Market Outlook, Payer Collaboration and RCM Excellence

Jonathan Wiik: [00:00:18]
This is the Health Care Rethink podcast. Hello everyone. I'm Jonathan Wiik and this is the Health Care Rethink Podcast. I am honored to have Brad Tinnermon, VP of Enterprise Revenue Cycle with me here at Banner. We're going to talk about all kinds of stuff. Brad and I know each other. He wrote the foreword and one of my books, I was very honored to do that. He also has used my books and some of his training with his staff. He's been around the block. He spent some time at various organizations, which we'll talk about, but he is one of my good friends. I he actually has some good singing voice as well, which we might talk in a minute that we're really going to just wrap about what's going on at Banner. What is Brad seeing in the market in terms of where we're at? Hospitals have got a lot of headwinds going into next year, I think. And we're going to talk about tech and where we're at. And Brad, welcome.

Brad Tinnermon: [00:01:13]
Thanks, Jonathan. Yeah, it's great to be here.

Jonathan Wiik: [00:01:15]
Cool. We'll go into like just some personal stuff Now, you don't have to go too deep, but, you know, where do you go to school and where you live in now? And what's up with you?

Brad Tinnermon: [00:01:24]
Yeah, I grew up in the Atlanta area and suburbs of Atlanta, Georgia. I went to college at University of Tennessee, so I grew up a Southern boy. I got into consulting earlier in my career and travel quite a bit, mostly up in the Northeast. I spent time in Boston, New York, Philly, D.C. area. So we got to know the northeast part of the United States and early consulting areas. And yeah, that was my early, early part of my life.

Jonathan Wiik: [00:01:52]
Nice. How about career stuff? Like where did you get your start in health care? What brought you to this wonderful interest industry that stresses us out? And I'm kind of walk through career path a little bit for me.

Brad Tinnermon: [00:02:03]
Yeah, I love to. So I had family and health care, had an uncle specifically that was in hospital administration that kind of help guide my career. You don't necessarily listen to your parents, but you listen to your someone else. So I was listening to him. He seemed to have a good life and doing well for himself. And I like the connection to the health care and the community. So he helped kind of guide me through college in the early, early career in health care. So when I was getting out of college, we talked about, do you go work for a health system or does it make more sense to go into consulting something along those lines? So ultimately decided consulting you'd see more faster? I thought we got into that. So I worked for some smaller firms like Stock AMP, and I work for some larger firms like Ernst and Young Help. And then we I took a little sidebar into health care technology. I work for eclipses, which is now all scripts worked on technology platforms and revenue cycle. So that was a good foray into understanding how technology works, how it's built, databases, integration points, all, all of that. So that was a great part of my career. But outsourcing became a thing. And after I'd been in health care for about 12, 13 years, so the creatives started to come to the market. Tenet had brought Conifer to the market and then Optum brought on to the market using relationship with dignity.

Brad Tinnermon: [00:03:32]
So I had people that I'd worked with at Ernst and Young and in Stock AMP that started some of the original founders of a creative. So I did join the creative after I left the technology realm and got my first foray into outsourcing quite a bit in that area to gone different leadership roles and looking to build that company up a bit. I certainly wasn't a founder, but I think I did leave my mark on that. That organization learned a lot about measurement models and contracts and what makes a good relationship. And of course the creative had a few early missteps. Some you know w recognition measuring model and you know, stuff like compliance. So I moved on to Optum. So Optum was acquiring different services and technologies at that point in time and looking to stitch it together and do it end to end revenue cycle solution. So they recruited me to help kind of create that end to end revenue cycle solution. I spent a few years kind of building that outsourcing solution out and ultimately Dignity took notice and it was interested in an equity stake. And that kind of took Optum from dabbling in that space to being a player in that space and renamed it, spun it out as Optum 360. So having said that, I'd done a lot of consulting work in technology outsourcing. So I had total health systems, had to do their job for a long time.

Jonathan Wiik: [00:04:54]
It's easier.

