← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Byron Glasgow, MBA, Vice President of Finance at Temple University Health System
00:23:34
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- [00:02]
A
For healthcare services, predicting and negotiating prices can feel like a guessing game. But with Claritif, complexity becomes clarity. With Claritif's technology, data and insights, payers are equipped with the information needed to help reduce claims payment errors. Providers can get more insight into payments and fair pricing, and employers have the analytics to make more informed decisions on benefits design. With Claritif, healthcare decisions can be made with confidence. Claritif More Clarity, less guesswork this is.
- [00:35]
B
Alan Condon, back with another episode of the Becker CFO and Revenue Cycle Podcast and today I'm thrilled to be joined by Byron Glasgow, Vice President of Finance for Temple University Health System at the five Hospital Academic System headquartered in Philadelphia and anchored by Temple University Hospital. That's one of the most reputable, most distinguished academic medical centers in the country. And Byron, a real pleasure to have you back on the podcast with us today. For those who are listeners who mightn't be as well acquainted with you or the work that you do at Temple Health, do you mind sharing us a little bit more about your role and your background?
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C
Absolutely. So thanks Alan. I really appreciate you taking the time to speak with me today and hopefully your audience enjoys the conversations. So my name is Byron Glasgow. As Alan said, I am the Vice President of Finance over at Temple Health. I've been at temple health for 15 years. Over those 15 years I've had eight different roles. I came to Temple right after I graduated college, moved to Philly, got my MBA there while simultaneously working so MBA at Temple University and really haven't looked back since. Temple's a very special place and I really enjoyed my time there. Give you a little background on Temple health systems. Around 3.5 billion in revenue. We have 1200 licensed beds, around 10,000 employees, 1000 physicians and we have seven facilities across Philly. One facility is our Fox Chase Cancer Center. It's a PPS exempt cancer hospital, one of 11. It's NCI designated and it's credible outcomes. Really well established brand in the oncology market. We have our new women's and family campus right in North Philadelphia, recently opened over the last few months. We have our Episcopal campus which is Behavioral health, has Crisis Response center and really is on the forefront of fighting and combating the opioid epidemic that plagues our city of Philadelphia. We have Jeans Community Hospital, which is a community hospital as I stated, it's right across the street from Fox Chase and it has a robust bone marrow transplant department. We have our Northeastern campus outpatient community facility, Chestnut Hill Hospital, which is a Community hospital. And then we have our flagship which is Temple Maine on Broad Street. As Alan stated, it's a academic center, but it's a pretty unique place. Philadelphia is the largest city in the country without a public hospital. So Temple Main on Broad street really comes in and fills that void. So to put into context what this academic center, while again being an academic center, it also operates as the community hospital in North Philadelphia. And we sit there, our inpatients recently last year, 72% of our inpatients are Medicaid eligible. So either have Medicaid as the primary insurance or their dual eligible patients. So it is a void we fill and we're really proud of that to serve the community.
- [04:01]
B
Yeah, fantastic. I think really appreciate the kind of breakdown of yourself, your history of Temple Health, obviously the makeup of the health system as well. Certainly helpful to nosy. Dive a little bit deeper into our conversation here. $3.5 billion in revenue, seven facilities, hospital facilities. I believe that across Philadelphia, the largest city in the US without a public hospital is not something I was aware of. But Byron, I guess at the time of recording, it's middle of December or at the end of 2025 going into 2026 like you said, I guess ubiquitous challenges, but it sounds like a lot of growth as well going on at Temple Health. What are the two or three kind of key trends that you're paying most closest attention to healthcare today in your seat as VP of finance.
