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- [00:02]
A
R1 is the leader in healthcare revenue management, helping providers achieve new levels of performance through smart orchestration. With more than 20 years of experience, R1 partners with 1,000 providers, including 95 of the top 100 US health systems and handles over 270 million payer transactions annually. If you want to learn more about how you can transform your revenue cycle operations, Visit us at www. R1RCM.
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B
Hello and welcome to the Beckers Healthcare podcast. My name is Will Riley from R1. I am joined today by Jim Heilsberg. Jim is chief Financial Officer at Tri State Health. Jim, welcome to the podcast.
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C
Thank you, Jim.
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B
I'm looking forward to talking to you. To start us off, can you tell us a bit about yourself, Tri State Health and the community that you serve?
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C
Yeah. I'm Jim Heilsberg. I'm from Tri State Health in Clarkston, Washington. We're a larger rural critical access hospital. Full service for all hospital services along with physician practices, both specialty and large primary care presence in the valley. The hospital has been there since the mid-50s and continues to be a very independent, entrepreneurial type facility. They have continued to provide services to the local community in a spirit that you don't always see in the current environment. We work with other area providers. It's a primarily rural environment, but it's a great environment to be in and we look forward to the future.
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B
Cool. Yeah. Tell us a bit more about the environment, the community that you serve. Tell us about some of the key priorities that you have for 2026 in terms of meeting their needs.
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C
So Trice, the valley is Lewiston, Clarkston. So we're right on the Idaho border. Lewis and Clark came through there and notoriously they identified, went all the way down to the ocean down the Snake river which meets the Columbia. So it's a long history of both port activity, a lot of agriculture. As far as serving the community, we serve not only the agriculture, rich in agriculture area that goes north, south, east and west, both grains and cattle. So there's a lot of historic and traditional values that are there. Our main focus is to continue to provide for those needs that are in the valley as best as we can. We don't do everything, neither does the other larger for profit hospital. But we do provide a lot of services that are needed for the valley. Our real goals are to continue to be able to provide all the services possible, expand where appropriate so that we can meet the needs of the community. As far for the future. One of the things that's happening is that we are expanding our surgery services the local orthopedic presence has made a change. The for profit hospital has purchased that orthopedic group along with an asc and we're involved in creating our own orthopedic group now where we were, both hospitals just used the one. We will continue to serve those that are physicians that are part of that orthopedic group. They'll continue to do services at our hospital. But we have almost 50% of the primary care population. Over time it's become clear that we both need our own presence and the ability to serve our physicians and our community. We are the provider of choice in the valley. The other thing that's happened that we're having to deal with is a primary care group was also part of that orthopedic group. They did OB and they were also purchased as part of the by the for profit. Our goal really is to continue to serve all the patients that want to come our way. Clarkston and Lewiston and the surrounding area, our general surgeons, we are expanding from basically two to two and a half physicians. We, because the OB providers with this transition decided that they didn't necessarily want to go work for the for profit. They've come to work for us with the exception of one. We don't deliver babies. But we're providing those services to the community for both OB and OB GYN because it's a needed thing to do. A lot of great opportunities that we see. And on the other side of that coin, nothing's free. So we are investing in infrastructure. We did remodel two clinics that we had on site for both OB and then ortho. And we're continuing to look to the future to say what do we do with our surgery building or sterilizing and processing area? We're expanding into that and we'll be adding an SPD in the near future looking at a surgery country building. But we're trying to figure out how do we fund all that. Some of our big challenges are saying how do we fund in this time where there's nothing that's certain. All, all of our revenue streams are at risk. With the big beautiful bill act relating to Medicaid and changes there, everything seems to be in flux.
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B
Yeah. Okay, so you've got big capital projects, you've got workforce projects. Where does. So where does technology fit in that agenda too? Right. Because that's moving quickly and you probably want to use to expand access and make life better for your providers as well.
- [05:26]
C
It's interesting in listening at this conference and others, one of the big Challenges I've seen over my career, 35, close to 40 years has been related to how many times we've talked about reducing revenue cycle cost. At the same time, we've had conversation of how do we it's evolved to how do we allow all of our physicians and our nurses, technologists, et cetera, to work up to their license. To me, technology is going to have to solve not only the revenue cycle, it has to solve all of our issues. I think that there are many initiatives that are out there that could be helpful. AI is certainly evolving quickly. Three years ago, four years ago, we implemented Experian and that product allowed us to rejuvenate our revenue cycle. We have Meditech Expanse as our main ehr and with Experian it allowed us to move a lot of manual workflows that we didn't find solutions completely in Meditech to much more automated and streamlined solutions. They were partial AI. We just implemented one of their modules which is Denial AI, which allows for work to be done prior to a claim going out. A AI tool tells the things that need to be fixed. The claims go out. If they're denied, they come back. And that that tool then builds both an understanding of what happened, looks at the needed fix and puts that back into the initial engine so we can fix the new claims that have been denied with different reasons and uncover new trends. It gives us a way to categorize all of our claims that came back in both a financial strategy. So with our largest claims and those that have the highest propensity to pay, that's a great example of what I see will develop. I think right now we're still in the infancy of AI. We're still having people tell what's going to happen. I listened to a solution yesterday which is about automated calling. It still has a pause when it thinks and just like we do, but different. And I think people pick up on that. I have listened to another one where it was related to a follow up for insurance. It was much more seamless. So I think in the next 24 months we're going to see major changes in, in both the language models that are out there, the other solutions that allow us to be much more efficient and find ways to manage the revenue cycle. But what I think we really have to find ways to deal with is how do we help all of our clinicians work up to license to eliminate those tasks that they don't have to be doing anymore that the AI can do for them?
