← Becker’s Healthcare Podcast
Loading summary
Transcript71 lines
- [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.
- [00:32]
B
Hello and welcome to the Becker's Healthcare Podcast. My name is Will Riley from R1. I'm joined on the podcast today by Peter Banko. Peter is president and CEO of Bay State Health. Hello Peter. Welcome to the podcast.
- [00:46]
C
Hi Will. Thanks for having me.
- [00:47]
B
You bet. Peter, do you want to start by telling us a bit about you and tell us about Bay State Health?
- [00:52]
C
Yeah, I've been with Bay State Health since June of 2024 as president and CEO. Bay State's an academic affiliate affiliate with UMass Chan School of Medicine. We're also the safety net health system for Western Massachusetts. If we don't do it, no one else does and we're an true integrated system. So five hospitals, 1300 Physician Provider Group, integrated, employed, and then our own health plan, Health New England.
- [01:21]
B
Fantastic. Tell me, Peter, about some of the big priorities facing you as you go into next year. What's on your list?
- [01:27]
C
Yeah, well, our year started October 1st, our fiscal year.
- [01:30]
B
So there we are then.
- [01:31]
C
We've got four priorities. First, access, so physician access, hospital throughput access. The second one is accelerating our high reliability organization journey, HRO journey around quality safety experience. The third is better integrating our health plan and our providers together. Huge opportunity there. And our last one is cost transformation. So continuing our cost transformation journey.
- [01:59]
B
Got it. Okay. I will probably explore some of those a little bit as we as we go here and maybe the last one first because I want to ask you about innovation and I want to ask you about technology. Healthcare providers have traditionally moved fairly slowly and cautiously when it comes to technology investments. Right. It's been fairly conservative. But I wonder if you feel that with the advent of a lot of AI tools and technologies that's changing, is healthcare becoming a bit more assertive about using technology?
- [02:29]
C
Yeah, I would say we've been slow. I think the one big beautiful bill is going to bring it to a stall though. This next year. The boards and leadership are going to be distracted. But we're starting to use AI more on the behind the scenes back office services where we think our clinicians are adopting it in a variety of areas. But we think there's some big cost transformation opportunities With AI in revenue cycle. It, Human resources, marketing.
- [03:00]
B
Yeah. Okay. And how are you, how are you going about it? I mean are you, how are you thinking about partnerships in that space and are you working with the traditional players that you've always worked with or that always provide the infrastructure for you? Are you working with new disruptors and insurgents?
- [03:17]
C
Disruptors, yeah.
- [03:18]
B
Is that right? Okay.
- [03:19]
C
I don't think the traditional paths are as innovative. So we're out there finding partners like on revenue cycle, for instance, on front end, back end, back end, making a better consumer experience. We've, we found that those tools are better on the outside as bolt ons to your established system rather than going with established tools.
- [03:40]
B
Yeah. Okay. Okay. And how do you then partner with them? I mean obviously you bring some significant advantages in terms of scale and data and so on. How do you form those partnerships and make them productive?
- [03:52]
C
Yeah, well we look for organizations that have a common mission, vision, values and quite honestly people that we like working with. Yeah, that boils down to it. There's a lot of, you know, we're at Becker's, there's a lot of people selling stuff here, but it's really. Can you work with them and can you work with them in the long term? So those are the things we're really looking for. And then is what you're. They're offering real? Because there's a lot of vaporware out there in the AI space. So can it deliver results? We're not going to be in alpha or beta, but we're going to make sure it's been tested before.
- [04:25]
B
You mentioned you have an imperative around cost management. Right. Sizing cost. I can't remember exactly how you phrased it, but that. And then you've talked a bit about finding fertile ground in financial processes and revenue cycle. Can you tell us a bit more about that? Because revenue cycle has been an area that has always been very labor intensive. Right. Neighbor first, technology, second tools, supporting people. But very much people centric. It feels like. It does feel like a prime candidate for widespread automation.
