Michelle Joy, President and CEO of Carson Tahoe Health

Summary

---

Podcast Summary: Becker’s Healthcare Podcast

Guest: Michelle Joy, President & CEO of Carson Tahoe Health
Host: Will Riley
Date: January 14, 2026
Episode Theme:
A discussion with Michelle Joy about leading a rural, independent health system in northern Nevada, highlighting behavioral health initiatives, workforce culture, financial challenges, and technology adoption—especially AI—in healthcare operations.

---

Episode Overview

Michelle Joy, President & CEO of Carson Tahoe Health, joins Will Riley to discuss the priorities and challenges facing a not-for-profit, rural health system. Joy shares insights into behavioral health strategy, the organization's unique culture, financial pressures due to government funding, and the navigation of AI technology for clinical and administrative transformation.

---

Key Discussion Points & Insights

1. Introduction & Background ([00:49]–[02:44])

• Michelle Joy summarizes her career path: 11 years at Carson Tahoe Health (3 as CEO, previously COO), prior executive experience at Banner Health.
• Carson Tahoe Health:
  • 200-bed acute care hospital with behavioral health services
  • 100 employed medical providers & 20 ambulatory care sites
  • Serves ~200,000 people primarily in rural northern Nevada (“eastern Sierra front”)
  • Sole acute care facility for a broad region beyond Carson City (state capital, ~60,000 pop.)

2. Strategic Priorities for 2026 ([02:44]–[06:37])

a. Behavioral Health Crisis Response

• Major focus due to Nevada’s ranking 51st in the nation for youth mental health.
• Investments in new adolescent inpatient beds, youth crisis stabilization centers, outpatient spaces.
• Launch of “Carson Tahoe Vehicles of Change”—mobile outreach similar to “ice cream trucks,” equipped with engaging activities:

  “Really trying to give these kids an opportunity to create versus just always ingesting off their phones and giving them tools to build resiliency.”
  —Michelle Joy [05:11]

• Includes a mobile soundstage with a built-in podcast studio to engage youth creatively.

b. Workforce & Culture

• 2,300+ employees; distinct family-like culture.
• Employee engagement is a key differentiator:
  • Recognized by Forbes and Beckers as a top Nevada and healthcare workplace, and a top female-led workplace.
• Focus on retention, internal growth, and maintaining “Carson Tahoe family” ethos.

  “You're becoming part of the Carson Tahoe family.”
  —Michelle Joy [06:04]

c. Financial Viability

• Significant uncertainties from Medicaid and government funding:
  • 75% of revenue is government funded
  • Risks tied to Medicaid cuts, 340B changes, site neutrality
• Close scrutiny of cost structure and profitability, with an openness to new partnerships or affiliations.

3. Technology & Artificial Intelligence ([06:37]–[12:45])

a. AI Adoption in Clinical Operations

• Strategic focus on “transform and innovate”
• Implemented ambient AI for documentation, replacing remote scribes in the medical group:
  • Mixed adoption: Primary care more satisfied; tool less suited for specialists.
  • Major benefit: Physicians finish documentation more quickly.

    “They're leaving at the end of the day... do a quick review, sign off on it... giving them a little bit more balance.”
    —Michelle Joy [09:26]

• Governance challenge: Managing multiple AI pilots across independent physician groups, ensuring compliance, IT safety, and patient protection.

b. AI in Revenue Cycle & Administrative Processes

• Exploring future use of AI in revenue cycle management; not yet implemented due to resource constraints.
• Recognizes the shifting dynamic as payers increasingly deploy AI:

  “How do we protect ourselves within that space and making sure that we have all the coding and the documentation that is needed so that it doesn't get kicked out by the payer's AI?”
  —Michelle Joy [12:24]

• Sees AI as “a game changer” for efficiency and payer relations, but with workforce retraining challenges:

  “We want to keep them within the organization wherever we can... Let’s retrain and use them where we can. But change is always hard, especially when you have folks that have worked for the organization 15, 20 years.”
  —Michelle Joy [13:02]

c. AI Governance & Board Education

• Developed a governance committee spanning compliance, IT, and medical leadership.
• Board is actively engaged, seeking education on AI’s impact on workforce and operations:

  “Our board has asked us to look at...what are the future workforce implications and how are we going to adjust as potentially positions change, positions are no longer there.”
  —Michelle Joy [10:54]

4. Challenges with Payer Relations ([14:11]–[16:01])

• Longstanding “battles” with insurance payers using AI claim editors; significant financial impact for a small hospital.

