← Becker’s Healthcare Podcast
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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 Becker's Healthcare podcast. My name is Will Riley with R1. I am joined today by Mark Bale. Mark is the president and CEO of North Bay Health in California. Welcome to the podcast, Mark.
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C
Well, thank you. Will appreciate having me here.
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B
You bet, you bet. So to start us off, Mark, tell us a bit about your role. Tell us a bit about North Bay, the community that you serve.
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C
You sure? Yeah. So I'm the president and CEO of North Bay Health and I've been there since October of 2023. North Bay Health's a great independent regional community based health system. We're located in between San Francisco and Sacramento. So we cover pretty, pretty broad area. Napa County, Solano County, Yolo county, all the way up into Sonoma County.
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B
What's the, what's the community in the area like? Is it, is it rural? Is it urban?
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C
Yeah, so we're definitely in. When you look at the Bay area, there's about 15 million people in the North Bay there. It's definitely more suburban, more rural settings. Obviously there's a lot of agriculture, ventners, for example, in Napa and Sonoma. So it's definitely has more of a sort of a rural kind of feel to it at times.
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B
Okay, and what are some of the key initiatives and things that you're trying to do as a health system as you go into 2020?
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C
Well, I would say primarily one is we announced a couple years ago that we would have our ambulatory network strategy, which is really transforming our system from more of a hospital based system to definitely geographically dispersed ambulatory care, primary care specialty hubs, ASCs, you know, really helping prepare us for the future. And so that's a significant investment. We have to build out new locations, recruit more providers. And so that's been a huge focus for us in 25 and we'll continue into 26, 27. And the other one I would say is we're moving from Cerner to epic. That's a significant investment of resources, but also will help transform us into that ambulatory system.
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B
Got it.
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C
So that's another one. And then obviously we're just trying to deal with the challenges, the legislative challenges that are in front of us from the state of California at the federal level, really just trying to keep up with those and trying to make sure that our strategies and tactics are prepared for them.
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B
Got it. Thank you. That's great grounding. I'd like to start by talking a little bit about technology. Obviously you're in the middle of an EMR transition. I want to pose a question to you. It feels like historically healthcare has moved fairly conservatively when it comes to technology, right? Not necessarily been on the leading edge, but it also feels like that is a bit different with the adoption and implementation of AI based tools and technologies. And it feels that there's much more enthusiasm, much more pull for some of those technologies than maybe we've seen in healthcare before. Do you think that's true?
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C
I do think that's true. Sound interesting? You say conservative? Yeah, I think over the history in healthcare, traditionally we have not adopted the new technologies. In fact, even going back to the electronic medical record, we were sort of faced with penalties if we didn't implement it. So it's always been sort of kicking and screaming, sort of to adopt some of these technologies. Not, not with the healthcare delivery, you know, in terms of, you know, the technology and the ors and in the bedside, but definitely, you know, from a systems perspective. So I think in this new wave, as we talk about AI, it definitely does feel different. There feels like there is more of the, you know, the organization really wanting to find solutions, really wanting to more embrace this new technology. And every day it seems like there's, there's a little more hope. I think this time around that there are some solutions out there that will really get to, you know, some of the core frustration that our teams are having. So I agree with that. I think it's different today.
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B
And why, why is that? Why is that? Why is that more positive energy around? Is it just that the technology just works and so people see it immediately or like, what is it?
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C
Yeah, I think that that's it. I think people are now experiencing it every day in their own lives and they're seeing how they're transforming the way that they get their entertainment, the way that they order goods and supplies and just the way they connect with others and the way that they do their own research, it's changing. Everything's, you know, sort of happening so rapidly. They're sort of now waiting to see that in the work environment. And so I think that's where, you know, we're seeing the pull come from. You know, it's different when you, you're experiencing it and you can see the value of it, but you're not seeing it translating to your workplace.
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B
Yeah. Okay, so when you think about healthcare innovation, one of the things we think about is a couple of archetypes or ways that, that innovation can be delivered. Incumbents on one hand and let's call them insurgents on another. So incumbents, you've got large est, established health systems, established payers, large technology providers like the EMR players and so on. So they, you know, those folks have all the data, the infrastructure and so on. And then you've got insurgents like coming in with a different agenda, very maybe AI, native technology enabled solutions looking for different kinds of, different ways of working. When you think about innovation at North Bay, are you an incumbent? Are you an insurgent? Are you using incumbents or insurgents? Like how, how are you? Where are you in that mix?
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C
Yeah, well, we talk about that a lot and we have to be, because we're an independent, you know, system, we're not, you know, positioned to be the insurgents. We're really not going to be the pioneers in this space. We really have to be more like early adopters of technology that's proven. And so because we just simply would, we would spend a lot of money and energy and resources because there is that in any new technology or any new venture, there's a certain amount of that, you know, sort of trial and error in research and development and having to invest a lot of, a lot of money from the organization to find out that something might not work. And so we, we just can't really put ourselves in that position. So we will look to where there's been success in our environment. Now I'm not saying that we wouldn't, you know, take some, some bets on some things that we think will work and we're going to do that, but I think we're going to be very, very more, very much more reserved than maybe other systems, particularly the larger systems.
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B
And you're, I mean your, your, your EMR replatforming is a big initiative here too. Right. So that must play into your thoughts around the future of technology enablement at the health system. Clearly.
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C
Yes.
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B
Right. Tell us more about that.
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C
Yeah, it was a big driver for the decision to make the move. We really feel like, you know, that investment that EMR allows them, those, those technologies and that, that investment that's being made through EPIC and having seen that from the marketplace around us, we're now one of the only systems in California still on the system that we're on. So looking around us and knowing that our customers, our patients are all using EPIC has been a big driver for us. We know that they have the technologies that they've invested in in an ambulatory setting, which again is different than becoming a hospital based strategy. So that sets us up to have some of that technology that we would otherwise have to go and find in the marketplace to sort of bolt onto what we have today.