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C
So the big trends I've been looking at is I'd say the first two kind of bounce off. One hand washes the other, which is the rising cost of health care as well as in concert the value based care that we're all moving towards. And the third one will be I obviously can't, can't miss it. It's at your dinner table, in your house, on signs everywhere. So of course I'll touch on that. But as far as costs go and the rising cost of health care, we've it's getting close to 18% of GDP. We've seen a response from the federal government with HR1, and obviously there's many implications of that for a health system like Temple University Health System with our flagship hospital on Broad street when it comes to provider taxes and all the other redetermination things like that. But even if you take that and put it over to the side and just talk about the actual rising cost and why that's such a hot topic, you really have to consider the place hospitals are in and they're really on the forefront and on the front line of healthcare. And a lot of the focus is on hospitals on how do you reduce costs. And it's pretty unique to kind of all other products and services out there in the country. Hot button issue in the election was grocery stores and the rising cost of groceries. And really it was, well, what are the government going to do about it? Years ago was gasoline and what's OPEC and the government, how are they going to combat these rising costs? But often when health care costs come up, it's hey, the hospitals have to figure this out. And I think the difficulty for hospitals and executives in the field to try to wrap their head around is how thin the margins are when you compare it to the total, the entire ecosystem of health care. So if you walk down the halls of the hospital and you see robots and you see pharmaceuticals and implants and all these price electronic medical records, all consulting firms, and you step back and say, well, we're making the hospitals are 1 to 3% in margins and you're under for safety net, you're less than 1. And then all these other parts of the continuum of health care are. You get to the insurance companies on the next layer and they might be 5% or depends on the service line they're in, whether it's Medicaid, managed care, Medicare, commercial. And then you get out to that next layer which is like I said, pharmaceuticals, robots and all those kind of things and they're over 20%. So I think to combat the rising cost of health care, we need to look at it from a more broad level and understand what hospitals can do and what they can't do. And in my mind, you always need to keep your side of the street clean in a lot of ways. So we do of course need to internally look and say what can we do to fix this? And we've been taking steps with our Medicaid managed care partners. Obviously that's big for us at Temple. And we've had conversations about how do we get claims processed quicker, how do we minimize denials, how do we minimize touches on clean claims, things like that. You know, where are we doing, where is there way too much administrative burden? And we've made a lot of progress in the contracting world on that. And obviously there's more to be done, but there is only so much you can really do without all those other inputs being evaluated. And recently in the last couple weeks, we have seen the federal government take a much needed look at all of the inputs across healthcare and say, hey, we need to have some type of level of containment outside of the hospital and the insurance companies. And I think that really moves into the next layer for me, which is value based care. And those two things, cost containment, rising costs, those kind of run in concert together. Because for me, when I think about value based care, I think about the opportunity and the need or the focus of a lot of people with risk based arrangements. And one of the things that's really important to note when you talk about risk based arrangements or taking up that upside or just or downside risk or being at full risk with insurance companies is the level of predictability in the mlr. And I think year over year you see pretty big swings, at least on the Medicaid front, whether it's disenrollment or the sick folks staying on the plans when it came to the epidemic and healthier people leaving. And it's really hard to for a safety net such as Temple to enter some type of full risk arrangement with a Medicaid plan because there is not those guardrails that exist on those other externalities that are going into the spend of healthcare in general. And it would be irresponsible for us to take a full risk agreement, which like I said, it's kind of a trend when you talk about value pace care, because we can't deal with a $10 million swing based on a big shift in an MLR. It would shut, you know, it would shut our hospitals down. So I think until we have some type of guardrails around, cost and more predictability, it's going to be tough to align ourselves with value based care, particularly in the safety net front, just because it's not sustainable and razor thin margins and just not being able to sustain huge losses one year and then a big swing up on the next following year.
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B
Really, really appreciate the level of detail specificity on some of those trends. Washington I guess my immediate question in terms of as we start to see more health systems enter more of these full risk arrangements in terms of value based care, but what are some of the guardrails that will be beneficial, that will be helpful for safety net providers like Temple Health to engage in some of these full risk arrangements and Medicaid, is there anything that's worked on the commercial side maybe that might potentially be beneficial down the road for some of these Medicaid value based care programs?
- [11:12]
C
So on the commercial side, it's a little bit different for us. Most of the patient populations on the commercial products are a large corporation that are self funded when it comes to our Medicaid products. I think there's opportunity if they had, you know, ceilings on losses and things like that. Here's the most you can lose in any given year. But one of the, I would say hurdles for that type of arrangement is the fact that you would have to you partner with the MCOs to let the state understand how expensive is to make sure for care. Right. This is how expensive it is to treat patients, what we need for capitation. You're partnering and championing these things together. A lot of that time that's going to lead to an increased burden on the state or the federal government, which was kind of one of the things that HR1 and other legislation is about is how do we reduce the costs. So I think it's difficult at this time unless there are massive protections on the downside risk for health systems to be in any type of risk arrangement until you know, out of pocket spend for insurance companies on the drug front, pharmaceutical front are really combated. And you're seeing that on a day to day basis right now at our federal level and our state level.
