there's people on all sides of the fences there. Some think, well, hey, maybe some practical approaches are going to come down the pipe. Truth is we don't know. We don't know. So the good thing about healthcare is we've always been resilient and we've always been able to react. And so I think part of that is having the right technology stack in place. So you've got the stack in place, you understand your metrics, you understand your data, you understand your processes, and the more we can optimize, the better we're going to be regardless of whatever change comes down the pipe. And then obviously people are talking about AI an awful lot too. So in the practical nature of that, and revenue cycle is one of those areas where there's big upside.
Jonathan Wiik:
Yeah, absolutely. I'd love to ... let's double click on that. So AI and revenue cycle is super fun right now. I remember when everyone would roll their eyes when they heard those two letters together. It was not that short ... not that long ago, maybe three, four years ago. Now it's like, "Ooh, what do you got? What are you using it for?" What do you see an AI being used for in revenue cycle?
Phil Sobol:
I would almost say where I want it to go.
Jonathan Wiik:
Good. Love it.
Phil Sobol:
Where the utopia would be, and there's one of those critical areas which is dealing with insurance companies. Insurance companies have all the data, they've got all the metrics. For an organization, they really know their stuff, sometimes to the detriment of hospitals and health systems. And so being able to apply AI on this side of the table when it comes to just charges and everything else, contracts, is going to be critical. And I think AI is probably hopefully going to give hospitals and health systems that didn't have that, at least a competitive landscape because it'll give them that visibility that they don't have today on those negotiations.
Jonathan Wiik:
Yeah, I think there's a big application right now on the contract side. I mean, I'm seeing that where frankly, hospitals and health systems just are blind. They've signed this contract, but it's a static document with not a lot of analysis on it. There's not, I think it's a big application to get some language models, some machine learning, understand that. The RCMTAM stages to loop back to that, have those in those four and five stages.
Phil Sobol:
Yes, they do.
Jonathan Wiik:
That's where I'm going to see, I think, your hospitals and the hospitals we serve hold them accountable to what their contract says for payment.
Phil Sobol:
Right. Right. But you can't hold them accountable if you don't have the information, if you don't have the data. And I think that's where plugging those holes makes a huge difference for organizations.
Jonathan Wiik:
Super huge difference. Super huge. Is this your first HIMSS? You've been here before?
Phil Sobol:
I've been to a number of HIMSS over the years.
Jonathan Wiik:
Have you, too many, right?
Phil Sobol:
Yes. Yes, exactly. I've seen it grow, contract, grow. So yes. But the energy at the HIMSS is palpable. And it's fun to talk to the folks that haven't been here before.
Jonathan Wiik:
Yeah. Yeah, they're a little overwhelmed.
Phil Sobol:
They're very overwhelmed.
Jonathan Wiik:
Well, hey Phil, that's all I got.
Phil Sobol:
Excellent. Pleasure.
Jonathan Wiik:
I really appreciate your time and enjoy the rest of the conference.
Phil Sobol:
Well thank you very much.
Jonathan Wiik:
Always a pleasure to see you, sir.
Phil Sobol:
Pleasure is mine. Thank you.
Jonathan Wiik:
Thanks guys. Jonathan Wiik here, VP of Health Insights with Phil Sobol from CereCore at HIMSS live, having fun at the podcast. Thank you so much, and I'll see you at the next one.