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B
Talking about that ambulatory strategy in that ambulatory setting and thinking about technology, what, what are you looking to do to make life better for the physicians and the patients? Right. That, that, that are coming together in those ambulatory centers using technology.
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C
We want to try to, you know, make it as frictionless as possible. Right. And I think that those interactions that our physicians have with, with the record has to change and it is changing. You're seeing that today with some of the ambient AI that we're using and we'll continue to have that with EPIC as we expand that. That's much different than it was 10 years ago. Our physicians were spending two, three hours documenting and going into the record oftentimes late at night. To have that technology available, that's going to be very meaningful to them. And they already see that today. The same thing with our patients. They want to be able to schedule, appoint, they want to be able to get the results, they want to be able to communicate with their, with their physician or app without having to wait. Everything needs to happen in, you know, in real time. And so those investments that we're making are on how do we create that type of experience that they're, that they have today and everything else they do in life. Right? Yeah. If you want to order food from a restaurant, you can do it on your phone and 45 minutes later it's at your doorstep. And you don't really have to do much but just, you know, scroll through the app, make the selection and meet them at the door. And so when you look at healthcare, you know that those are the things that we're up against. You know, we're going to have to figure out ways to provide solutions that, that feel like that.
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B
Yeah. How about on the administrative side and using AI or just new technologies there? Like in. Tell us a little bit about maybe some of your payer relationships and how they're playing out and potentially then the role of technology in making that relationship better if it, if it needs to be improved.
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C
Yeah, well, yeah, so we, we actually spend a lot of time with some of our payers, you know, trying to develop better relationships and trying to understand how they're approaching that with consumers, with their, with their members. Right. And how we can help work together to create a better experience. For example, we have some of our payers who were actively connecting with their members while they're in the, you know, sort of healthcare process to try to reach out to them, whether it be, you know, whether it's rehab or therapies or behavioral health, telemedicine. And to not have that connected into our system, to not have visibility to that creates, you know, this fragmentation of care. And so we're working with them. We all share in the same goal here. We're trying to, you know, create better outcomes. And so we have to work together on that. And those payer providers, wider relationships have, have been, you know, strenuous to, at the, to say the least. And so like any relationship, you have to invest in it. And so we are spending time with our payers, trying to meet regularly to have conversation about what's working, what's not working, what can we do better? And that's, I think, going to be important as we're going forward.
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B
If you look at other areas like that, you know, maybe that can help. As you think about maybe your epic implementation or other forms of technology, do you think that you can use technology much more in some of those financial processes than you have done? Right. It's always been a very manual kind of area and space, but it feels like it's ripe for transformation through technology. Yes, that payer interface.
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C
Yes, that's a payer interface in particular, no question about it. It's a very manual process. It's very frustrating process for the payers. It's very frustrating for the healthcare systems. It's frustrating for the patient. So I think that trying to figure out tech solutions there is going to be really important. And those, again, require cooperation and collaboration with each other to try to figure that out. Trying to figure out how do we take those repetitive tasks that our employees have today trying to process the revenue cycle for us and create tech solutions that can allow them to focus on, on the top priorities. Yeah, because ultimately what we're trying to do is we're trying to, you know, take that, whatever happened in our system and translate that into, you know, the, for the payer, what has happened so that we can get paid and so that, you know, we can, we can adjudicate that and create really a, a frictionless process for the patient. That's really the ultimate goal.
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B
Yeah, right. Right. Mark, bring us home. You talked at the start a bit about the legislative environment. Maybe we can end there because there's obviously pretty dynamic both at the state and federal level. Tell us about some of your concerns and hopes for that world in 2026.
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C
Well, again, you know, we're in the state of California and so there's a lot of regulatory requirements there in California and you know, we have a governor and a president that don't get along very well right now. So we're trying to, you know, sort that out what that' going to mean for us. Ultimately it creates challenges that on the again from a just a payer, from the payer side in terms of government, about 70% of our revenue comes in from government payer sources, either medical, which is Medicaid or Medicare. And both of those are have cuts on the table, significant cuts on those that we're facing. So when you talk about our financial strategies around that, we again we're trying to transform as an organization into from a hospital to ambulatory. So we're going to have to continue making those investments. But you also have to prepare well the way to prepare for that. When 70% are being subsidized by government payers, we're going to have to get really good at value based care. We have to be able to manage patient populations and take some value based arrangement or some risk based arrangement with those payers, with those government payers in order for us to be successful long term. Now this old model of taking the commercial revenue that's coming in and continue to increase that to the consumer to help offset we have in the government side is just simply not going to work. It's not a recipe for success. So we're going to have to invest in ways to manage patient populations and take risk.
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B
Mark, is there anything else on your mind as we, as we wrap up right now?
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C
No, I think it's exciting times. I mean I was just. Right now, you know, in San Francisco you can, you can get into a, you know, waymo at a taxi that has powered by AI and it drives you around the city and they're very prominent. You know, I use them all the time when I go into the city. I actually prefer them. And I think it sort of represents the sort of the excitement of what it could mean when we talk about technology in the future. But it's very, it can also be scary, you know, for healthcare systems again because traditionally we don't really embrace that. But I think if we can, if we can really keep this momentum going and start to use, you know, AI to help, you know, our frontline teams and our patients. I think we're going to be successful.
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B
Wonderful. Thank you very much, Mark, for spending time with us today. Thank you.
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C
Thank you. Appreciate having me here.
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B
Thank you. Thank you.