Brad Tinnermon: [00:04:57]
Well, so the reason I got into health care is I. I did want to be part of the health system, be part of a community, and serve those communities that I lived in. So I had a relationship with a senior vice president at Banner through the Dignity Project with Optum 360. He recruited me over to Banner, and it just seemed like the perfect timing, the perfect fit for me to work for a health system, bring what I've learned, the technology, information, outsourcing, tactics, the consulting, you know, the discipline that I have and brought it to banner. And so I've been a banner just over five years now. Then I've been a great run so far.

Jonathan Wiik: [00:05:37]
Nice five years. Boy, that went by. It's funny. Our careers are like, exactly opposite. Like I started as like a hospital transporter to get into it and then, like, made, like, no money and then slowly worked my way up to a role. You have now and then worked for it. You did the opposite, I would argue. You probably made a lot of money doing consulting that you came across at that level from all that experience. That's just a really nice bent straight. No wonder we get along. We kind of complement each other with with our career paths. It's like we're two puzzle pieces. That's great. You know what types of books you're reading and what's up there? Like, like what kind of authors would you recommend to our audience? So on things that have helped you either personally or professionally?

Brad Tinnermon: [00:06:21]
Yeah, a great question. You know, I you know, I'm still an old newspaper guy. I get the Wall Street Journal every morning or journal. I mean, I like to flip through that. So I get my business news from there. I definitely read Becker's magazine. I read your books are not to plug it, but really some some strong books that I have used with my leadership team. You know, most recently I got into or went back to an old book that was recommended by a couple of colleagues called Atlas Shrugged. It was not published, published in the 1950s. And it's an interesting story about the the struggle between capitalism, socialism, feminism, women in the workplace. Yeah, yeah, industry in general. So it's a really, really cool book that I had overlooked. I knew I think it was popular in the eighties and nineties, even though it's written in the fifties, but still very valid today. And the challenge is that they talk through. So that's what I'm reading right now.

Jonathan Wiik: [00:07:16]
That's cool. That's cool. Yes. Some advice may have you try to read more of that, less of the journal. You might be a happier guy. No, that's absolutely. That's very true. Yeah. Cool. That's awesome. You know, what do you do for fun? What's what's some of your hobbies? And, you know, how do you keep yourself happy outside of work?

Brad Tinnermon: [00:07:32]
And I'm. Yeah, I don't sit down very often. So I've got a lot of little, little hobbies. I like to exercise, run. I've played soccer, you know, organized since COVID. But I grew up playing soccer and still like to play in men's leagues, old cars. I have several old cars that I tinker with, like working around the house like carpentry. So, you know, I got three boys. So they definitely keep me, keep me busy. But yeah, not a lot of time to sit down, relax.

Jonathan Wiik: [00:08:00]
Absolutely. I'm into soccer, too. I'll have to make a bet on the World Cup. My my son's a big Messi fan. He's got the jersey and he's rooting for Argentina. We'll see where they end up. And.

Brad Tinnermon: [00:08:10]
Yeah.

Jonathan Wiik: [00:08:11]
And I played soccer as well. I don't know if you knew that I played in high school and collegiately a little bit also so yeah yeah we're off one of these times. And what did you play, Were you a forward or did you play defense or do you kind of all over?

Brad Tinnermon: [00:08:26]
I was well, the game evolved over the years, but I started out as like a striker and right winger. And then as the game evolved, the midfielder was more important. So I played center mid and right mid sweet.

Jonathan Wiik: [00:08:37]
We always faced each other on the field. I was primarily defense, so and I was a wall dude. There was no way you were going to get by.

Brad Tinnermon: [00:08:43]
You remind me of some people I've had to deal with before.

Jonathan Wiik: [00:08:47]
Okay, that's awesome. That's great. Well, let's let's, let's transition a little bit into kind of what banners up to. Tell us a little bit about Banner help educate the listeners on on what's going on there and what banners health kind of strategy and philosophy is and how your revenue management enhancing or averting that.

