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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
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B
This is Madeline Ashley with the Becker CFO and Revenue Cycle podcast. And I'm excited to have Clay Ashdown, CFO of Intermountain Health in Salt Lake City with me on the podcast today. Clay, thanks for joining me.
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C
Thank you for the invitation.
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B
So, Clay, I know we had you on the podcast back in March with my colleague Alan, but before we kick things off for our listeners who might not have had a chance to catch that episode, do you mind sharing just a little bit about yourself and Intermountain Health?
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C
You bet. So I have actually had the pleasure of being at Intermountain for a little over 25 years. Actually, I've been in the CFO role for just over two years, but I've had a variety of financial leadership roles over my career. Prior to that, I was in public accounting at kpmg and just really fortunate to be part of this organization.
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B
Wonderful. Well, it sounds like you've had a nice, strong run with Intermountain and sounds like, you know, everything's going really smoothly two years in. How do you feel in your, in your CFO role?
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C
You know, I don't know that I'll ever feel entirely comfortable, but I would say I am, I am blessed with a really high performing team. And I would extend that not only to the financial leadership, but, but the senior leadership of the organization, which is just fiercely committed to the mission to constantly improving. And so that makes my job a little bit easier. Although, as we all know in this industry, it is immensely challenging. But again, being part of a team like what we have here is incredibly helpful.
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B
That's amazing to hear and that's actually exactly what I want to get into. You mentioned you've, you know, been with the system for 25 years. You've probably seen a lot of ebbs and flows in the health care industry. So could you share some, some broader challenges that you're closely keeping an eye on right now from your financial perspective as we head into 2026 and why?
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C
Yeah, I would say we're in a period right now of pretty significant uncertainty. And I know that's not, you know, too revolutionary or anything, but, you know, as, as we've been going through our planning cycle and we just wrapped it up looking at not only our annual plan for 2026, but obviously as we're looking out on the horizon beyond that, 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. And so that relates to certainly government pay and the level of those and how significant of an impact those will have. We have workforce redesign uncertainty. As we look at the implications for technology, automation, AI and what will that mean in healthcare, we see tremendous opportunity there, but we also know that there will likely be disruption. And so trying to really capture how that will affect us. And then I would say the more typical dynamics, it's looking at the inflationary pressures of our expense costs relative to the increases that we see on the revenue side and how it is just very challenging to keep pace with those revenue, pardon me, with the expense increases and what we're forecasting both from a supplies perspective, from a labor perspective, and goes on from there. So I would say some of these forces are more acute than perhaps would otherwise be the case and others are just kind of the constant changes that occur in healthcare and trying to be an efficient model while still delivering extraordinary care.
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B
Right. And you just said times right now are, you said unknowns and this is a time of uncertainty more than you can even recall from the past. So what are some ways that you're really, maybe some solutions that you found have been helpful in terms of working with your finance team just amid all of this uncertainty that we're seeing. What's been your, you know, your strong point?
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C
Yeah, I think what it requires is enhanced collaboration, really trying to be a partner focused on solutions and not just being a preservationist of saying, well, you know, let's hunker down, let's, let's be even perhaps more judicious in terms of protecting our resources and our assets and that sort of thing. I think it requires an added level of courage and innovation. Now that's not to say that we don't need to be incredibly disciplined because I think this requires perhaps even a level of discipline that we haven't seen in the past. But at the same time, we can't be so risk averse and cautious that we aren't willing to take necessary chances and risks. As we look internally at our organization, we have been Very well known for pursuing proactive care, which is how we label value based care and really thinking about how can we fundamentally change how we not only deliver care to make sure that we're being, being more proactive in that delivery, but also how can we modify the economics in a way to make sure that those incentives are aligned so that we are fairly compensated for the services that we offer while we're also driving down the cost of care to the populations we serve.
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B
Yeah, I've heard some, some system leaders say, you know, I'm, we don't want to take those risks right now. Other system leaders say, you know, take those risks. Are you kind of in the middle? Are you like safely take those risks?
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C
You know, it's a great question. I don't know that I would characterize it as safe. I think ultimately it's making sure that you have the right arrangements, the right partners, the right agreements. So, you know, it's, it's not a matter of, well, as soon as we get to a certain percentage of scale in risk based contracts, then, you know, from then on it's, it's, you know, easy, easygoing. I think ultimately it's being very thoughtful and pragmatic and not, not being safe in our approach, but being thoughtful in how we partner and engage and execute on these contracts to make sure that they are really well orchestrated.
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B
Yeah. And again, amid all these changes, could you dive a little deeper into how Intermountain is kind of deciding right now where to invest in its revenue cycle?
- [07:37]
C
In revenue cycle, yeah. So that's, it's a great question. So as you may know, and I'm sure many of the listeners are not aware, we actually just transitioned on September 6th so that our entire enterprise is on a single instance of epic. And prior to that time we had parts of the organization in epic, part of the organization in Cerner, actually the majority of our organization in Cerner. And then we had some ancillary areas that were even on some different EMRs. And so now we're all on one consistent platform. So that, that was obviously a massive investment, a large undertaking to make sure that we have a consistent platform. So we're still, even though things have gone well, we're still obviously digesting some of those changes. But what I would say is, although that is a large investment that has significant ramifications for Revenue cycle, that is not the only thing we're doing with Revenue Cycle. And through our partnership with R1, particularly in, in Utah and Idaho, they have been aggressively investing in, in technology. They've been partnering with other organizations to really see how we can implement technology and AI and to really streamline some of those processes. So some of it we're doing through, through our R1 affiliation and some of it we're doing independently as we look at really innovative technologies that can enhance and simplify the way that we approach our revenue cycle.
