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Becker’s Healthcare Podcast
Abigail Abongwa, MHA, System Vice President of Revenue Cycle at UW Health
00:15:56
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- [00:02]
A
@ Athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom Practicing medicine is complex, but running a practice can be that much simpler. With Athenahealth, see how simpler is healthier@athenahealth.com.
- [00:44]
B
This is Andrew Kass with the Beckers Healthcare Podcast. I'm thrilled to be joined today by Abby Abongwa, System Vice President of Revenue Cycle at UW Health. Abby, it's a pleasure to have you on the podcast.
- [00:56]
C
Thank you for having me.
- [00:58]
B
Before we begin, why don't you tell us a little bit about your background?
- [01:02]
C
Sure. I am the System VP of Revenue Cycle here at UW Health. I've been with the organization for over eight years. Prior to this role, I worked in Southeast Wisconsin with the healthcare system for about 21 years in a variety of roles. I was in strategic planning for many years. I did government relations, I did community relations. I did work on board governance. So my entry into Rev cycle I feel was very non traditional. To be honest, I feel like I was bored and not challenged in my role that I was in prior to being encouraged to consider the Revenue cycle role. But it wasn't something that I always thought I wanted that VP role in lifecycle. So from my perspective, I really appreciate the diverse background that I have and my non traditional again entry because it helps me look at things and the work that we do truly from a patient perspective versus we've always done it that way in Rev cycle or being accepting of the ways things are sometimes in our world that from a patient perspective really could be or should be improved. If that makes sense.
- [02:12]
B
Yeah, that's great. Now let's jump right into this. What are three of the top trends you're following in healthcare right now?
- [02:20]
C
It's so hard to boil down to three, but I will do my best. The first area I would say is this advancement in technology, the AI generative AI perspective and of course automation. There's a significant amount of investment that's happening in this space to try to automate repetitive tasks or tasks that are error prone when manual processes are used. And also using predictive analytics to anticipate things like denials or Cash flow issues rather than as maybe historically reacting when they happen. The other thing I'm paying attention to just how we use generative AI in the rep cycle for tasks like documentation improvement. This requires partnership with our clinicians and also in things like appeal generation, drafting appeal letters in response to denials, and possibly in areas like advanced coding or even diagnosis assisted coding workflows, which is a little bit more complex, but I see the technology evolving to that place where it actually can help with some of these workflows. Patient financial experience would be the second area that is really of interest to me, obviously being again a non traditional entry into my role. I'm so dedicated and focused on really doing a good job with transparency and engaging our patients in the best way possible in their financial care because patients are bearing increasing responsibility financially. Right? Deductibles, co pays, coinsurance, all of that's going up, not down. And so we need to continue to put emphasis on how we are transparent, how we engage the patient on the front end, ideally if possible to try to plan financially for their care so there's no surprises on the back end when they get that bill. We're doing things like estimates and again just paying attention to what happens in the field from an estimate and also like flexible payment option perspectives again for patients and then looking at trends associated with like digitizing of the payment portals, better customer service, financial counseling, again simplifying, that's the key word, simplification of the front end financial planning and the post care billing journey then for the patient and then the third area will be kind of two areas I'm going to blend together. It has to do with like analytics and data and real time monitoring in response to denials that we're seeing and trying to prevent them. So in the past a lot of times we had data, but it was more like you'd see the data for the last month or last two months. But there's more trends now that are showing us that there's data and analytic tools we can use to be more proactive or be more real time time. Like every day you can look and see what's happening with a certain payer and you can easily pick up if oh my gosh, it looks like there's a trend over here with X type of new denial so we can start responding way sooner than we did in the past. So these AI, generative AI and other financial experience and then data analytics, real time monitoring and response to denial management and prevention strategies would be the top three maybe that I would put out there, even though there's a lot more that we're tracking.
- [05:46]
B
Okay, and what is the biggest headwind you're facing right now as a revenue cycle leader and how are you addressing that challenge?