Brad Tinnermon: [00:09:05]
Well big question. So banner is I think we're around we're probably pushing 13 billion and some of that is in provider some of that is in payer I think probably two and a half billion in payer or the balance in provider. 32 hospitals across six states, integrated delivery, everything from urgent care, home health, hospice, the hospitals are a very diverse as well. We have three academic hospitals. We have some large community hospitals, some big boys, and then we have safety net Critical access hospital. So we're a pretty good cross section of US health care, frankly, across many states. And in dealing with the regulatory requirements of different states and just seeing patients and all the different dimensions that you can. So pretty diverse health system, I think like a lot of health systems are trying to balance payer and provider because you kind of need that that ying and yang when the provider business is killing it, the payers take it, you know, in the bottom. Iron and vice vice versa. So I think they're trying to balance out, you know, building the portfolio on the payer side a little bit more, which on the revenue cycle side, we need to be aware of that so we can work on paper rider collaboration opportunities within our own organization. So that's that's a bit about there.

Jonathan Wiik: [00:10:14]
Cool. Yeah, let's explore that a minute. I think you and Jamie Davis, who I also know really well and presented with her at Banner, a brilliant lady was on the cover of HFM a couple months ago. I still need to get that signed. I'm going to try to drag that with me next time I go to an event and teaser. But yeah, you're one of the few that actually has shown some love for payers that I That's fun. Yeah, that's true. And I think that would be interesting to kind of walk through our listeners on that. Like, like why do you think payer provider collaboration is important and what is the work you and Jamie are doing in that area? Why do you think that's the future instead of what you mostly see is kind of this disdain and I can't trust you as far as I can throw you, and I'm not giving you any information payer. You can pull it from my cold. That hand is what I hear from a lot of executives right now. But I love this collaboration talk.

Brad Tinnermon: [00:11:00]
Let's get into that. Yes, there's a lot to unpack here, but I've worked in my consulting years. I worked on the payer side. So I've done claims audits and process audits. So I have a sense of how payers run and like the mirror image of of the revenue cycle side of the house. I mean, transactionally it's difficult on both sides of the House, contractually, it's difficult on both sides of the House. I think when we if you start talking in what is the data really saying, I think you can you can bridge a lot of gaps between the payers and providers. I don't think our payers are necessarily doing anything that is inappropriate, but I think it can come across that way if you're not understanding the relationship correctly. So for instance, an interesting thing now that we had, we had price transparency on the payer side or on the provider side a couple of years ago and now this year we're coming out with rate transparency totally. We can see the correlation between our rates and the initial denials or the fights that we had with payers. The payers that we have negotiated the highest rates on are the ones that, you know, the ones that are high in the market are the ones that we get the most pushback on, which kind of makes sense. Only tell us both sides of that story before. But no, I don't I don't think they're doing anything evil. I think when I get down to it, I understand where they push back and why they push back at times. But then again, the payer market is complicated because each region could be a little a little bit different. So we are in we are a payer. We we are in the Medicare Medicaid space. We're also in the commercial space, not as big as some other major health systems out there. I think they're really pushing hard on that. We're not like a Kaiser or it's, you know, well balanced.

Jonathan Wiik: [00:12:45]
In that idea. Yeah, but we're.

Brad Tinnermon: [00:12:47]
We're bigger some we have more than some others. But I think you need to have that payer side as we talked about before for the ying and the yang side. But so much is moving to Medicare Advantage. If you're not in that space, you're going to lose those for those populations. So we are have a tight relationship with Aetna, and I've tried to have tighter relationship with Blue Cross, Blue Shield, Cigna and UnitedHealth Group as well. But Aetna has been the one that's played the nicest so far. So we have formal initiatives or what we call frictionless billing, but we have kind of phase one and phase two of what we're doing with Aetna. First thing is just make it more pleasing for the for the patient. So we've done a lot in that space. Combining an EOB with a statement is one simple thing that we did, because you could get you could get those two documents and they don't match. You don't understand what an EOB is. So we've compressed those into a single, single statement. We have a customer service unit that's designed just for for Aetna people so they don't get mixed up with with other areas. A few innovative things we've done. We have an app that's called a patient concierge app. So when you get your your bill, you can fire up this app and it brings an avatar out that walks you through your bill.

