← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Sham Firdausi, Deputy Chief Financial Officer of County of Santa Clara Health System
00:23:10
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- [00:02]
A
Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details. Visit BeckersHospelve.com and click on the Events tab in the upper right.
- [00:38]
B
This is Alan Condon, back with another episode of the Becker's Healthcare Podcast and today I'm delighted to be joined by Shyam Ferdasi, Deputy CFO of County of Santa Clara Health System. Shyam, I know you've done a podcast sort of Sephora in person at one of our live events. A pleasure to have you back on the podcast today. For those of our listeners who mightn't be as well acquainted with yourself, the county of Santa Clara Health System. I'd love to hand it over to you just to hear a little bit more about your background and your experience at the health system.
- [01:09]
C
Awesome. Well, thank you for having me. It's a pleasure to be here and then looking forward to being there in person in April. My name is Sean Ferdasi. I'm the Deputy CFO at the county of Santa Clara Health System. Currently, you know, I oversee a team of finance, revenue cycle and supply chain. A little bit background About Me I'm a military veteran. I have degrees from both Brown and Yale. Recently was recognized by Beckers in both the CFO to know and the 100 healthcare leaders under 40. I think to me the credentials that matter most are the ones you know, I earn every day working alongside my incredibly talented team here at the Public Health System. A little bit unique background. I've worked both on the PEAR side in the health plans and in the hospitals. Was overseeing a hospital for Scion Health Watertown Regional in Wisconsin. Understand how these relationships work from both sides of the perspective and where we are today, especially when it comes to better partnership and public health safety. Where we are currently work for the county of Santa Clara Health System. We're one of the nation's largest public health systems. We serve almost 2 million residents across our four hospitals and multiple clinics providing comprehensive care from primary care to specialty services. We are safety net, which means we serve everyone who walks through our doors regardless of their ability to pay. To me this work is very personal and here's why. You know, I was once myself a recipient of Safety net care. And I know what it means to when a system shows up for you, regardless of your ability to pay. That's why I'm committed to this mission. And now I get to protect it for others. It drives me every day, single day. And I'm again thankful and blessed to be working for a health system that gives everybody the chance to be able to get health care as needed.
- [02:59]
B
Yeah, no, absolutely. I really appreciate the. The context, the background, some of your experience as well. And working on the health plan side, the provider side, I believe. A Pakistani American, if you're. If I'm not mistaken. Thank you for your service. I just received my American citizenship a couple of weeks ago as an Irish American, but so have that in common with you as well. Sham, I think you kind of set it out very clearly there. I think as someone who has experience being a patient of a safety net system in a different age, and now being a leader at a safety net system arguably in one of the most challenging periods of, I imagine, in terms of safety net systems today, I'd love to kind of just hone into one or two initiatives that you're most proud of. Most important, over the last year, maybe something that's ongoing. Is there anything you'd like to particularly highlight in terms of what initiative you led? What were the results? I'd love to kind of kick the conversation off here.
- [03:53]
C
Yes, absolutely. I think two of the big initiatives I'm proud of is my time at Watertown region. Know, you know, as I mentioned, part of Scion Health, multiple hospitals across the country. But, you know, what I'm really proud of is leading a business within a business model. For me, that's important. I think, you know, finance for a very long time has kind of just been in the backseat, whereas now in the time of crisis we're in, you know, being involved in the operations and learning with the team is very important. So the mindset and the models that I led at Scion Health was really giving service line leaders, real time financial insights, having a seat at the table with the CEO, the cno, clinical leaders, operational leaders, where we all made decisions together. And it wasn't really finance telling teams what to do or dictating operations. It's us working together, not in isolation, whether it was a clinical team or operations teams. For us, that was success and that drove a success for Scion Health. It really helped us achieve our targets and goals when it came to the margin side, but also won us multiple awards when it came to quality and improving just overall our performance. In the system. The other big project I worked on really enhanced our value analysis process. You know, as I mentioned, collaboration was key here. And then I developed a Revenue Cycle 101 framework. I put together a comprehensive playbook that standardized, you know, across the system, both our front, middle and back end processes and embedding like shared accountability across the enterprise. I was able to look into it, tell where denials are coming from and how to prevent them upstream. And I think that key trying to do the same thing here at the county Santa Clara, trying to bring in an operational focused finance business partner model. For me, the focus is really always on my team's development, finance, revenue cycle, operations, supply chain and how we work on this in collaboration with our clinical and operational leaders and give them the support we need. Hoping to bring that success I had previously and trying to emulate that here again and very excited.