  "We were negotiating trying to settle around $4 million in unpaid claims. The payer views that as...not substantial impact. But for us that's a huge impact to our organization because of our size."
  —Michelle Joy [15:13]

• Persistent advocacy to secure fair payments and “fight back” in negotiations as a smaller provider.

5. Looking Ahead—Patient Care and Community Trust ([16:01]–[17:00])

• Commitment to 75 years of serving rural Nevada.
• Primary goal: Meeting community needs, restoring and maintaining public trust in local healthcare post-COVID.

  “Just making sure that we are doing the absolute very best that we can for our community and that they know that and trust us with their care.”
  —Michelle Joy [16:47]

---

Notable Quotes & Memorable Moments

• Youth Outreach Innovation:
  “Our sound truck actually folds into a soundstage, has a podcast studio built in the truck.”
  —Michelle Joy [05:08]

• On Technology Adoption:
  “This is our first for everybody first try at this. And so I’m sure it’ll continue to change as others gain more learning too, and we do as well.”
  —Michelle Joy [09:57]

• On Workforce Transformation:
  “We have a lot of folks that have worked for the organization 15, 20 years and now you’re going to ask them to learn something totally different.”
  —Michelle Joy [13:08]

• Financial Pressure as a Small Provider:
  “We just were that little organization that just keeps nipping and fighting back wherever we can because every dollar makes a difference for us.”
  —Michelle Joy [15:52]

---

Timestamps for Key Segments

• [00:49] Introduction & About Carson Tahoe Health
• [02:44] Strategic Priorities for 2026
• [06:37] Technology & AI in Clinical and Administrative Operations
• [09:37] AI Governance and Board Involvement
• [12:45] AI in Revenue Cycle and Payer Relations
• [14:11] Challenges with Payers & Financial Pressures
• [16:01] Aspirations for Patient Experience and Community Trust

---

Summary in the Guest’s Voice

Michelle Joy’s leadership perspective reflects both pragmatism and creativity, as she addresses the mental health crisis with innovative programs, values a deeply connected workforce, and balances new technologies with the enduring realities of rural healthcare. Her candidness about both operational hurdles and aspirations for community trust makes this episode especially compelling for anyone facing similar challenges in independent or rural health systems.

Transcript

[R1 Representative]

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.

[Will Riley]

Hello and welcome to the Becker's Healthcare Podcast. My name is Will Riley from R1. I'm joined today by Michelle Joy. Michelle is president and chief executive officer at Carson Tahoe Health in Nevada. Welcome to the podcast, Michelle.

[Michelle Joy]

Thank you, Will.

[Will Riley]

I'm looking forward to talking to you today. To start us off, tell us a little bit about yourself, your background and tell us about Carson Tayo Health.

[Michelle Joy]

So, Michelle Joy, President and CEO of Carson Tahoe Health. I've been with the organization for 11 years now, three as the CEO and prior to that as the Chief Operating officer. My past background prior to coming to Carson Tahoe was working for Banner Health in multiple different locations and a variety of executive leadership roles. So have been on the large health system side and now have the opportunity with Carson Tahoe to lead a small program, private, independent, not for profit system. So we are comprised of a 200 bed acute care hospital that includes behavioral health services as well as an employed medical group with 100 physicians and apps with about 20ambulatory care sites spread throughout northern Nevada, really Carson City, the surrounding rural community. So taking care of that eastern Sierra front.

[Will Riley]

Got it. And your community that you serve is predominantly rural, would you say? Or what's, what's the demographic and population sort of mix?

[Michelle Joy]

Yeah. So Carson City, state capital of Nevada, is roughly 60,000 individuals. And then there's a large swath of rural Nevada to the east and south of us. So we tend to take care of that area as the, the only acute care, sole community hospital for that area. There are several critical access hospitals in those rural counties, but we're the main acute care facility. We're 20 minutes from Reno, but tend not to be in that Reno market. So our total service area population is about 200,000, mainly rural.

