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- [00:01]
A
This is Madeline Ashley with the Becker CFO and Revenue Cycle podcast. And I'm thrilled to be joined today by Derek Goble, CFO of Altrue Health System. Derek, thanks for being on with me.
- [00:11]
B
Hey, great to be here.
- [00:13]
A
So, Derek, before we kick it off, do you mind sharing with our listeners a little bit about yourself, your background and Altru?
- [00:20]
B
Yeah, happy to do so. So I'm CFO here at Altru. We're based in Grand Forks, North Dakota, which we have locations really across northeast North Dakota, northwest Minnesota. And it's a broad span. We, we span about 400 miles from east to west 20 counties, and we cover about 200,000 lives in that, in that span of geography. It's a, it's a great community. And I'm certain lots of folks haven't had a chance to visit North Dakota or northwest Minnesota. I encourage everyone to do so. And, and while we're certainly rural in comparison, you know, to some larger metro areas, there's, there's always a lot going on in, in this community and, and it's a, it's a great place to, to live and, and raise a family. We're, we're home to University of North Dakota. The Fighting Hawks were sister city to Grand Forks Air Force Base, and lots of new business and lots of things happening and really growing in the right direction to me.
- [01:31]
A
I would like to, I might come visit.
- [01:34]
B
Well, you're welcome anytime.
- [01:36]
A
So, Derek, can you share just a little bit more about your background too? More about you?
- [01:40]
B
Yeah. So I've been here at Altru for 15 years. I started in planning and development, moved over to performance improvement before I, I joined the dark side in finance as an analyst. That was in 2015. And from there I moved into, into leadership. I was, I was named manager of finance and then on to director and then was named as interim CFO in, in January of 2023, and then was, was selected as the permanent CFO in August of, of the same year. So been. Been a, a Grand Forks kid pretty much my whole life. I was actually born right here in Grand Forks, so.
- [02:21]
A
Oh, that's amazing. Well, thank you.
- [02:24]
B
Great to work at a place that, that you watched grow with you.
- [02:27]
A
I can imagine. No, thank you so much for sharing that. So. So Derek, I'd love to dive right in. And here, you know, you said you've, you've been with the system for, I think you said 15 years. So could you share maybe just three, two to three trends that you're very closely following and why you're following These so closely and also like how they might even affect the system.
- [02:48]
B
Sure, yeah. And two to three was limiting. There's a lot going on in healthcare today. Right.
- [02:53]
A
This is true.
- [02:55]
B
So top of mind has to be reimbursement. Right. And whether it's the big beautiful Bill act or changes in the reimbursement space, there's just a lot going on on the reimbursement side and I think we're, we're, we're really undergoing, it's a fundamental transformation and while challenging, there's some necessity here. We, we hear about the fiscal cliff that's always looming, the Medicare trust fund running out of money. I think the current, current estimates are 2033. Well that's, that's really right around the corner. We have aging populations, we have rising debts and so it's not sustainable. There has to be some change and that's going to come with challenge for providers, for folks really all around us and it makes us hyper vigilant when we look at our financial sustainability. A little more on reimbursement. You know, Medicare Advantage continues to grow and that might seem attractive to, to patients. Maybe you've got a low premium but there's some hidden risks in there and certainly we see challenges with prior auth and denial rates and the increased administrative burden for some of those plans and that's not seeming to improve at anytime soon. But it's just something we're going to have to continue to work through and collaborate with payers to, to get the best product that we can for patients.
- [04:35]
A
Definitely something worth following and keeping an eye on.
- [04:38]
B
Yeah. And then you know lastly on reimbursement, the shift from fee for service to value based, you know, absolutely the right path. Of course everybody wants quality and the patient experience to improve. No question about it. And so but that, that might come with some good intention but certainly we see disparate metrics across plans and we see some, some cost to implement some it burden and some new things that, that maybe weren't originally intended in the value based shift. And, and really we, we, we have a great relationship with, with payers in our market. I'm you know, very, very pleased with our ongoing execut efforts to continue to improve outcomes but that there definitely is a challenge to make sure that we're all working towards the same outcome and really intending to just give patients the best experience that we can.
