← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Keisha Downes, MBA-HM, RN, CCDS, CCS, Vice President of Mid-Revenue Cycle at Beth Israel Lahey Health
00:10:30
Loading summary
Transcript18 lines
- [00:00]
A
This is Scott Becker with the Becker's Healthcare Podcast. We're thrilled today to be joined by a brilliant leader. We're joined today by Kesha Downs. Kesha is with the Beth Israel Leahey health care system and just has had a tremendous career. Kesha, can you take a moment and tell us a little bit about yourself and some of the work that you do in revenue cycle?
- [00:23]
B
Of course. So like you said, my name is Kesha Downs. I am the vice president of Mid revenue cycle for Beth Israel Leahy Health. We are a 14 hospital system here in Massachusetts and providing care across the spectrum. Academic medical facilities, community hospitals, and also some specialty care. So really excited to be a part of this system.
- [00:49]
A
Well, thank you. And talk about sort of trends that you're watching in revenue cycle. I know you've got this vast split. Insurance costs are of course going up, but between commercial insurance, governmental pay, and then people paying for themselves, what's that balance that you see? And are there different trends or challenges in different areas, commercial versus governmental versus individual pay?
- [01:12]
B
Yes, you know, I think we're keeping an eye on all those things, especially with so much that's going on in the government right now. And when it comes to what's being allowed and not allowed, of course we're keeping a close eye on telehealth and how that's going to impact how we're able to provide the care on that spectrum. Also, you know, even things like hospital at home, you know, not having access to that anymore. Other trends that we're thinking of, especially when it comes to the payers and how they're interacting with us, is denials and how we're better understanding what we are being reimbursed for and what we're not being reimbursed for. And you're. We're almost having to take a different approach to this and being more proactive and better understanding how we can try to send out that claim as clean as possible versus being reactive and having to try to determine what to do after we've already gotten the denial.
- [02:08]
A
No, thank you. And I hear so much that people used to put up real premium, get the claim out, then work the claim. Now there's so much more stress on getting the claim out clean to begin with so that the payer doesn't screw around with it. Give us a sense of how that's changed over the years.
- [02:24]
B
Yeah, you know, the volume is just exceeding the people that we have to do the work. And I think that's where we seeing such a burst when it comes to technology in this space and having AI and machine learning be able to help our staff be able to create these appeal letters and like you said, being able to get the claim out clean to begin with. So I think we're in a space right now when it comes to revenue cycle that we have to have technology to be able to support all these efforts.
- [02:55]
A
And how much is that evolution happening? How quickly is that happening with technology plus people? And are there lots of rote tasks that can be put through to AI and automation or what, what are you sort of seeing there and what, what's going.
- [03:09]
B
Well, I think that it's happening almost faster than we can get our hands around it. Right. Like we have all these great technology that's out here and trying to understand for your particular system where it can be best used and, and how it can best streamline and optimize takes a lot of time, takes a lot of data research, better understanding. So I know in our space we're looking at, you know, we have the AI scribe, so that's helping with the documentation, making sure that the documentation is as optimized as possible. We have, you know, coding solutions that are helping our coders be able to select the codes that need to be selected that are going to hopefully make that claim as clean as possible. We have technology in the pre bill space again, just kind of that, that last check before it goes out the door, making sure that there's every opportunity that we should be considering and an accurate reflection of what's happening. Have we done that? And then you get to the back end. You know, when we do get that denial, having AI be able to review that denial letter, review the medical record in totality and then help draft a letter is significantly helping with the administrative burden.
- [04:29]
A
No, thank you very, very much. And that's really been a quick evolution and as you say it sometimes it's moving faster than expected, but it's needed because staffing is so challenging and the payers are so aggressive as well that this evolution towards technology is so, so important.
- [04:44]
B
For sure. I think we, we've gone from a time where we would sit back and wait to see what the response would be and, or wait to see what would come back to. Now we have to anticipate and we have to be more pro. It's definitely caused an acceleration and a heightened awareness of what's out there when it comes to technologies just so that we can stay ahead of the game.
- [05:06]
A
Thank you. And is there a particular technology that you're particularly excited about that you're watching or things that you're. You know, we. We don't, like, talk about anything that you hate because we don't want to get sued. But. But is there anything that you love that's going well?