Brad Tinnermon: [00:13:58]
Literally, it's standing on top of your bill and you can touch different parts of the bill and the avatar. We'll talk to you about the bill. We created explainer videos for some of the more complicated parts of revenue cycle and health care that give you a little 60 minute animated shorts that kind of take a complicated topic and help you understand what's a copay, what's a code? Let's go insurance. Why might your estimate not match the final bill stuff, Stuff like that. And the last I would call kind of innovative thing we've done is we got some inspiration from like Domino's Pizza and Amazon. I'm like, Where's my pizza or where's my package? Well, in health care space, kind of you you send the bill or you go you go have a visit or you have a clinical encounter, and then where's the bill? Or am I going to get billed and is it going to come up, show up in three weeks or a month or six months? And so there's kind of that black box. I don't know what's happening right now. So we we're taking those key triggering milestone events and putting them into and outward facing basically statement tracker. So a patient can can tell once they've they've been to the.

Brad Tinnermon: [00:14:59]
A doctor had their visit. What's going on with the adjudication of their claim and why hasn't it shown up? Did it go to zero? I'm not going to see one or we're still working it out and expect it in the future. So we felt like that was kind of a transparency area. So that's kind of our phase one approach that we've gotten through so far. And so far we we've gotten Promoter Score. Our first reaction to this has come out and we are definitely several standard deviations above our baseline already within within just six months. So that's been a positive so far. That's great. Phase two is getting much more integrated with a payer. You know, when when you're running your own plans or even a medicare Advantage plan, you're managing lives. So population health becomes a bigger component of the of the collaboration. And being able to share data makes that work better. So if you can think of an example on the front end, when you're registering a patient and making sure you have that eligibility correct, if you can peek into the payer system and just double check, you can also see the deductibles co pays. You can make sure you understand the medical necessity components. So having an API or at least a portal where you can see that data, you don't have to buy it from a third party.

Brad Tinnermon: [00:16:12]
If you get an off, you can put the number of both of them so they tie and lock. You can get props when you're doing scheduling on population health items like getting vaccinations, colonoscopies, mammography, things like that that you can bring into that scheduling conversation. It's like, well, you're going to be here for that. Why don't you get these two things while you're there? Linking that together with a payer can create a lot of power. But also on the back end, you think about we have a billing editor, they have an adjudication editor, we have a contract management system. So they can we use the same, where can we sign off on the same billing error and say, if it clears these edits, we're good, all right. And and once it runs through these contract terms, we've both signed off. They're accurate. This thing is done. Can you literally stop the billing and denial component and come down to a single adjudication group and cut the costs out and all those all those places as well? That's our phase two approach. So we're we're pushing that through kind of funding phases with our senior leadership team, both on the Aetna side and the banner side, hoping to push that project forward. And you want to turn 23.

Jonathan Wiik: [00:17:14]
That's exciting stuff, right? I mean, I don't think there's anybody that I'm aware of that's innovating, at least at that level and that kind of as a strategic plan. You know, it's there. You hear this in pockets, I think Epic, you know, has a portal. I know you guys are participating in that as well, a payer kind of platform to where data is being shared. I get the opposite end of the spectrum of like, I don't think our payers have any business looking at our records unless it involves payment and those types of things. But you know, as you're talking to other colleagues or peers in the market, what do you or what advice do you have for them in terms of getting to this place to get them out of this sea of hate to a see a collaboration? Wow. But what is that first step to kind of move towards this payer provider collaboration? I think people would appreciate that.

Brad Tinnermon: [00:18:01]
You know, most people I talked to about this concept are like, yeah, that makes sense. It's good for the patient, it's good for the payer, it's good for the provider. You can cut costs out, you can provide a better product, more entitlements, less money, all of that. So everybody I talked to feels like this makes sense, but that collaboration with the payer is really hard to get done. So I feel like we just need to prove the concept and stop talking about it. And that's what I'm not trying to do because it's enough about the skepticism. Let's just do it. And if I'm right, I'm right. If I'm wrong, I'm wrong. We're about to find out.