- [08:05]
B
Yeah, okay, maybe let's talk about Both of those examples a little bit more. Let's go to revenue cycle first. Revenue cycle's been an area historically that has always been very labor centric. Right. It's always been human powered with technology aids and supports that have got sort of better and better over time. It does feel like, based on what you were talking about and what we've seen, that it, that the equation is flipping and it can now be technology driven and human supported. Right. It's a complete reversal of how it's been. Do you, do you agree with that? Do you see, do you see it going that way? That it will be essentially autonomous with human aid and human support?
- [08:45]
C
I think that we're beginning to see that cite a couple projects that we're working on. One is related to bots, so not AI where it is more of a programmatic workflow redesign and rediscover with electronic solution. Payment posting is a notorious issue. Where do the payments go? How do you get posted? There's clicks that people have to do. Keystrokes they have to do. In the end they provide no limited value. A human has been needed because we want to make sure it's right. Just implemented a payment posting bot solution which is nothing more than an Excel macro from the past that allows for keystrokes to not have to be done. The information can be both typed in and then copied into metatech by a bot that eliminated 40, 50% of a workflow. Yeah, that's significant. There are many workflows like that in the revenue cycle that if you can discover them and you can program in a way that don't. That it doesn't regularly break. One of the big challenges is any macro. Anybody that has ever done a macro in Excel knows that it can break if you bring new data, a new data set, new other factors in. We see that and so we're experimenting with old tools in a new way. AI in theory is going to provide a different set machine learning. So the ability to merge bots with AI in the future can make it much more efficient. That's where we're going to see a change right now. We're having to create which is timely and it has potential to break. Right?
- [10:21]
B
Yeah. Okay. And how about on the clinical side? You talked about that too. Using technology to make clinicians lives better. Obviously you've got some advantages as a, as a local, independent, not for profit provider that clearly are attracting providers to you. But like how are you trying to enhance their experience of working with you?
- [10:43]
C
I, I think that there we're doing A lot of things to work to expand in traditional ways, which is to look at their workflows and understand what can we do within metatech. What I think we will see in the next 24 to 48 months is something that allows us to take. They're no less manual than other people's. They do typing, etc, but there's the algorithm or the perspective that they're different. What they do is, it is special but what they do is in a way that it can't be duplicated. I think that there are many things when we look at the new solutions that are relating to their dictation, relating to listening in on their conversation, creating coding that could not be done before. I think we're starting to see the opportunity where we can help our physicians, where we can help our nurses. We can eliminate manual work that they do to allow them to be much more efficient, see more patients, allow for our nurses to actually work up to their license. Maybe at some point there will be less in the same way if there's less steps, but it's, it's yet to be discovered. Yeah.
- [11:50]
B
Okay. Okay. And let's, let's round it out then. Jim with a view on patients and how do you continue to put the patients at the heart of the experience? What are some of the things that you're doing to make patients lives Paranesia.
- [12:05]
C
Yeah, like every hospital we have press ganey we have other solutions that record, you know, what they've felt about the experience. I think that as we continue down the AI path we will be able to have more of our caregivers be more, more consistently focused with the experience during the stay. We work at trying to get that connection now. It's what allows us to have our ratings that we do. We're one of the few that received the CMS rating is, you know, a five star for the state of Washington doing a number of things right. On the outpatient side, we have a lot of our staff that is equally as focused, but it's not as easily seen as some of the ratings. But we work hard both to connect with them, with AI, call them ahead of time, provide opportunities for fitting them into schedules. We have a large minor care presence that allows people to get in if they can't get into physician through a traditional way. There's many different ways that we continue to work to try to get, allow the patients to be seen when they're most ill, when they need to see somebody along with then how do we get when they're trying to get in to see a specialist to have their time be valued and place them in a spot, in a queue. That's more efficient for them and us.
- [13:19]
B
Wonderful, Jim, bring us home. Is there anything else that you want to bring up that we haven't talked about?
- [13:26]
C
I think that in general, as we look at healthcare, we always have to make it personal. If we don't experience healthcare individually, it's hard to make it personal. Our caregivers are on the front line. They're able to see that every day. As support staff, one of the challenges I've seen is how do we continue to gain that experience? I fell into healthcare. I never sought it out. It's been a great journey that's allowed me to actually make a difference where I don't see that I would have in other industries. I'm not producing a widget. We're not. We're producing solutions that allow people to get at times healed, to have their life better than what it was before. And I don't know of a greater career than you could have than doing that.
- [14:13]
B
Jim, thanks so much.
- [14:14]
C
Thank you, thank you.