The Revenue Cycle Management Technology Adoption Model (RCMTAM)

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      FinThrive_EXEC_Revenue Management Automation Guide-svg

      Your Guide to an Autonomous Revenue Cycle
      Plot a course toward forward-thinking innovation that improves efficiency, the patient experience and your bottom line.
       

      HIMSS 2024 Nicole Clawson

      Healthcare Rethink - Episode 95

      In this episode of Healthcare Rethink, conducted at HIMSS 2024, host Brian Urban engages with Nicole Clawson, the Vice President of Revenue Cycle and Finance at Pennsylvania Mountains Healthcare Alliance. They delve into pressing issues facing community hospitals and explore innovative solutions in rural healthcare settings.

       



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      Brian Urban:

      Yes, this is the Healthcare Rethink Podcast live unscripted at HIMSS 2024, where we are continuing to have great conversations with innovators, change makers and doers across the ecosystem. We just happen to find our next one here, Vice President of Revenue Cycle Management at Pennsylvania Mountain Healthcare, Alliance, Nicole Clawson, welcome to our live little show.

       

      Nicole Clawson:

      Thank you. This is great.

       

      Brian Urban:

      This is fantastic. You're fresh off the stage from this morning too. So right off the top, how has your HIMSS experience been so far?

       

      Nicole Clawson:

      Great. There was a great crowd this morning, even though it was at 8:30 in the morning. So the crowd was good. Asked a lot of good questions. We talked about adoption models and end-to-end products, and really got into all kinds of fun and innovative discussion this morning.

       

      Brian Urban:

      That's good to know. I think everyone's seeing HIMS this year as a confirming message to what their work is standing for and what it's meaning for individuals that it's eventually touching at the end of the day. So Nicole, you're a risk-taker, not just an innovator. The work that you do supports 16 community-based hospitals across Pennsylvania and one in New York state as well. And when I hear community-based hospitals today, I immediately think about the challenges economically that are facing them and the closures that have happened.

       

      Nicole Clawson:

      Absolutely.

       

      Brian Urban:

      Maybe since just after 2010, that's a continuing trend, aside from them being an opportunity to be acquired, whether that's good or bad for a community or for patients. So my first question to you here is what is the biggest challenges facing a community hospital today?

       

      Nicole Clawson:

      Well, of course, to reduce revenue leakage, but I would say the biggest challenge overall is to keep the services in the rural communities with that quality care that the patients need. And that's the bottom line of what we're trying to do at PMHA.

       

      Brian Urban:

      I think the most interesting thing about the work you do, it's not just the actual anchor in a community, the community hospital, but it's the lives that they serve as well. So you're no stranger to rural Pennsylvania. And if our listeners don't know Pennsylvania, you go from a city to a rural location in a snap. There's basically three or four large cities in the state and there's just farms and rolling mountains across the whole landscape. So with that, I think about access to care challenges. So it's critical. A lot of people have a point of care that they can rely on and trust on. Is trust a continuing challenge in terms of patients and healthcare overall in rural, because it's very different with urban populations. But is that something you're seeing across the hospitals that you support?

       

      Nicole Clawson:

      Yes, most definitely. There was one, not in our membership, but a hospital in Pennsylvania, rural Pennsylvania that closed their maternity, within the last month. And that scares everyone that there could be mothers trying to deliver babies and they have to drive 50 minutes to hopefully get to a hospital. So that's really the meat of it, is trying to keep those services available for that community that sometimes there's still connectivity issues, so they couldn't even do telehealth in some of the locations of rural Pennsylvania.

       

      Brian Urban:

      And a lot of your work does extend beyond just point of care in a physical location too. Tell us a little bit about technology adoption overall as it exists for rural healthcare practitioners and the hospitals that they work with there.

       

      Nicole Clawson:

      The technology is so very important, and that's what we started a couple years ago is trying to see where we needed to be 5 to 10 years out and who was investing in technology. So that was a core strategy and task force that we put together to help our member hospitals and continuing to do so. We have to make for sure that we can automate. Automation is big because in the rural communities, we can't find the staff or the talent to perform.