- [05:37]
A
Yeah, I appreciate you sharing a little bit of a deeper look into some of the trends that you're following in the world of this ever changing Healthcare industry. So, Derek, I would also be curious to hear some things that are most exciting to you right now at altru. And I know we've, you and I have discussed this previously, but in late June of last year, Common Spirit, you know, revealed it was discussing to sell its critical access hospital in Devil's Lake, North Dakota to altru. So I would be curious to hear any updates that you have on this acquisition right now. How things are going.
- [06:11]
B
Yeah, things are going really well. Common Spirit has been a fantastic collaborator as we work through the, the transition. Devil's lake is about 90 miles west of, of Grand Forks. And we actually, we already operate a pretty sizable clinic with primary care and some outpatient services, renal dialysis in that, in that space. In fact, it's connected to the hospital that we're working to acquire. And so we're, we're actually just waiting on, on some activity from, from Rome of all places, because ALTRU is acquiring from the Catholic system their common spirit. We've got to wait for that process to happen there in the Vatican to get that final sign off, but we've, every document that we can has been signed. We're eagerly awaiting the result from the Vatican to execute that transaction. And so both sides are anxious to see that come to fruition. It's going to be a really great thing for the, for the community. That was lake.
- [07:19]
A
That is so interesting. It's not every day you say you're waiting to hear back from the Vatican, right?
- [07:24]
B
A kid from Grand Forks, North Dakota is waiting for documentation from the Vatican.
- [07:28]
A
Wow, that's awesome. Well, yeah, no, it sounds like a very exciting acquisition. Any advice you might have for other, you know, finance leaders looking to do similar acquisitions?
- [07:39]
B
You know, I think we, when we think about growth or sort of that direction for altru, our strategy has been very focused on keeping care local with local independent control. ALTRU is an independent organization. We're not affiliated with any large system. And so we know that that's important here in North Dakota. We're fortunate that our state also feels that that's really important in North Dakota. And so we've explored lots of different avenues to cut the cost from healthcare, but continue to keep independence and serve the population that we need. And I think we also recently joined the Rough Rider Network, which is a clinically integrated network here in North Dakota of about 25 hospitals. And that helps keep critical access hospitals and us as a PPS hospital independent of each other, but able to share resources and ideas and think about ways to improve, improve the delivery of health care in North Dakota.
- [08:36]
A
So, you know, once you do hear back from the Vatican saying everything is a go, what's the next step?
- [08:43]
B
Well, the next step is actually the, the transition of the staff and the providers that work there in Devil's Lake onto, onto the Altru team. We've got some onboarding planned. We've got EPIC implementation expected in Devil's Lake in the basically the next moment once we have that acquisition done. So it'll go pretty rapidly. We've worked through, we've worked through the transaction documents and details and ultimately waiting for that final piece. So it should be a very quick transition.
- [09:17]
A
That's awesome. Anything else you can share? Just about how you're looking at growth at Altrue over the next maybe 12 to 24 months or anything else that's exciting to you right now?
- [09:27]
B
Yeah, I think the different ways that folks still receive care, I should say telemedicine and virtual care is certainly the future. I think organizations that really lean into that IT sustainability. Altru is the host of about 16 community connect sites under our EPIC platform across North Dakota and Minnesota. And we, we see that connection as a way to again stay independent but see some growth across the space. But without having that IT look or that forward looking IT strategy that we have, I think we'd be pretty short sighted. And so we're leaning into automation and AI in our Scribe program and some of our back office functions. And, and while most of that's going to reduce that cost side, it helps to then use those resources to focus on access and growth as opposed to running the, running the background daily operations that comes with running a system of our size.
- [10:40]
A
Well, Derek, it sounds like such an exciting time right now at Altru and I appreciate you taking the time to connect with me and I'm excited to talk to you again down the line.
- [10:50]
B
Yeah, happy to be here. Thanks for the time today and look forward to talking again soon.
- [10:57]
A
Of course. Same here. Thank you.