- [05:54]
C
Oh, the biggest headwind I will talk about is just the financial margin pressures that we are facing as a healthcare system. And these are associated with increases related to like labor wages, pharmaceutical costs, supply costs. So things outside of, not just within the rev cycle, but obviously impact us and make it difficult for us. Because my team is over the pricing strategy for the organization and we want to keep our prices as affordable as possible. Right. So trying to manage these things where our costs are going up and trying to not price ourselves out of the market and price too much. Right. From a patient perspective when they're owing more is a real issue that we're trying to balance. From a revenue cycle perspective specifically too, as it relates to our margin pressures is again, something I mentioned earlier, which is the payer denials that we're seeing. There's something new every day, if I may say that, from the payer perspective. And so trying to be organized around those, track them well, ensure we have response put together in the organization engagement of contracting in those conversations with our payers. Those are all things that were focused on. And then reduction in coverage for indigenous patients as a result of some of the changes with some of the Medicaid programs after the pandemic, where we've had some unwinding and a lot of patients who had access to Medicaid, for example, no longer have. We've seen that data, even in Wisconsin, show a significant decline. And so what this means is now we have to watch our charity care and our bad debt. Right. So all in all, parts of the pressure that we're finding. But from how we're tackling these, obviously one of the things we're doing is really trying to make sure we manage well to our overall cost to collect. So looking at the right mix of our internal staff to outside vendor help that we can leverage, you know, because we can't be that good at everything. Right. So we don't, we don't have a strategy at UW Hull to necessarily outsource our entire rep cycle, that's not something we're interested in. But there are certain areas where there are vendors who do a really good job and they can do probably better and maybe more cost effectively than the way that we would. So we have some vendors we partner with. And then obviously technology is also something that we're using to kind of balance that equation to do our best to reduce the cost associated with the work that we. The other area of what we're doing to kind of tackle these challenges is really a huge focus on reducing and understanding first and then reducing our controllable write offs that basically reduce our reimbursement. So you have a certain amount you expect the payer to pay. Oftentimes you don't get paid that amount for whatever reason. And really making sure we understand the reasons for those. And what are the strategies internally to prevent that from continuing to happen. And then the other last area as it relates to how we're tackling these financial margin challenges. There's a lot of work happening in our clinical documentation improvement space again with our providers. We're the number one hospital in Wisconsin, have been for I think over nine years, maybe ten at this point. So we are a well sought after institution because people recognize the quality of care. Unfortunately, sometimes our care isn't really reflected in the documentation or the complexity of it isn't reflected. So we're doing a lot of work on the inpatient and outpatient space in partnership with our physicians and other clinical folks team members to make sure that they work with us on appropriately documenting all of the great care that we provide here. We know we provide it. We just want to make sure that the documentation actually represents that as well.
- [10:00]
B
And what are you most excited about right now?
- [10:04]
C
We have such a great team at UW Health. We're a great institution. I'm excited about the fact that we have though, the ability to really have our teams, I'm going to steal this phrase, but work to the top of their license by leveraging technology in those areas that are predictable, rote, and don't really require the smarts of our people. We've seen technology help a fair amount in some of the areas where we've implemented it. So the ability to continue to leverage analytics and technology advancements to be more efficient and effective in our work is something honestly that excites me. At the same time, this excitement is tempered by how we continue to work with our team members to prepare them for this new world where the work they do is not the same as maybe the way they used to work in the past, where there's a lot more technology supporting the work we do is going to require different skill sets, different analytical mindsets and things like that. But this excites me. Technology excites me.
- [11:12]
B
And how do you prepare your employees for the changes that come along with technology?
- [11:19]
C
Yeah, I think it's really just having dialogue with them and keeping them involved and updated along the way. So when we're making a decision, or at least starting to expand, explore, for example, explore a vendor in the space of autonomous coding, for example, we don't go off and make all these decisions and bring a vendor in and start doing the work without talking to our teams. The teams know we're struggling to keep up with volumes. Right. So the, the dialogue is all right. How are we together going to figure this out? We know we can't get through all of these work queues. We want to support the organization as it's growing without adding to the FTE. And of course, with FTEs, you know, we have people turnover and things like that, so the staff know the situations they're dealing with. We have overtime, sometimes voluntary, sometimes mandatory. We don't like that. So I think by having a team be aware of the context in which they work is the first one. But then how you involve the teams as we go through the process of making the decision, make sure that the leadership that's involved in these conversations are bringing that back and we're sharing along the way. So the change management, if that's the word, is very important to ensuring that these technological implementations go through smoothly and we have great adoption for them.
- [12:38]
B
And the last question I have for you today is how are you thinking about growth over the next 12 to 24 months?
- [12:45]
C
Sure. On the organizational side, with these margin pressures that we're facing, one of our big areas of focus is access, access, access. Like I said, we're number one hospital here in Wisconsin, so we have a lot of people wanting to seek care here. We have partnerships in our market and we have. Part of our organization is in Illinois, so we have a lot of referrals coming into our organization. Unfortunately, we have capacity constraints. So right now there's a huge effort to try to figure out how we create that capacity. Not just brick and mortar. Right. But also how we work, how we leverage telehealth, you know, to do work. So there's a variety of things happening in this space. Our CEO calls it the wicked problem of access from a rev cycle perspective. My goal is to figure out how Rev Cycle is positioned to ensure that as we grow and add more surgeries or add more services, we have everything we need to appropriately clear patients to get that care so that we don't have reimbursement issues. Because you could grow a lot. But then if you're not doing it well, from a rep cycle perspective, making sure you're positioned to get all you need from a patient's perspective, the documentation and all of the pieces, then you're not really maximizing the revenue associated with that growth and access work that's being put in right on the front end. So that's from my perspective organizationally, is how revcycle supports this access work. When it comes to from a personal perspective, I'm just all ears. Learning, right? So there are being someone who didn't grow up in recycle as I call it, there's a lot still I don't know after 11 years in a rap cycle, to be honest. And so just recognizing that there's something new I need to learn every single day because there are things I still find out after eight years at UW hall that I go, oh, I didn't know that. And you know, we do that. Why do we do that? And so just really continuing to be curious, I think is my way of letting myself be open to learning new things so that I can be an effective support and leader for our teams here in neuroscience.
- [15:03]
B
Well, thank you very much for joining us today, Abby. It's been a pleasure speaking with you and I hope we can talk again soon.
- [15:09]
C
Well, thank you so much for having me. This is fun.
- [15:14]
A
At athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom lines. Practicing medicine is complex, but running a practice can be that much simpler with Athenahealth, see how simpler is healthier@athenahealth.com.