       

      Brian Urban:

      I think the challenge too, that you just mentioned is a common theme across a lot of rural-based healthcare systems, let alone community hospitals, is attracting and retaining physician talent and upfront work staff as well. So is that a trend that's still happening today and is technology being adopted that's helping alleviate some of the burden?

       

      Nicole Clawson:

      I'd say yes, but really with some of our... We always say that we have independent members or independent-minded members, because some of them have formed their own affiliation amongst the smaller hospitals within our membership, which is a good thing because they're not competing with each other, they're just trying to keep their communities whole and keep the services. And one big piece of that is sharing docs and the physicians can then go perform surgeries at each of the hospitals or see patients. So sharing the physicians and having that technology platform that they can see wherever they're at, the documentation and conditions of the patient.

       

      Brian Urban:

      That I would imagine information sharing is a critical component of having a fluid care coordination and care continuity onto itself. So I'm thinking about the hospitals that you serve. It's amazing because I think about the far northeast of Wayne Memorial.

       

      Nicole Clawson:

      Oh, yes.

       

      Brian Urban:

      And I think about also the far south going down into the Washington County area and Allegheny and Butler, it's amazing that you touch so many different hospitals. They're in the same state, but their culture of care is very different. Tell us about that?

       

      Nicole Clawson:

      Well, some of the hospitals are very close to each other and have affiliated with larger either insurance companies or bigger hospitals, and they've reduced the services. So I think one key aspect is keeping the services whole. I'll come back to that each time because really making sure that the community has the service when they need it.

       

      Brian Urban:

      That's the core piece of it. And looking across the different things we've talked about so far, economics, telemedicine I think is a really big uptick and hopeful continued adoption in the rural community. But then you also have these other partnerships that exist as well, trying to help community-based hospitals too. So I'm curious, with all that said, is telemedicine the biggest change driver for accessing care or is it still, we're still learning about it for rural populations?

       

      Nicole Clawson:

      I think it's good in some situations where it can be used. I think telemedicine is very helpful. Even say in the ERs, if we can do telemedicine and urgent cares or ERs within the hospitals, we can keep the patients out of the facility if it's appropriate, where you don't have to lay your hands on them to examine them. But it's helping, telemedicine is helping. Again, we're in rural Pennsylvania for the most part.

       

      Brian Urban:

      It's funny, there's been a lot of conversations around HIMSS '24, HIMSS '23 about closing the digital divide, improving broadband access. But that doesn't necessarily imply that there's literacy in terms of digital use from the user end. So there's a lot more work to do on that. And it doesn't seem like more vendors will help, but the right vendors connected to the right hospitals might make an impact.

       

      So I'm curious to go back a little bit to earlier part of our conversation. Nicole, you mentioned end-to-end, this is where I think you're amazing risk-taker, a creative risk-taker at that. So to adopt a end-to-end technology system or approach or a model, there's a lot of complexity, there's a lot of replacement that comes with that, but then there's also a big reward at the end of it. So I'm curious, from your experience adopting an end-to-end technology model, what has that meant for all the hospitals you serve?

       

      Nicole Clawson:

      So we're still in the middle of it, and it's going to take quite a while to fully execute all the hospitals and the products they want end-to-end or a la carte, so to speak. It's going to be absolutely phenomenal, the amount data and the analytics we are going to get from going end-to-end.

       

      Brian Urban:

      That's exciting. And I think it speaks to your longer-term view. I think if we continue to do the same things that we get stuck in, whether it's serving rural hospitals or larger metropolitan areas, we need to be able to look five-plus years out. And you've done that and you're taking the appropriate stages to ensure that a revenue cycle management technology is adopted end-to-end, so it's a little bit of a cleaner process and I appreciate you mentioning that, and that was a large part of your conversation this morning with us on stage.

       

      But I want to shift gears completely. I want to talk a little bit about social determinants of health, the challenges facing rural populations. I have family relatives that live in rural Pennsylvania. And when you think about screenings, you think about detection of disease, it all happens way too late and it's creating a huge disparity in terms of geographical populations and also with age and then health literacy. So after someone gets a diagnosis, they are not only going to be challenged with getting care in home, how they get care and testing and examinations out of home, and how is their family a part of it? Are they completely dependent on it? It's all these very complex storylines that take place on a daily basis in rural Pennsylvania, let alone rural America.