- [12:39]
B
No, that's certainly helpful to understand. And one quick follow up, Byron, just going back to your initial point around just the rising cost of care across the board. Health care now approaching 18% of GDP like you've mentioned, I believe around about 35% or 40% of nonprofit hospitals still operating in the red have been inching their margins back towards a break even level. Again, no respite. Sounds like no respite coming next year and the year after. When we think about some of these Medicaid cuts coming down the pipeline, the impact of the ACA subsidies that may expire Dec. 31. But is it fair to say Vice President of Finance CFOs Health care finance leaders like yourselves have had to this year take arguably a harder look than they've ever had to take at the cost structure. Through no fault of their own, of course, but granted, no silver bullet. But has there been anything that has been particularly effective for Temple Health in terms of reducing costs? Whether it's on the vendor side, wonder it's on the supply side, the labor force, anything that has been significantly effective in bringing down some of your costs this year or maybe into next?
- [13:49]
C
Yeah, we have some supply chain adjustments with large scale partnerships to reduce acquisition cost of certain implants and supplies. That's a big piece that we're seeing. I think we've seen less on the cost side. It's, it's hard for me to answer of one silver bullet because when you're in the shoes of Temple where you're operating on razor thin margins like we are, we're always with our back against the wall. So we're constantly looking on how to get the most out of every dollar. So that's a, that isn't really just. Just because of this. Everything that's happening in the Medicaid market, it's a day in, day out thing that we live with routinely. But we are always constantly trying to get out what we can. And like I said, we have a big supply chain initiative with implants that we're looking forward to. But I think more of the revenue opportunity, opportunity and minimizing of unnecessary burden of administration. And that would kind of lead me into the topic of the AI piece. So I think on the AI front it's going to be a pretty large capital investment that we're going to see or it could potentially be. So I have that one piece, that fear that's inside of me just being a risk mitigator and thinking through those processes of how much is it going to cost to get fully functional with AI and is it going to lead to a gap between the haves and the have nots? That's a little bit of a fear of mine. But then I've also seen and talked to 30 plus vendors or so about different AI products out there and I've seen some that I'm really excited about. And on the payer contracting front and rev cycle front I've seen some and one in particular where it really focuses on minimizing, I don't want to say the rev cycle war of getting claims processed, but the number of FTEs it takes, the number of touches on claims and what I've seen and focused on one product is essentially have a AI agent that is linked to your payer, goes through all of your claims and before they even go out the door it says hey, we're linked to your payer policy. We know your contract. We've seen 100 denials in the last 30 days and here's what we think you can do and it's either going to you need to change X, Y and Z diagnosis code or it could be some type of modifier, whatever it may be and then there'll be a separate bucket for it that just says hey, we don't know why this is claims, it's going to be denied. There's nothing in the contract or payer policy that's really indicative of what's causing this. And that's really helpful because one of the things that's difficult when you're dealing with your Medicaid managed care plans or your Medicare plans is they can't really process claims or it's really detrimental for them to process claims two years late or you know, a year later or whatever it is. They really need to process these claims in real time in their year of submitting them to the state to say this is how much the cost of care, how expensive the cost of care is, because when those claims come in late, it really isn't accounted for in next year's capitated rates. So one of the things these will do is say, okay, we have 150 claims that were denied for the same reason. We don't know why they're denied. And you can hand those claims over in real time to the payer and say, hey, these all have the same issue. What can you do to get these adjudicated? Is it a vendor that's processing your claims and there's some type of misalignment or is there something we're doing wrong that we just haven't figured it out yet? And that's going to differ a lot from traditional processes where know people are working claims but you're one off claims, you're getting them onto a log, then you're working with the payers to try to get these claims processed. And of course you want to lump up as many claims as you can that have similarities, but that's a very labor intensive process and you need the traditional revenue cycle process to commence and work through what it is. And I think what AI is going to do is allow us to have all of these claims that have similarities in real time, get out the door to payers and have them dealt with so we can be on the same page and work together and work efficiently. So I'm looking forward to that piece.