- [04:54]
C
Yeah, we've got a lot of disparate systems still in at Bay state, which a lot of systems do. So we, we're, we're buying and partnering with organizations, put systems on top of that to make it easier for our labor to do their work, monitor their performance. And then on the digital side we're adding front facing tools for consumers on the front end and back end. That's in the process. Right. Right now. And then starting to this next year use AI agents. So, so Many of the calls around your bill can be handled by AI now having that at our fingertips and for. For our patients will be beneficial and perhaps with.
- [05:39]
B
With payers as well. I mean, you, you have probably have to make quite a few calls to them too.
- [05:43]
C
Oh, we have our own health plan, so we're, we're doing a lot of that in our own ecosystem. Right. So making, creating less friction between our providers and our health plan.
- [05:53]
B
Yeah.
- [05:53]
C
Around prior auths and.
- [05:55]
B
Yeah.
- [05:55]
C
Some gold carding and all those things. So we're, we're showing preference to our own health plan because we think that that's where the biggest opportunities are.
- [06:03]
B
Yeah. Okay. Okay. Presumably in things like clean claim submission and things like that as well.
- [06:09]
C
I would imagine If a doctor 99% of the time is following process and protocol, there's no reason to. To do a prior auth. Right. So.
- [06:19]
B
Right.
- [06:19]
C
Making the. Our doctors complain most about our health plan and the friction that it causes and the amount of time that they're spending and their staff are spending. So just trying to reduce the friction between people providing the care and payment of claims.
- [06:33]
B
Yeah. And what about on the clinical side? How are you using some new technologies to help physicians and make their lives better?
- [06:40]
C
Yeah, I would say we're, we're early in that process. We're going through an EMR review right now with the system we're on versus where we need to be in the future. So our platform's a little bit weak there, but we are using. Using some tools in cardiology, oncology. I was at, I did my physical last week. Ambient listening.
- [06:59]
B
Yeah.
- [07:00]
C
Tools. Trying to find the right one for our clinicians, helping them or letting them guide that process.
- [07:06]
B
This is an area where a lot of people are using new technologies in their daily lives. Not just consumers, but like physicians, all of us. Right. And they're finding remarkable results from it and really good utilization from it. Are you seeing a lot of demand and pull from within your organizations to use?
- [07:24]
C
I'd say it's just beginning.
- [07:25]
B
Would you?
- [07:26]
C
You know, we had a board retreat in May, and our chief of cardiology, he's a cardiac surgeon and our head of cancer, really using it a lot. You know, they said that the things that they're using what used to take a month are now taking a couple hours for them to do. But it was, it was surprising. It AI still in its infancy and adoption on the, even on the clinical space.
- [07:50]
B
Yeah. Okay. Okay. Are you setting up new governance frameworks or management frameworks to, to think about how to implement it? And use it.
- [07:59]
C
That was a big discussion at our board. Advance in May was we're just now starting to set up governance structures, policies, procedures. You know, our board's talking about adding AI expertise to our governance. So really, I think, yeah, we're probably more in the infancy around educating board, educating leadership, educating clinicians.
- [08:23]
B
Yeah. Okay. Okay. It's interesting. Do you think you might need new roles because. Or.
- [08:28]
C
Absolutely.
- [08:29]
B
Yeah, absolutely.
- [08:30]
C
I think at a governance level, having that expertise and then on the leadership team to having that expertise.
- [08:36]
B
Right, right, right, right.
- [08:37]
C
And probably in the clinical space, finding a physician or another clinician that could help guide the clinical piece too.
- [08:44]
B
Yeah, yeah. Okay. Okay. How do you think that that will play out for you in the long run? Because like again, going back to say, revenue cycle has been very labor centric. You've talked about some clinical use cases that are emerging. It will change the nature of the labor force that's employed by a big healthcare provider like you.
- [09:05]
C
Yeah.