Jonathan Wiik: [00:18:35]
I think you're going to be right. You know, I'm not a gambler, but if you were on the wheel, I'd put my my chips in your number. Man, I think that you're a smart guy. You got a smart team, and there's a lot of dollars here. You guys are making a big bet on it, too, right? And and you don't you don't have to spend discretionary income to kind of mess around with risky things. The expense side of this must make a lot of sense on both sides to be able to get to a common goal. And I do think it's the future. I think, you know, there's been a lot of siloed workflows and things, and I'm I'm hopeful for you. I hope Boehner is the tip of the spear and Aetna, for that matter. And it could get those United's and Cigna's and Humana and stuff and gear to to kind of get moving. That's great. Congrats and keep us posted. We might have another series later or another podcast that get an update from you as we go forward. Well, you bet. Let's talk about, you know, hospital profitability. You don't have to get into specifics with Banner.

Jonathan Wiik: [00:19:31]
I think people can find that stuff out if they wanted to. But I released a financial report. I'm happy for the listeners to kind of get that in December. I shipped it to you, Brad, as well. It looks pretty story into into 2023 for a lot of hospitals. It depends on your community. You and I talked and we were at Becker's a little bit too just about how it depends on kind of how well you were doing before, during and kind of after the pandemic and whether you had stuff squirreled away and had a strategic. Plan to kind of handle that stuff for you, you know, you know, playing it by wire. You know, what advice do you have for hospitals right now and revenue cycles to kind of navigate the storm, to use a cliche, because I think a storm's coming. And and if you don't have your ducks in a row, you're going to see hospitals that have fractured or health systems that have fractured really start to open up those cracks. So what are you suggesting? If you were in a different financial position or maybe manner of looking at those cracks today?

Brad Tinnermon: [00:20:25]
Yeah. So this armchair quarterback time, this is.

Jonathan Wiik: [00:20:27]
Fun probably for them.

Brad Tinnermon: [00:20:30]
So yeah, so we went through two years of a pandemic and a lot of disruption. You know, people work from home. You know, the the traveling nurse situation was, was a big one and we did a lot of deviations from our normal business to try to accommodate the situation that that we were we were dealing with. You know, one bit of advice I would give and and this was probably getting a little outside of my revenue cycle area. But one thing that that I'm seeing is there's an opportunity to capitalize and there's an opportunity to save money. And those don't necessarily go together. So what I mean by that is, you know, you're looking at your costs to deliver care, particularly in that that traveling nurse situation where a lot of people are like, enough's enough. We're cutting that out. We're not. We're going to reduce our inflow of patients or just, you know, move to the medical side, put surgical on on pause for a little bit, shut down some of the outpatient stuff. We'll survive this until the costs come back under control. Right. The problem with that strategy is physicians are the key to everything we do. And they're also that mass of referral patterns that they have, particularly in the surgical area. If you start to limit their ability to deliver care, particularly in the surgery area, they're going to find another path of least resistance.

Brad Tinnermon: [00:21:52]
So there are there are clear winners and losers here where people have cut costs. Because of that, labor was too high and they were potentially losing money. And those referral patterns have changed. And there's other people that did not do that and have picked up market share from that. So I think that was a real interesting, important lesson for different health systems where market share literally shifted during a very turbulent time. And those relationships and those those referral patterns take years to develop and they can change very, very rapidly. So I would certainly caution around cutting too hard during a period of instability because those doctors have to make money to you and they're going to find a place to to make it, whether you're helping them or not. So that's just something I saw that kind of came out of the pandemic. If you're not playing the work from home game and playing it well, finding a way to create a great culture and and keep that tie with with your your team, I don't think going back to the office the way it was before is going to happen in the next two or three years. They might slowly work back to that over time. Who's who's to say. But I think there's a lot of people that that that's a new expectation and you need to figure out how to do that really well.