[Will Riley]

Got it, Got it. Okay, great. Thank you for the background. And tell us a little bit what's on your priority list for 2026. What are some of the initial initiatives that you're pursuing?

[Michelle Joy]

This is perfect timing because we have been working through our strategic projects with our board as we finalize our budget for 2026. So one of the areas that has been a key Focus. The last couple of years is really around behavioral health. So Nevada ranks 51st in the country for youth mental health services. Youth mental health is a crisis across the country. Definitely more than a crisis in Nevada. So we have made huge investments over the last really year with support from the state of Nevada to open adolescent inpatient beds, a youth crisis stabilization center, outpatient treatment space, and then we have what is called Carson Tahoe vehicles of change. So not your typical mobile outreach clinic concept. You really have to think of these as ice cream trucks. Bright colors, lots of activities, whatever we can do to draw in the kids, break down the stigma and be able to connect with them through sound, food, play, art. So our sound truck actually folds into a soundstage, has a podcast studio built in the truck. And so really trying to give these kids an opportunity to create versus just always ingesting off their phones and giving them tools to build resiliency. And just, you know, kind of thinking back to probably when we grew up as kids, the time we spent outside. And so huge initiative for us, something that we're really excited about, has tons of community support. So that's number one. The other piece is looking at our people and our culture. So we've made a lot of investments in our workforce. We have over 2,300 employees. What differentiates us from a market perspective is we really try to focus on family coming to work at Carson Tahoe. You're becoming part of the Carson Tahoe family. And so we've seen that play out through employee engagement surveys, recognitions that we've received. So this year we're a top Nevada employer by Forbes. Beckers has recognized us as well. We're a top workplace in Nevada, top healthcare workplace, top female led workplace. So we're really leaning in to how do we continue to grow our own and retain all of our great employees. So that's our second initiative. And then obviously with the OBBA facing us, what's the impact the Medicaid cuts are going to have along with potential 340B changes, site neutrality. So the board has really asked us to look at what's our cost structure, what's our service line profitability, where can we expand into new partnerships, collaborations, affiliations? We are 75% government funded.

[Will Riley]

Yeah.

[Michelle Joy]

And so any changes in any of those programs really has a huge impact to us.

[Will Riley]

Very good. So you mentioned efficiency, for example. Let's key in on that perhaps, because I want to ask you a bit about technology and the adoption of technology at a facility or health system like Caster Tahoe how are you thinking about the adoption of AI technologies? Because it seems to offer promise in terms of finding efficiency in areas like supporting clinicians and their care for patients. Some of the administrative processes that support the back end, like revenue cycle, for example. How are you looking at.

[Michelle Joy]

So we. One of our strategic pillars in our 2020, 2030 strategic plan is transform and innovate. And so this falls right into those initiatives. We have brought in an ambient AI product for our medical group. We use that to replace live remote scribes, which absolutely brought a significant cost savings to us on the medical group side, mixed adoption, depending on whether you're primary care or specialist. But that is our first sort of step into AI. We have some independent groups that come into the hospital or are hospital based that are also piloting their own AI products from an ambient AI perspective. And so we have really tried to figure out what's that governance structure when there's outside groups bringing in different technology. And then we know that probably the next area that we will expand into is revenue cycle. We just haven't had the time or the resources to really drill into that piece of IT yet.

[Will Riley]

You mentioned some physicians using it, adopting it, adopting enthusiastically, others less so. Can you tell me more about that?

[Michelle Joy]

Yeah, I think for our specialists, the tool that we implemented was really primary care based and so it didn't necessarily capture the information in a way that was beneficial to the specialist. We know through the vendor that they continue to update and refine the product, that it will get easier for those specialists. But the initial feedback coming from our providers is they're leaving at the end of the day. They're not having to stay hours later trying to get all their notes completed. Like they can walk out of the room, do a quick review, sign off on it and be done with that chart and then move on to the next one. So it really has, I think, improved their productivity, but just also their own well being by giving them a little bit more balance.

[Will Riley]

You brought up the topic of governance and different solutions sort of popping up. Can you tell us more about how you're thinking about governance of some of these new projects?

