← 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.com.
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B
Hello and welcome to the Beckers Healthcare Podcast. My name is Will Riley with R1. I'm joined today by Nick Barcelona. Nick is the Chief Financial Officer for WVU Medicine. Nick, welcome to the podcast. Thank you. Will, Nick, start us off by telling us a little bit about yourself, your role. Tell us about WVU and the communities you serve.
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C
Happy to do so. Yeah. So as you said, I'm the Chief Financial Officer for WVU Medicine. Been in the role for almost three years now. Exciting to, to, to be part of that team. So we are a large healthcare system that serves four states, predominantly in West Virginia, but we also have hospitals in Ohio, Pennsylvania and Maryland. We started our own health plan back in 2023. And so we're, we're growing pretty dramatically. We've, we've actually almost tripled in size over the last four years or so.
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B
Wow.
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C
Pretty exciting times for us.
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B
That is exciting.
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C
Yeah.
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B
So with that growth, what are some of the things on your mind as you go into 20, 20, 26 for the, some of your priorities?
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C
Yeah, so we, we continue to invest in, you know, different geographies and we're really, you know, we call it investing in breadth and depth. Right. So we're sort of the traditional hub and spoke model where we have a large academic medical center, you know, in Morgantown, which is where our headquarters is, almost 900 beds there. And, and it's, it really is the hub of our health system, certainly from an academic perspective. But really, over the last few years, you've seen us grow and expand geographic regions around the state and beyond, as I said before. And so for us right now it's about investing in those other regions. So it's, it's really the Martinsburg region in the eastern panhandle of West Virginia, kind of a bedroom community of D.C. it's up the northern panhandle for us, that's Wheeling and Weirton, that's kind of just west of Pittsburgh in the Pennsylvania area. We have the center part of our state in Charleston and then the sort of western part of our state in Parkersburg. And so it's investing in those hubs so that we can keep that care closer to home. It's better when those patients do not have to travel 4, 5, 6 hours to come to Morgantown for everything they need. So we're really focused on investing in that breadth and depth. And that's been a lot of our growth, certainly on the provider side the last few years. And as I said, it's also on the insurance side. So we started peak healthcare back in 2023. We went live in Medicare Advantage back in 2024, and we've seen really dramatic growth. And we're very excited about being an integrated delivery network. And, you know, we think that that really strengthens our investment and commitment to serving better, that focus on population health. Our mission is to improve the health trajectory of West Virginians and all those we serve. And so being both on the payer side and on the provider side, we think that gives us the best opportunity to do so.
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B
Fantastic. Yeah. Okay. I'm sure we'll come back to that a little bit later on in our conversation. So that's a great setup. Let's talk a little bit about technology if we can. So healthcare has historically moved pretty cautiously with technology. Not necessarily been at the front of the curve or whatever you want to call. Feels a bit different with artificial intelligence right now. And it feels like healthcare is taking much more of a driver's seat perspective on this new technology. Do you agree with that and how is it playing out for you?
- [03:53]
C
Yeah, I think I agree with that. You know, it seems very convincing. Yeah, I mean, maybe not. You know, look, I think AI is revolutionizing a lot of different industries and I think health care is certainly one of them. I suspect probably why you hear, you know, those types of comments is because frankly, health care has been a bit behind the curve, I think. Yeah. From a lot of other sectors that have embraced, you know, activity based cost accounting and, you know, really customer centric and customer focused tools and technology. You know, you walk by the coffee shop and it knows you're there and it says, hey, why wouldn't you come in and, you know, order a coffee and just click a button to do it? We've, we've been a little slow flow, you know, to adopt those types of things in healthcare. And I think AI, you know, is, is finally something where everybody's getting excited about it. So there's benefits for certainly the, the consumers or the patients. I think there's a lot of benefits for the physicians and the clinical staff. And that's what I'm most excited about, certainly from an efficiency perspective, especially when you think about the workforce challenges and burnout, you know, finally having something that can hopefully help. Yeah. Alleviate some of those challenges. And obviously I think there's some opportunities and, and some exciting things from a cost savings persp being the cfo, you know, I think leveraging technology to be able to be more efficient, that's certainly something that I'm excited about.
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B
So when you think about pursuing some of those innovations, how are you, how are you doing it at wvu? Because you can we talk a bit about incumbents and insurgents, right? So incumbents being the well established providers or the well established technology vendors, they have the data, they have the, the, the scale, the infrastructure and so on, or insurgents, the up and coming, you know, DISRUPT coming in with a, with a natively technology or native AI driven approach. How, how, how do you think about innovation at wvu? Who do you do it with?