Jonathan Wiik: [00:23:07]
I think those are great insights. I think, you know, I think I shipped you a volume report to you saw that trough when the surgeon general turned the the faucet off in March of 2020. And there were hospitals like yourself and systems out there that are like, well, hey, we can do patients like we are having a surge right now. I think the government and the industry kind of learned that. And to your point, that disrupted a lot of referral patterns where there's a lot of hospitals that try to figure that out. And then with this labor crisis that's happening, which I want to talk about here in a minute, too, and how Boehner is handling that, it it it's causing this kind of shell game. Do I, you know, ramp stuff down? And what I'm hearing you say is be careful with that, because if you're not continually engaged in that, you know, your physicians and your referral patterns are going to migrate to another system or independent, and then you may never get that volume back if you siphon it off. Now, that's huge. And I think CFOs are really struggling with that. Do I bet on keeping my volumes up and those patients coming, or do I come down because I can't afford the premium labor or where we're at? And I'm starting to see that kind of stabilize. And I bet Banner has as well. Labor kind of was this nasty, nasty mess this year and it seems to come to calmed down. And I really appreciate that point about being careful with where you're at. Let's talk about labor for a minute. Like I love the strategy of playing the work from home game, but what other things specifically like Revenue management, is banner done to kind of stop the bleeding there? Or how do you even add any bleeding? Have you have you experienced labor shortages on the revenue management side?

Brad Tinnermon: [00:24:42]
You know, I think we've weathered it better than most for several reasons. One is we took work from home very seriously. Yeah. And not not only for the pandemic, for the for the future state and really thinking ahead, how do we keep these people engaged? We do have. Activity quality, but it's way more than that. You don't it's not just about making sure that they're quality and productivity. They need to feel part of a health system and it gets harder and harder to do when you're not co-mingling with staff. So investments and travel investments and being part of organizations like like FMA going to Becker's, things like that, really encouraging them to get out and work with their peers, get certifications to tie them together and tie them to us. So that's one we do utilize from my outsourcing days. There's core competencies and there's things that you should probably look for vendors to do. Things like low ballots is definitely a strategy. Onshore, offshore. So we look at where our cost of collect is and how what level can we do in house paying. And then if a vendor can do it for lower cost, that's where we're going to go. So we have kind of a line of demarcation where we'll send things to a to a vendor and then we'll allow things offshore.

Brad Tinnermon: [00:25:57]
Once they've gone through the compliance and attestation process, we send things off offshore to overall keep our cost to collect where it needs to be. And the third thing is everyone's investing in the space is automation and bots. Totally. Jamie Davis on my team is leads up that team as well as many other things we've gotten good at doing an internally. We looked for vendor partners and help in that space and struggled finding the right partner to do that. So we've ultimately done a lot of it in house. I'll call it a a strategy, but a risky one because I think we've moved a lot to bots and we've had some very successful bots. But once you get reliant on those, if you're out carrying, feeding for them and monitoring them, if they break, you're in a really bad spot. So we've we've, we've moved into a very, very carefully to make sure that the bots that we turn on are solid or they have a monitoring, they have a backup plan on all those. So they have saved this money and they have created efficiency, but they're still a nervous liability for me as we move into that space because we're not professionals in that space. We're a health system trying to create it.

Jonathan Wiik: [00:27:02]
So we yeah, yeah, robotics and automation. I do get that answer quite a bit when I ask that question. And I think your point about treating them like a houseplant is probably a good one. Not to minimize what you're saying, but you got to water them and care for them and put them in the sun and take a look at them and talk to them and make sure they don't wither and die because a lot of your processes will will go there. And having a good partner with those types of things I think is very, very important. As you look at RPA, Fin thrives trying to enhance a lot of its solutions and adding automation where we can because we just realized that, you know, even if we're finding things or solutions or where we're at, there's still this human element of resubmitting a claim or rechecking eligibility or loading the new coverage. And every piece of that involves a human touch in revenue management. No matter what you're doing. If you can't automate it, that's great. And I kind of call it the two headed or two double edged sword or double edged wand, if you will. One, it gets people back, like you talked about at the beginning, gets people back to why they got into this business.