- [05:18]
B
You know, I don't think there's any that I hate. I won't name any names, but, you know, I think it all comes down to what you need. So I'm really excited about some of the autonomous coding solutions that are out there. And it's not so much so that we are cutting out people from doing the work. You know, if we have technology that can help some of these, you know, mundane coding practices that are pretty straightforward, and we can have the technology help support that, I say, why not? But we have to better understand what that means. So when someone comes to you and says, you know, we have this AI coding and it can do this autonomous coding, you have to know the right questions to ask. You know, what does autonomous mean? What is that percentage? What is the quality around that? What is the accuracy around that? And when we're able to better understand all of that piece, you know, you can get really excited about what it can do for you. The same thing with some of these, you know, like I said, the appeal letters. It is so exciting to see, you know, you think just like, you ask a question to, you know, your favorite OpenAI or your. Your favorite tool that you use, you can have it generate that letter in. In seconds sometimes. So I'm really excited about how some of this technology is out there and that can help. I. I think one of the coolest things, Scott, you know, you've probably heard of these rpa, like the bots that are able to call the insurance companies and wait on hold so that, you know, your staff don't have to do that. There's some really cool things out there right now.
- [06:47]
A
Oh, yeah, 100%. And so helpful. Because, of course, even like today, hey, when I'm on hold with Expedia to change a flight, I might want to shoot myself. And that's only waiting eight or nine minutes today. I was in the area of Verizon for an hour, and, you know, and then, of course, you get off the phone if you've been waiting and they can't solve the problem. And so, yes, no 100%, the use of those types of tools. Fantastic. I think I need them to call Expedia and everybody else talk a little bit about, as you look to this next year, Keisha, what are you most focused on and excited about Heading towards the end of 2026, 25 and into 2026.
- [07:22]
B
You know, I think I'm excited about a lot of things. Part of that excitement is I'm, I'm still new to the organization. I've just hit 10 months, so I'm still in that phase where I'm looking at where we are centralizing work, centralizing teams, you know, helping them, helping my teams understand where in the organization we have cross functional support. So that's been really exciting to kind of help standardize those things. You know, being able to standardize KPIs and data points when I first came on and to now see the, the fruits of my labor, I guess you can say where we're really hitting those marks. And it's really because of all the work that my teams have been doing. So that's been super excited, super proud about that. And then, you know, just looking forward, looking at what other technology we can be considering. You know, there's an appetite for having AI come in and help support our teams. And I'm so excited to have such a forward thinking leadership team at BILH when it comes to that. So it gets me excited and it makes me think outside the box of how I can have some of this, some of these solutions come in and provide some support and help.
- [08:38]
A
No. Fantastic, Kesha. And one more thing, you've had this terrific leadership career. You've been a lifelong learner. Just fantastic. Talk for one moment about what advice would you give to emerging leaders.
- [08:51]
B
So there's a couple things I'm happy that you touched on the point about being a lifelong learner. You know, I'm still in school now, I'm wrapping up my doctorate at Northeastern University. And that was not so I can get a job down the road. That was for me to be able to have a structured way to learn how I can better lead my teams. So, you know, never be afraid of learning. You know, remain curious. And then I would also say to connect with leaders that you admire and just reach out to them, ask for coffee and learn where they, how they got to where they are. I've done that plenty of times. And you know, thankfully leaders are usually very generous with their time when they have someone who has, who's an aspiring or upcoming leader and want to know what they can do. Some of the consistent things that I've heard when I've had these coffee chats is that no one had a straight path. So I would just remind everyone to, you know, constantly thinking around you, looking around, you don't be afraid of those stretch assignments. Don't be afraid to, you know, have those cross functional relationships, because what will happen is you'll have such a wider understanding of operations and things around you, and it just puts you in such a better position to be a strong leader.
- [10:12]
A
Keisha, I could not agree more with that wisdom, and I can't tell you how thankful I am for you joining us today on the Becker's Healthcare podcast. Thank you so much for joining us and what a pleasure to visit with you and what a terrific career. Thank you so much for joining us.
- [10:26]
B
Thanks for having me.