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C
Yeah, I love this question. And so first off, and this is, you know, I think something that similar kind of language, although maybe a little different in our case, but we, we think of it, you know, being West Virginia's, we think of it like pioneers and settlers. Right? So, so do you want to be a pioneer sort of on the Oregon Trail, right. Or do you want to be a settler and maybe sor. Those pioneers come in and the technology is a little bit more established. And I think in many instances we kind of want to be the settler, right? Like we don't want to be that pioneer because we don't need to be. Right. And so I think for us that's maybe a little bit of a conservative view to take. But, but that's kind of the way we think about it. And we've, we've formed an interdisciplinary committee, right? So we have a data governance committee and we have an AI governance committee. So similar, you know, data governance been around for a while. Yeah, AI governance relatively new, but pretty similar from a structure perspective. So you have clinical leaders, you have financial leaders, you have certainly IT and technology leaders at the table for that. And you know, I think having a balanced view from all those perspectives is really important. So that, that's kind of our view of the world of how we're, you know, we're not trying to, you know, always be leading. Look, we're open minded and if there's something that's transformational that is going to be right for us and for our patients where, you know, we're, we're willing to try it, but perhaps in a, in a relatively small setting so that we can make sure we're manage that, you know, safely, and we can understand what the implications are going to be for our patients.
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B
Totally. Tell me a bit about how that governance group works. You mentioned some of the participants in it. What do you do? What are some of the issues that you. That you run through? Is that in that team?
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C
Yeah. So this is a great question, and I think a big challenge for lots of organizations because there's no shortage of good ideas. Yeah. Literally hundreds of, if not more of, you know, groundbreaking ideas and, and new things that are going to revolutionize the industry. And so, you know, a lot of what that committee does is prioritize.
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B
Okay.
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C
And so what we've really done in a thoughtful way is, is set up metrics so that we can evaluate and kind of rank the projects so that we can figure out what we're focusing on. And we've more than doubled the size of that of our AI team, you know, from four people to eight people. So it's not a huge team, but again, it's growing. And, and, you know, I think that's just a good example of, you know, you have to really prioritize what those projects are because you don't have the resources to do everything. No, you know, I'm. They kind of make fun of me a little bit being the cfoc, but I always like to say, at WVU Medicine, we can do anything. We just can't do everything.
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B
Yeah, right.
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C
And the punchline of that is you just need to be able to prioritize.
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B
Sure.
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C
And so we spend a lot of time looking at those metrics and figuring out how we're going to prioritize. And I think, you know, in. In my past experiences in other organizations, it's probably true at ours too, sometimes. But like, often you do the project based on sort of the loudest voice at the table. So the, the physicians that are most engaged or most interested or the rev cycle leader or, you know, pick your person and to some degree, you have to have interested parties in order for a project to be successful.
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B
Right.
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C
But you also have to be able to step back and say, you know, how many patients is this going to impact? Or, you know, what's the dollar hard dollar implications of this service line that we're going to try to focus on or whatever. And, you know, I think sometimes you get lost in that when you might have a squeaky wheel, so to speak. And so we really try to be ob. Objective about how we prioritize those. Those opportunities.
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B
You've talked about efficiency being a big driver for you as naturally probably is from a CFO perspective. You also talked a bit about the provider experience. Are those the two key dimensions for you around which you make these evaluations?
- [09:30]
C
I think so. You know, I think in rev cycle, like a revenue cycle. Right. So sort of my team, I think it's a bit of an arms race. Right. So you have the payer side and the provider side and yes, we have our own health plan as well. And you know, I think that's an interesting lens for us to sort of be able to see from both perspectives. Like, how are you implementing and leveraging this technology to improve? That's all about efficiency, though. Efficiency from a patient experience perspective or from a covered life experience perspective. Also efficiency from how you just get administrative cost out. Yes, the provider side, I think, is a little bit of the harder nut to crack, you know, because a lot of the things that we've done historically have added time or added stress to the nurse's life or the physician's life. And I think what's most exciting to me is when you look at some of the technology that we're using now, so ambient listening for documentations, we're working with the bridge, and that's going exceptionally well. And I think the ROI looks good and the physicians are excited about it. And so to be able to see some technology that's actually having a really positive impact in the physicians coming and kind of saying thank you. Yeah, you know, that's meaningful. Right. And, and having an impact in their sort of, their, their health and well being is. Is. Is important to us, you know, and I think we've. We've done a lot of things over the years that have added sort of burden to the physicians and the nurses. And to be able to try to limit that and maybe even take some away, that's something I'm really excited about.
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B
Yeah, right, right, right. Creates that groundswell of enthusiasm as well, doesn't it? Yeah. For more widespread use of technology. Yeah. You mentioned revenue cycle a couple of times. That seems to be an area obviously that can benefit a lot from some of these new technologies. Revenue cycle's traditionally been a very labor first paradigm. Right. Or world people using technology, but using it as an assistant or as an aid. Now it feels like that equation is getting turned on its head. Right. It actually feels like an area that can be technology first and human supported. Do you, do you see that too? And what are some of the implications of that if you do?