Jonathan Wiik: [00:28:03]
They didn't want to get on the law into health care, to do kind of repetitive tasks and be on the horn with a bear for 20 minutes about an authorization or rechecking eligibility, those types of things. So it helps them have like a better day at work. It's not like this sucky place to go to work with their well thought about what, about automates that and have a robot do that and then let them talk to patients and help them navigate their bills and those types of things. So it's kind of a double edged thing in that it helps productivity by automate things and also keeps your staff kind of happier, maybe lying out a little bit longer and really enjoy the work they're doing. So I applaud you and Banner and Jamie's efforts and if you haven't read that article in HFM, I'll plug it for Jamie. It's it's fascinating to talk about how they built that farm and really put a lot of governance around it to keep it successful, to make sure that the the plants are growing in the window like they should be.

Brad Tinnermon: [00:28:55]
Oh yeah.

Jonathan Wiik: [00:28:56]
Cool. It ran a course on time here. A couple of other questions for you. Just let's talk about patients for a minute. And consumers I know has done a lot of work there, too. You mentioned the word frictionless, which is one of my favorites when it comes to that. Some of the things you've done with statements and chat bots and avatars, let's walk through that. I think health care is not getting any cheaper, bills aren't getting any simpler. What does Ban are doing to kind of meet the patient is payer to coin my term? And what are some innovations there that you could share with our audience.

Brad Tinnermon: [00:29:25]
If we did something a little bit different in this space? You kind of define the patient financial experience. So any part of the revenue cycle that has that direct patient interaction. So we created a patient balance management operating unit within Banner and their responsibility is front to back from converting a self patient to a paying source, the self pay pricing, the financial assistance policies, the payment plans, the package plans, credit all those things on the front end, on the back end you pick up with. Customer service. How do you make that as as quick and easy as possible? That transition from in-house pre collect to bad debt can be an ugly transition. So we've done some innovative things to tie pre collect and bad debt together. So in a patient calls you can see the entire continuum of their bill. You know just to dive into that a bit. A big dissatisfied buyer is we combine bills because people ask to have their bills combined when everything everything's abandoned like a credit card statement. But if you go urgent care or emergency inpatient, physical therapy and down the line, those those dates are moving at different dunning cycles. So you can get a date, you can get a statement that shows all of them on there for one month and then a couple could fall off on the balance, comes down like, Hey, I didn't do anything and it's less.

Brad Tinnermon: [00:30:46]
But the reality is this moved on to bad debt and then they're angry, right? So the way we've constructed it is where you can have a a current and then delinquent in a single number and a single link where you can go deal with those. Those agents identify themselves as debt collectors, whether it's pre collect or bad debt, so they can look on both sides of the fence, potentially pull things from bad debt back into a pre collect. You know we do offer credit in house it's shorter term no interest and we have a credit vendor that we use for longer term no interest obviously we take a little bit of a haircut to to offer that the patients but we are trying to think about their entire experience front to back so that crew is is trying to minimize our self pay exposure you know extract our entitled reimbursement the lowest cost with the highest net promoter scores that we can get. And they're doing a really good job, I think, creating a focus that's horizontal there as opposed to you kind of dabble with it here, dabble with it here, dabble with it there, and different operating units doesn't work well that way. But if you tie it all together, it's better for the patient and it's much better for our performance.

Jonathan Wiik: [00:31:51]
I agree. I think your pizza tracker thing's brilliant. I'm a Domino's guy. I'll give them a plug. I mean, well, my wife's out of town. First thing we do at the boys, and I have to order pizza because it's like contraband in our house. Otherwise, what? We'll get out there. And I love the little tracker because I'll go do some sort of chore or something as I'm waiting for that. I think the same goes with the claims, right? And matching the obese to statements is huge and it's hard to navigate that. And you know, I've had health care issue. I even work at the hospital. It's confusing to me sometimes and I consider myself an expert. I'm like, and I'll look at my wife's name and things. I'm like, No, you don't have to pay attention to that. She's like, Why not? I'm like, You're going to get another three of them in the mail. That's that was Stubbs frustrating and confusing. So I think it's great that you've looked at that holistically. And I know a lot of hospitals are health systems as well, kind of looking at what is it that we can make simpler, frictionless to where people get it like any other industry, you know, paying for stuff on Amazon or boarding a plane or ordering a pizza, you know, it should be interactive like that.