- [09:05]
B
How are you thinking about that?
- [09:06]
C
Oh, well, you know, with kids in that 20 age range, graduating, graduate school and other things, I think jobs are disappearing. Right. So those entry level management jobs are disappearing. So then the question is, well, how do the people get the experience to take the second and third level? I think retooling our workforce for other areas where we need them is important. You know, we've got workforce challenges like everybody else, so AI will replace some contact center or frontline stuff, but retooling those folks to be able to take other needed positions that we have in the, in the workforce.
- [09:42]
B
Yeah, yeah, yeah, yeah. But it's going to be a significant transformation.
- [09:47]
C
Huge.
- [09:48]
B
Yeah.
- [09:48]
C
Especially. Well, I mean, for health care, it's got to be on the back office side. Right. We've got to, we've got to get overhead costs down below 8% given our headwinds in the industry. So we've got to embrace AI and take advantage. Not like we've done that before with scale and other things, but take advantage of the cost efficiency.
- [10:07]
B
Yeah, right, right, right. You mentioned headwinds. Can you talk a little bit about some of those that are facing you?
- [10:13]
C
Yeah. I mean, in our market, we're. We don't have a growing population in western Mass. We're 69% Medicare, Medicaid, which is not a great recipe. Right, right. And that's why access is a big issue. We have a lot of people that have commercial insurance leaving the market for Boston or Hartford, so we've got to retain those patients. But the heavy Medicare, Medicaid, I think One big beautiful bill at a minimum is 100 million right off the top, probably more like 150 million. And then as the state cuts trickle down. So in Massachusetts has really embraced trying to get everybody covered and that, that's going to reverse itself. So yeah, we have some headwinds coming.
- [10:53]
B
Next October and what can you, I mean you've got to, you got to move quickly. Right.
- [10:57]
C
We've got to speed up our cost transformation work. So we're doing a lot of heavy work this year, probably more than we really need to, to, to meet our expectations so that next year is not as heavier, heavy a lift going forward. But we're starting to talk about with the state and in D.C. about alternative payment models. So total cost of care. So we're, you know, the state budgets are impacted by all this. Our budget's impacted. So can we align around some creative waiver models to be encouraged to keep people out of the hospital rather than this fee for service?
- [11:32]
B
Yeah, right, right, right. Because in the end the reimbursement is less but the consequences in terms of uncompensated care and so on. Emergency room visits are pretty, pretty damaging as well.
- [11:42]
C
Keeping people out of the er, getting the right care, right place, right time. Right. Right caregiver. So there's some, I think there's. Well, we're going to have to flip the script and find new payment models.
- [11:52]
B
And in the context of all of that change, then you've talked about the patient a little bit, but how do you then also keep focused on the patient experience? Right. Because you're trying to manage costs and deal with this change and yet you're, you've got to keep your eye on.
- [12:06]
C
Yeah.
- [12:06]
B
Patient who you're serving.
- [12:08]
C
Quality. Our level of our clinician or table stakes.
- [12:11]
B
Yeah.
- [12:11]
C
Patient experience. And I, I would say access, like delivering care in a consumer driven way when the patient wants it where they want it. Because how my 30 year old wants care versus how I want care are completely different. So we're doing some of that work now around we've got an oath model orchestrated access to health care and just doing a lot of work right now around process because we're never going to find enough providers. So we've got to figure out ways to grease the skids for patients, make it easier to access. So we're, we're just starting that work right now. So when we talk in April, we'll be able to talk more about the things that we're uncovering. Okay.
- [12:55]
B
Okay. Super. All right. Thank you so much for giving us an overview of what's going on.
- [13:00]
C
Yes.
- [13:00]
B
Is there anything else that you want to add before we. Before we close?
- [13:03]
C
No, it's a great interview. Thanks.
- [13:04]
B
Well, okay. All right. Thank you very much. Much appreciate it.
- [13:07]
C
Yeah.