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C
Yeah, I do. And it's happening rapidly. Right. More law. Right. You think about how quickly it's coming. But, you know, one of the things that I try to take away from that, because I think there's a lot of anxiety amongst the team, right? About like, does this mean my job is going away? And in some instances, you have to be honest, like, yes, it does. And so I think what we try to focus on is, well, how do we upscale the team? And, you know, how do we retain those folks? Like, the answer isn't we're going to turn this on and we can just get rid of everybody. That's not the answer. The answer is we're going to need more people. We might need them in slightly different ways, in different capacities. Right. And so figuring out how we upscale the team and, and plug them in. So you, maybe you're a documentation liaison or a coding liaison, and, you know, you're sort of checking the underlying systems and making sure that what you think it's doing is what it's actually doing. So I think it's, it's. There's no shortage of, of need for skilled labor. Right. It's just making sure that we have those folks, we take care of them, we train them, and, and sort of, it's a little bit of an attitude adjustment, too, to make sure that they're not defensive or, or sort of trying to, to counter the implementation of the technology. And what I found in almost every instance is, at first people can be resistant, but then when they figure it out and figure that it's actually going to help them and make their daily lives sort of like we talked about with the physicians and nurses, right. When they realize it's going to make their lives easier and more efficient, they start to get exc.
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B
Yeah.
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C
And like anything in life, like, the best ideas don't always come from the CFO or the CEO. They come from the frontline folks who are sitting there, you know, processing the claims or sitting there putting hands on the patient and caring for the patient, that's where the best ideas come from because that's, that's the real work that we do. You know, I'm very excited about, you know, this transformation wave that's coming on the revenue cycle side as well.
- [13:33]
B
And what, what you've alluded to some, some, some of the power dynamics, of course you've got your own plan, but, but like, how do. Might level the playing field or bring a sort of forced peace between payers and providers? Do you think it will or not?
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C
Yeah, I mean, I'm not sure that it will.
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B
Okay.
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C
You know, I can be Cautiously optimistic. I mean, I think, you know, there's a lot of manual labor that occurs on both sides.
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B
Yeah.
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C
You know, the claim processing experience. And I think the more that we can leverage technology to take out some of the noise and actually get down to the tough conversations about, you know, pre authorization or prior auths and denials and, you know, working through care plan design and what's, you know, in. And not, not in. And, and those are difficult conversations that involve people and they're often individual and specific. And I, I get it. You know, sitting on the plan side, you have to have rules, you have to have guidelines, and, and we do just, just like others. But I think if you can leverage technology to make sure that you're focused on what you're really trying to accomplish, that that's where I think, you know, hopefully we can get to that point. So it's, it's not we're fighting and back and forth and they're getting denied, you know, based on technology. It's more we can focus on some of those tough conversations. And you know, the reality is, as you look at the increasing costs, you know, GLP1s are a good example or, you know, lots of different novel therapy, gene therapy, et cetera. These are exceptionally expensive and you know, you have to sort of figure out how you manage that. And I get it from both sides of sort of the payer side and the provider side. And, and hopefully we can use technology to help make those conversations go a little bit more smoothly between us.
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B
Yeah. Okay, Nick, maybe just to bring us home, how are some of these innovations and changes making life better for patients? We've talked about providers, we talked about administrators, but what's the knock on effect for them?
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C
Yeah, and I'll pick on the ambient documentation, ambient listening. I think that's a great one. Obviously the physicians and nurses, I think there's an application there as well. Be able to limit some of the complicated documentation that they have to do. And time spent sort of after hours. Right. You think pajama time people talk about. The other benefit that though, is they can actually sit there and look the patient in the eye. Kind of like we're looking each other in the eye, having a conversation that's meaningful. Right. And, and we've all been patients at one point or another in our life. And to have, you know, a physician sort of facing sideways typing and not even looking at you, that's not a good experience. And that could be the best physician in the world. And I'm not picking on those physicians. That's the sort. Dynamic we put them in as administrators, you know, but to. To sort of give that back to them so they can sit there and have real bedside manner and have, you know, meaningful human interactions with the patients. Again, I think that's the most beneficial thing for our patients when I think about the advent of technology. And yes, it's also convenience. It's, you know, AI looking at the schedule and figuring out when there's open slots and being able to geotag and look at where you live and, you know, what practice might be closest to you or what location might be closest to you and help you get in faster, easier, and help with quick registrations. And so I think there's. There's lots of exciting benefits coming for our patients. And. And some of them are here already, which is. Which is, you know, for me, it's. It's wonderful to see that and hear the positive. It's not all perfect, but it does make you feel good when you hear some of those success stories.
- [17:04]
B
Cool. Nick, thank you so much. It's been really great talking to you and hearing about what you're doing. Super. Really appreciate it.
- [17:11]
C
Thank you, Will.
- [17:11]
B
Thank you. All right, thank you. Thanks.