Jonathan Wiik: [00:32:51]
It shouldn't be the siloed. I got a call five different people. I should be getting stuff in the mail, hopefully that type of thing, to where it's better. I'm going to close this out here, I think really quick. You know, I'm going to have one easy question and then one fun question for you. But the easy one is, is is the time machine you did the armchair quarterback, let's do time machine. If it could go back five years at Banner, since you've been there five you know you that's a good ten year to an organization for a role like yourself So congratulations Matt Have them keep you around, which is great. You know what? What would you have done differently? What were some things you learned in that journey that that if you could go back, what would you change?

Brad Tinnermon: [00:33:30]
Yeah. So I joined Banner to do a modernization and a transformation. So we had, you know, probably at this point over 40 projects or what I call part of our playbook. There's different plays that we run and you know, a lot of them do really well. And then there's a couple of flops, you know, a couple that just don't don't go well. So I've used a similar playbook and outsourcing and now using it for banner. So so I'm getting better information every time I run those plays and what works and what doesn't work. And is the environment changing? That play should just be tossed out of the playbook. So so I learned early on on what works and what doesn't work. There's always gotchas like we are pursuing computer assisted coding on the ambulatory side, and we didn't realize the configuration problems that we had when our host systems were going to be such a problem there. We blew through the acute care. We did computer assisted in the CDI program and it went through without a hitch and created great results so far, but still just chugging away at the at the acute care side. So I think I'm always refining what I will do and how I will do it based on those past experiences and those past plays I did. You can't predict things like COVID, some of the regulatory things that came out. I never thought rate transparency and know I was going to kind of eat a pass. Yeah, you know, surprise billing, good things, smart things, really hard to execute on. So it's so hard to look more than a couple of years forward and. This industry because it changes pretty rapidly. Still bullish on payer provider collaboration. The stuff I talked about earlier today. Been trying that for six or seven years. So I'm hoping this will be the year that we push it over the finish line on it.

Jonathan Wiik: [00:35:11]
That's awesome. All right. The fun question with the Christmas tree in the back and this will probably air after that. But I always love asking dads this question because Christmas is this odd time for us, right? Your dad. So what do you want for Christmas and what do you think you're actually going to get for cuts?

Brad Tinnermon: [00:35:27]
Oh, man, that's a good question. What do I want for Christmas? I don't know. I don't I mean, there's not a lot I need.

Jonathan Wiik: [00:35:35]
For a material thing either. It might be.

Brad Tinnermon: [00:35:38]
Maybe a quiet afternoon. Yep. Yeah, that's probably what I'd like. Just some some time to. Time to make it still awesome. Yeah. My kids are a little older now, so it's not not quite as chaotic. And they don't want to. They don't want to see me as much anymore. So.

Jonathan Wiik: [00:35:52]
Yeah. What do you think is coming under the tree for you have any idea or any any hints or thoughts or.

Brad Tinnermon: [00:35:57]
I really don't. Oh, that's probably the agitated boxes under there. I never checked to see if my name's on any of them. Yeah.

Jonathan Wiik: [00:36:04]
Yeah, yeah. I don't. I don't know. It's. It's a crapshoot for me every year. I'm an outdoors guy, so I can't probably 30, 40 days out of the year I wrapped quite a bit. So there's usually some element of camping things underneath there, which my family's got me wired pretty good. But otherwise it's, it's interesting. Brad, this was awesome. I hope you enjoyed it as well. I think, you know, we talked about pair collaboration and we talked about Banner's approach to the market, what you guys are doing and navigating kind of the financial storm. We talked about how to meet the patient as payer and provide a frictionless environment. How do you keep your staff, how to leverage technology like robotic process automation and lessons learned to? I think it was great again of Jonathan Wick. This is Brad Kinnaman, this is the Rethink Health Care Podcast. I really thank all of you for listening in today and have a great, great rest your afternoon. And here's to 2023 and I hope that you can learn some things from this like banner and have a great financially prosperous year. And Brad, thank you so much, sir.

Brad Tinnermon: [00:37:04]
Thank you, Jonathan. This was fun.

Jonathan Wiik: [00:37:06]
All right. Thank you so much.