Becker’s Healthcare Podcast – Episode Summary

Episode Title: Clay Ashdown, CFO at Intermountain Health
Date: December 30, 2025
Host: Madeline Ashley (Becker’s Healthcare)
Guest: Clay Ashdown, CFO at Intermountain Health, Salt Lake City

Episode Overview

This episode features a conversation between Madeline Ashley and Clay Ashdown, CFO of Intermountain Health. The discussion centers on the evolving challenges and opportunities in healthcare finance, focusing on technological transformation, revenue cycle modernization, adapting leadership roles, and the increasingly collaborative nature of executive decision-making. Clay shares candid insights from his 25-year career at Intermountain Health, reflections on uncertainty within the healthcare landscape, and lessons learned from a major enterprise-wide EPIC EHR integration.

Key Discussion Points & Insights

Clay’s Background and Reflections on Leadership

• Ashdown’s career spans over 25 years at Intermountain Health, including just over two years as CFO.
• He credits much of his ability to lead amid industry challenges to a "high performing team" and a senior leadership group that is "fiercely committed to the mission" and constant improvement.
  • Quote: “Being part of a team like what we have here is incredibly helpful.” – Clay Ashdown (01:37)

Current Financial Challenges in Healthcare (02:32 – 04:39)

• Uncertainty: Clay describes the current environment as one of "pretty significant uncertainty," more so than at any other point in his career.

• Key Factors:

  • Government payment levels and regulatory unknowns
  • Workforce redesign driven by technology and automation (including AI)
  • Inflationary pressures (supply and labor costs outpacing revenue)
  • The need for efficiency without sacrificing quality of care

  Quote: “There are just a lot of unknowns and there are always variables that are hard to predict as we look at our forecast. But I would say this time it's perhaps more uncertain than any other time that I can recall.” – Clay Ashdown (02:36)

Navigating Uncertainty: Solutions and Team Approach (05:00 – 06:46)

• Collaboration & Innovation: Emphasis on breaking away from pure resource preservation and leaning into team-oriented solutions.

• Risk Balance: Intermountain is known for a proactive, value-based care model—seeking both cost efficiency and aligned incentives.

• Courage and Discipline: Clay articulates the need to be “incredibly disciplined,” but not so risk-averse that innovation is stifled.

  Quote: “It requires an added level of courage and innovation…we can't be so risk averse and cautious that we aren’t willing to take necessary chances.” (05:09–05:22)

Risk and Revenue Cycle Investment Decisions (06:46 – 09:19)

• On Taking Risks: It's not about being "safe" or "risky," but rather about thoughtful, pragmatic execution with trusted partners and careful contract orchestration.

  • “It's not a matter of…easygoing. I think ultimately it's being very thoughtful and pragmatic and not being safe in our approach.” (06:46–07:27)

• Revenue Cycle Transformation:

  • On September 6th, 2025, Intermountain migrated the entire enterprise to a single instance of EPIC, consolidating previous EMR silos.
  • Enhancements continue with technology investments and AI integration, in partnership with R1 and independently evaluating innovations.

  Quote: “We're still…digesting some of those changes. But…that is not the only thing we're doing with Revenue Cycle.” (07:36–08:16)

Technology Evaluation and Governance (09:19 – 11:06)

• Governance Structures: Both board-level Audit Compliance Committee and internal councils are actively involved in vetting new technology, especially AI and automation.

• Disciplined Approach: Focus on leveraging core platform strengths (e.g., EPIC, Microsoft) supplemented by carefully screened niche solutions.

  Quote: “We have a council that really takes a strong look at AI and other automation solutions to make sure that one, we're not just kind of buying into the noise that's out there…” (09:46)

Lessons from EPIC Integration (11:06 – 14:23)

• Implementation Approach: Rather than phasing, Intermountain transitioned to EPIC system-wide in a single day—acknowledged trepidation but ultimately pleased with rapid execution.

• Results: Initial challenges and a "sluggish start" for revenue cycle, due to prioritizing patient safety and continuity of care; quickly rebounded and now outperforming EPIC median expectations.

• Key Lesson: Unprecedented collaboration between business ops, revenue cycle, and clinical leaders created shared accountability and expedited improvement.

  Quote: “…it's not a, Whose responsibility is this? Who should we point to…? It's really been a collective desire to work together…that has been fairly remarkable.” (13:39)

Evolving CFO Role & Leadership Skills (14:29 – 17:08)

• Greater Importance of Adaptability: The CFO role now demands more cross-functional collaboration, not siloed expertise.
• Blurring Lines of Accountability: Modern leaders must “problem solve as a collective,” with communication and vision-setting more critical than ever.
• Continuous Evolution: The expectation for CFOs and other leaders to grow their communication and collaboration skills in response to rapid industry change.
  • Quote: “The siloed approach that perhaps existed in prior iterations…ultimately people need to bring those unique perspectives, but really problem solve as a collective.” (15:33)

Notable Quotes & Memorable Moments

• “I am blessed with a really high performing team…fiercely committed to the mission to constantly improving.” – Clay Ashdown (01:37)
• “This time it's perhaps more uncertain than any other time that I can recall.” – Clay Ashdown (02:36)
• “It requires an added level of courage and innovation…we haven't seen in the past.” – Clay Ashdown (05:09)
• "It's really been a collective desire to work together and come together and find these solutions and to really make sure that there is accountability and ownership. And that has been fairly remarkable." – Clay Ashdown (13:39)
• “Those lines of accountability continue to blur. And so it's so important that people bring good collaboration to the table…” – Clay Ashdown (16:08)

Segment Timestamps

• Clay’s background/Intermountain overview: 01:00–01:25
• Biggest financial industry challenges: 02:32–04:39
• Team solutions and risk philosophy: 05:00–06:46
• Revenue cycle investment/EPIC transition: 07:36–09:19
• Tech evaluation and governance: 09:19–11:06
• EPIC migration: lessons & impact: 11:06–14:23
• Evolving CFO role, leadership skills: 14:29–17:08

Takeaways for Healthcare Finance Leaders

• Embrace uncertainty with disciplined risk and innovation: Don’t let caution eliminate progress.
• Align teams and break down silos: True transformation requires cross-functional partnership and communication.
• Invest in technological infrastructure, but with disciplined governance: Centralized platforms provide clarity but must be managed with rigorous oversight.
• Expect constant role evolution: Finance leaders need to develop adaptability, communication, and collaborative skills to remain effective.