[Michelle Joy]

Yeah, so we not saying that we've done it right, but we have really tried to identify who within the organization, from our compliance officer to our IT director to our cmo, making sure that we have the right group of individuals reviewing everything. It is constantly evolving on what's the consent form, what's the communication, is the technology safe from a network perspective? And so really trying to make, make sure that we're protecting the organization, protecting our patients with that structure. And this is our first for everybody first try at this. And so I'm sure it'll continue to change as others gain more learning too, and we do as well.

[Will Riley]

Yeah, I can imagine it's bringing new conversations into your C suite leadership meetings as people are looking at this from their different vantage points.

[Michelle Joy]

Yeah. And really also a lot of credit to our board because they have asked for more information, more education around AI really, not just the technology part, but what are the future workforce implications and how are we going to adjust as potentially positions change, positions are no longer there. What are those positions that might be replaced by AI? Those are all questions that our board is asking. And so in early 2026, we will be doing a deep dive with the board into implications of AI.

[Will Riley]

It feels like you mean you touched on it on revenue cycle being an area where it's traditionally been very labor driven with technology playing a support role. But it feels like that equation can be flipped with this technology, with this advancement. Right. That it can be technology driven with labor humans playing us playing a support role now.

[Michelle Joy]

Yeah, absolutely. And especially when we look at the payer relations that we have and the amount of AI that we see the payers starting to use and how do we. How do we compete? I shouldn't say compete, but how do we protect ourselves within that space and making sure that we have all the coding and the documentation that is needed so that it doesn't get kicked out by the payer's AI and then we spend all that administrative burden trying to resubmit and justify what we're doing. And so it's definitely a huge, huge opportunity and could be a game changer in that space.

[Will Riley]

What are some of the ifs you think about that and imagine that future. What are some of the hurdles that you might have to get through with your own workforce and with your payer relationships as you sort of try and do this?

[Michelle Joy]

I think from a workforce piece is finding ways to make sure that folks know we want to keep them within the organization wherever we can, and that we are not looking at just eliminating those bodies, but let's retrain and use them where we can. But change is always hard, especially when you have. We have a lot of folks that have worked for the organization 15, 20 years and now you're going to ask them to learn something totally different. And so especially for us, oftentimes when you're in a large system, a lot of that rep cycle team is concentrated and consolidated at the Corporate office system level. But all of these folks are living in our community. We see them every day. And so making sure that we're taking care of our staff through this change. And then I think with the payer piece is payer relations ebb and flow.

[Will Riley]

Right.

[Michelle Joy]

We. We have one payer that we have been, you know, I don't want to probably the right word is battling for three years now. And so, you know, we know their editor tools are kicking our claims out everything else. And so I do think that it is an opportunity with some of our payers to make adjustments to our contracts and try and figure out how do we leverage some improvement on our side to show to the payers that yeah, we are trying, we are trying to code correctly. We, we just want to get paid for the care that we're providing and continue to. We have to work with them all.

[Will Riley]

So Figures you do, you do have to, don't you? Because you're, you're. You're somewhat on the back foot. Right. As a smaller.

[Michelle Joy]

Yeah.

[Will Riley]

Provider. So you got to look for advantages where you. Where you can.

[Michelle Joy]

Yeah. And it's, you know, in our last payer issue that we had, we were negotiating trying to settle around $4 million in unpaid claims. The payer views that as. This is not substantial impact. Yeah. But for us that's a huge impact to our organization because of our size. And so we ran into a lot of discrepancy on that piece of it. And so we just were that little organization that just keeps nipping and fighting back wherever we can because every dollar makes a difference for us.

[Will Riley]

What are your to conclude, Michelle? What are your hopes for from a patient perspective next year? You talked about your behavioral health initiative.

[Michelle Joy]

What else for us? Carson Tahoe has been serving that rural northern Nevada community for 75 years now. And so it is making sure that we continue to serve that community, meet their needs as we have the last 75 years. Bring continue to build trust and confidence within hospitals and healthcare because there have been a lot of challenges over the last several years post Covid on that level of trust. And so just making sure that we are doing the absolute very best that we can for our community and that they know that and trust us with their care.

[Will Riley]

Michelle, thank you so much. It's super. I really appreciate talking to you.

[Michelle Joy]

Thank you, Will.

[Will Riley]

Thank you. Thank you.