- [18:19]
B
Yeah, no, absolutely think the excitement around specifically the revenue cycle opportunities at AI is something that no doubt the finance leaders like yourselves are really looking forward to next year, kind of combating some of those baroque slow payments, denials and whatnot that have been such a challenge over the last year. So did you have anything to add in terms of AI in the clinical side that you're excited about?
- [18:39]
C
Byron yes, I'm really excited on that piece. It's obviously not my field or the topic at hand when it comes to this podcast, but I am looking forward to the minimizing of burden on the administrative end for our clinicians. I think there's going to be an increase in FaceTime and I always tell My team, let doctors be doctors, let nurses be nurses, and we're going to handle the rest of the. I'm excited for the opportunity for AI to kind of minimize all those burdens so we can maximize physician and nurse face time with our patient population.
- [19:15]
B
Yeah, no, I think opportunities galore on the clinical side, on the revenue cycle side, certainly. So excited to see where we might be this time. 12 months, 18 months down the line in those two respects. Byron, those are no doubts. A couple of areas that you touched on in terms of your excited about for the future when you think about growth, growth at Temple Health. I know you mentioned at the top of the call, some of the key areas are growing cancer hospital and a women's and family campus as well. How are you thinking about, how is your health system thinking about growth over the next 12 months or so?
- [19:48]
C
So as far as growth goes and opportunities, we have a balance between the growth initiative that I think there's that old saying, if you're not growing, you're dying. And that's true in a lot of industries. But for healthcare, we really need to be focused on sustainable growth and our core competencies and being true to our mission. So I think there's going to be growth at women's and family. We built it because of our core mission of taking care of the community. Since 1996, 13 of the 19 maternity programs in Philadelphia have closed infant mortality rates in North Philly, three times the national average. So when dealing with that kind of that situation, we looked at our service area and there wasn't really a facility located in the service area where a lot of the patients were originating or most of our patients. So we put a facility right there and it's exclusively for women's and family. And the idea here is to improve outcomes. I think we're going to see increased volumes and it's really going to stem the standard of care for women, centric care and urban centers. And I'm hoping that a lot of cities are going to replicate this model. As far as other gross initiatives have. We do 175 plus lung transplants, you know, one of the largest in the country, year over year. So we're always looking to grow our, our lung transplant program. We have our Fox Chase brand and it's such a well known, successful brand, well respected, that of course we're looking to expand our footprint in the market and we're doing the same thing with our urology departments. But while we're growing those products, those service lines, we're also focused on making sure that we're able to fulfill our mission and bring those services into our community. So Fox Chase has a great initiative sending clinicians over to Chestnut Hill, so bringing those doctors right to your front door. We have those clinicians coming to Temple, Maine and bringing that extraordinary level of care into our community. And the same thing with our urology group. So we're focused on growing strategically while sustaining our core mission. We don't want to sacrifice the quality of care and quality of life that our patients are experiencing to grow, just to grow. We're making sure that our growth initiatives align with our mission. So sustained growth, entering the market, new markets, while also bringing those expertise to our communities and, you know, to North Philadelphia, which is really our home.
- [22:32]
B
Yeah, absolutely. I think. Byron, I've been looking forward to this podcast for so long. Learned so, so much today. No doubt a lot of our listeners will have as well. Always a pleasure to speak with such leaders like yourself at such really top academic health systems doing great work like Temple Health. Again, thank you so much for taking the time out of your busy schedule and look forward to catching up with you down the line.
- [22:52]
C
Yeah, thanks Alan. It was really a pleasure. So thanks again.
- [22:58]
A
When it comes to negotiating fair prices for healthcare services, guessing is no way to go. That's why there's Claritif. With over 40 years of experience partnering with health care providers and the and the latest data driven insights built on 500 billion public records, Claritif is helping revolutionize the approach to healthcare services pricing, helping create more predictability for providers, more affordability for payers and employers, and more quality for patients. With Claritif, healthcare isn't left to chance. Claritif, more clarity, less guesswork.