       

      So all that said, you've seen this and you've lived around it and you've helped it. What are some of the challenges that the hospitals you serve are facing when addressing social determinants of health for the rural populations they serve?

       

      Nicole Clawson:

      I'd say making sure that they have the services that are prevalent in their area, so medical oncology for example, are those patients able to get the treatment they need when they get that diagnosis for success and that they can recover from something like that. So really trending, seeing social determinants. Is there a heavier population needing med-onc in a certain area? How do we wrap all of that up and together? I think that's what's hard.

       

      Brian Urban:

      I think it's amazing because a lot of the folks you talk to at HIMSS want to throw a digital solution at the problem, and that's not necessarily the balance that's desired or requested from a rural population, rural community, rural family. So are you seeing there being a challenge of balancing a digital health solution and an in-person, in-home care and hospital setting for someone that needs consistent medical care that lives in a rural location?

       

      Nicole Clawson:

      I would say yes and no. I mean, the technology's only as good as how well you use it and if you do continue to use it. So I think it can be very helpful in rural communities. For staff, we're really full speed ahead on implementing virtual check-in, and we're really excited about that. We know everybody's not going to use it. There is a certain population that they don't use their cell phone and aren't going to check in, in the parking lot of the hospital, but that's just one more thing that we can bring the latest and greatest to these rural communities in the hospital setting, to just make their experience better if they choose to use it.

       

      Brian Urban:

      I love where you're going, and I think it's the most challenging thing among many other story lines across healthcare in the US is, having digital transformation play in rural America and the adoption and the love that you need to show along that journey is critically important. So I'm curious, Nicole, is there any other teasers aside from the virtual check-in that you can give us on the horizon for Pennsylvania Mountain Healthcare Alliance, any cool things you can tease us with?

       

      Nicole Clawson:

      I'd say something very current and what we're just getting into it, is our contract management work that we do and how we're really looking at the variances between the payers. Just in looking at our contract management. I mean, we have one hospital that just as they set it off and what went live, they found $130,000 of missed revenue for a certain service that they were able to recoup on from a payer.

       

      Brian Urban:

      That's huge.

       

      Nicole Clawson:

      I mean, that part of technology that we can help with is going to help hospitals sustain.

       

      Brian Urban:

      I'm excited to hear more of these stories as your leadership takes big impact in all the rural hospitals that you're continuing to serve. One thing I am curious of in terms of the payer provider relationship, it's so funny, the last few years we've heard, payer provider collaboration, non-stop. The point of that, I think from a bigger perspective is we're a team. We need a team approach. If we don't play as a team, we're all going to fail. We're all not going to serve the lives that we're responsible for serving-

       

      Nicole Clawson:

      Right, it's all about the people.

       

      Brian Urban:

      Exactly. So I guess, how are those conversations going? I mean, you're having technology maybe as a bridge to being able to build those relationships better, but you got a lot of different payers that are contracting inside Pennsylvania, let alone lower New York state as well, where you have some support there too. So how are those relationships advancing?

       

      Nicole Clawson:

      I'd say its getting better. I will say payer rules are complex and I'd like to continue working with them to try to streamline that and make it so that we don't have to continuously guess time frames or timely filing limits because they're all different and it's complicated.

       

      Brian Urban:

      Yeah, and that's good because I think we're having a slew of new leaders come in as next generation players that are starting to have that type of effect. So a lot of the old habits and traditions of before are starting to change, and I think a lot of the payment structures will change addressing social determinants of health, adopting new technologies, everything. So Nicole, I have a question for you. What's your big takeaway from HIMSS 2024 that may impact your work for the rest of this year and beyond?

       

      Nicole Clawson:

      Well, I will say that this is my first HIMSS conference, so I'm a newbie here. But I would say just the amount of continued, I mean, I'm looking at hospital equipment to my left and technology to my right. So there's just a very wide range of technology and advancements being made, and I'm going to take in some more sessions and continue to gain, but it's refreshing that there is such a large crowd.

       

      Brian Urban:

      I love it. Moving forward, we are. So Vice President of Revenue Cycle Management at Pennsylvania Mountain Healthcare Alliance, Nicole Clawson, thank you for joining our show here today.

       

      Nicole Clawson:

      It was great. Thank you.

       

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