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B
And I'm sure keeping an eye on all of these incoming, you know, technologies, AI, it's a lot to consume. So how do you kind of sift through what's best? What, what works best for Intermountain? What's that thought process like for you?
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C
So we have, I would, we have a strong governance structure and I would call that from both our board governance perspective and our internal perspective. So at the board level, our Audit Compliance committee is very attentive to the sorts of technologies that we're evaluating and how we're incorporating those. From an internal perspective. 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 and any innovative solution that someone might hear about at a conference and just jumping on board, but having a thoughtful, circumspect approach to saying, all right, where do we just want to lean on our key platforms? So think epic, think Microsoft, et cetera. And where do we see opportunities that are truly differentiated that can speak to those platforms, but perhaps can bring in some niche solutions that otherwise wouldn't be available? But having a very, very robust process to make sure that we are thoughtfully reviewing those and incorporating those. Because you know, the last thing we want to do is create so much confusion and chaos in our, in our interest of innovating that ultimately it slows us down because there's just too much noise.
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B
Yeah. And like you said, it's. It's been a little over three months since that, that major EPIC integration into Intermount. Any lessons learned here, Anything that you would like to share with listeners, any updates you can give?
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C
Yeah. As you can imagine, we really thought long and hard about whether to phase in the implementation or whether to go all at once. As I mentioned, we had parts of the organization that were already on epic, but for those that weren't, we ultimately opted to do a one day transition on September 6th. And there was a fair amount of trepidation about that. As you might expect, it was a busy day. Yeah. But in retrospect, I'm very pleased that we went this way and ultimately allowed us to transition quicker. I think There were obviously a number of tickets and issues that needed to be addressed, and we're still in the process of mitigating some of those things. But the fact that we went through it all at once, we are cleaning things up as a system as we go, I think it's actually been quite a success story. It was a little antithetical to, I think, what a lot of people thought initially we should do because, like, well, let's test it out in a location and then let's just incrementally roll it out. But this has really been, I think, a successful implementation. What I would say is from a rev cycle perspective, I'd say we perhaps based on a lot of other EPIC peers, got off to a little bit of a slower start because there was so much emphasis, as it should be, on patient safety, on continuity of care. And although the coding and the billing was certainly important, we wanted to make sure that those other key areas were addressed first. So I would say we got off to a bit of a sluggish start on the rev cycle space, but since then, we have not only passed through what EPIC gauges as their, I guess, median expectation, but we continue to outperform. Now we're not, I would say, exactly where we want to be yet, but we have already seen the results of that coordination. And I would say the other thing, from a lessons learned perspective, there has been such tight collaboration between our business operations folks, our revenue cycle leaders and caregivers, and our clinical leadership that it's not a. Whose responsibility is this? Who should we point to to make sure this is happening? 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.
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B
Yeah, no, I mean, like you said, even going all in on September 6th like that, it sounds like, you know, everything has really paid off. And the integration, you know, was very successful just now. Something to kind of keep an eye on and watch as things continue, correct?
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C
Absolutely. No, we certainly have not declared victory. It is an ongoing effort. So.
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B
Yeah, yeah, no, definitely. Thanks for sharing those lessons there. Final question for you here. And again, we. The theme of our discussion today, we've definitely talked on a lot of unknowns, challenges across the industry. So could you share maybe over the years, you know, the last few years in your role as cfo, how it's even evolved during that time, just beyond finances and maybe the importance of some. Some communication, different leadership skills that you're experiencing and what also will be important in the next few months.
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C
It's a. It's a really terrific question. And I think the ability to adapt is more important, arguably, than it ever has been. Technology is evolving so quickly, the industry is evolving so quickly that I think clearly people need to bring their own unique sets of skills, their training, their expertise to the table, because that is a really necessary data point to inform these decisions. But the siloed approach that perhaps existed in prior iterations in the past, where you have a finance leader really specifically looking through a finance lens, an HR leader looking through an HR lens, a communications person looking through a communications lens, et cetera, et cetera, I think ultimately people need to bring those unique perspectives, but really problem solve as a collective. And I think that willingness to collaborate, look beyond your own sort of stereotypical area of expertise and really come together to say what is in the best interest of our organization and more importantly, the best interest of the people that we serve. I think that ability is more important than it ever has been. And I think the ability to continue to evolve. You know, I look at the CFO role and I've had the privilege of working for some. Some really good ones. And I see other leaders that have served in different capacities. I think those lines of accountability continue to blur. And so it's so important that people bring good collaboration to the table that they can communicate effectively, not only with their peers, but with those that they lead to drive an inspiring vision. Now, I'm the first to admit I wish I were a stronger communicator than I am, but I think that is something that we need to continue to work on because it's never been more important.
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B
Yeah, no, communication is definitely always key, but those are some really strong insights. I appreciate you sharing, Clay, and I'm sure I'm really looking forward to connecting again down the line, and I'm sure we'll have lots more to discuss. Never a dull industry. Healthcare.
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C
It is not. Yes.
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B
Well, thank you again, Clay. Always a pleasure. And, yeah, look forward to chatting soon.
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C
Thank you, Madeline.
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B
Thank you.