- [05:55]
B
Fantastic. I think really love those kind of two initiatives. Specifically for the purposes of this podcast, I'd love to sha maybe follow up specifically on the revenue cycle initiative and maybe just kind of get your thoughts there. We've been talking to CFOs like yourself, revenue cycle leaders really across the board in terms of potential opportunities when we think about AI specifically in the revenue cycle. No doubt this is a big area of focus for you. I'm kind of curious as someone who has both experience on the health plan side and also the provider side. When you see providers and health plans really kind of playing catch up in terms of using AI in the revenue cycle, how do you kind of envision this quote unquote AI arms race, for lack of a better term, playing out over the next couple of years? When we see more providers using AI, it's being more deeply embedded, more deeply integrated in the revenue cycle. No doubt health plans on the other side have been ahead of the game in this regard for quite some time. But any kind of thoughts there? Maybe Is there a specific use case where you're leveraging AI or have found specific results in the revenue cycle so far?
- [07:03]
C
Yes. Yeah, I know I could give you great perfect example, I think and you are 100% correct. I come from a very large plan. I was head of FP&A and strategy for Centene's Florida health plan at $15 billion. But Centene across the country $140 billion worth of health plans. Right. Focus on that. And they were already leveraging AI and technology when it comes to that. So yes, hospitals are playing catch up, but I think the future is going to be great when it comes to that in utilizing AI to solve these complex revenue cycle problems, A because it's going to give people the time to actually focus on the areas that matter most. Right. You know, patient care, patient service upfront from registration to back end. Right. Follow up. The other part that's going to be important is if we build out certain AI models. Sorry, I have a technology background so I'll share with that. If we build out certain technology models that can kind of resolve the issues like the simple ones that where denials are prevented, what codes to add to, you know, resubmit different claims and appeals, I think AI is going to be very important in that. And as a county, Santa Clara, you know, we're very important. We are looking into AI. We're starting to pilot, you know, in the ambient side for ambient listening for the clinical leaders. But my big focus is having, you know, oversight over my revenue cycle team is where we bring in to help us start whether it comes to, as we think about certain coding challenges where we look at denial management. So I think that's going to be important. I. Where I think the real partnership is going to come and that's really going to be key for the future of AI. Yeah, AI is going to make things easier, but it's where partner, it's with pairs and hot health system where they're going to have to talk and have to have that partnership. AI can only do so much. AI is models you build, you know, they're going to be able to do what you ask them to do. The complex part is going to be how payers and providers collaborate in the future. And that's what I'm excited about because it's going to take all the noise out of the little day to day work and it's going to get those clinical leaders, those peer to peer teams to have more open conversations. And I think that's important and that's what's really needed, especially given in the healthcare environment that we're in today.
- [09:08]
B
Yeah, no, I think so. So well said. I appreciate bringing that technology expertise and background into the equation as well, I guess. Last quick follow up specifically on this Shaun, before we kind of jump to the next question, what you just kind of echoed there is a sentiment that I just heard on a recent podcast with Cleveland Clinic CFO Dennis Laraway. In terms of what's really going to make the difference to your point is really this collaboration with payers and providers in terms of the AI and the revenue cycle going forward, no doubt the patient is of course in the middle of this push pull dynamic. But are you seeing maybe any sort of willingness in your conversations with payers recently to kind of geared towards that, more of a collaborative partnership as it comes to that, or is this something that still some work to do to get to a point to make some sort of head, some, some real progress there?
- [09:56]
C
I think, I think they're more open to it. And recently I actually, you know, read somewhere online scan as a health plan. I think their CEO is very vocal as well. So it's not just, you know, on the provider side you are seeing a little bit more shift. You know, I think Dr. Sachin is his name, I believe from the scan and he's very vocal about provider payer collaboration and how he wants to partner more. You know, at the end of the day we're all given a challenge, right? When it comes to the payer and provider. We have a goal where we need to provide access, provide healthcare to the system. Why not partner up on the. Yeah, there's some payers that might not be up for it right now, but I think with technology where things are going forward, I think it's going to really bring that model forward and I think that's, that's key here. We have to partner, we have to talk. I mean with the rise even in value based care, you know, being on the pair side, I used to work very closely with health systems in the state of Florida, talking to them, how their financials looked and how those models work, whether it came to outside medical costs or whether it came to other areas. So yeah, I think there is a rise in that and I do see a hopeful future of better payer provider collaboration.
- [11:06]
B
Yeah, absolutely. Certainly something to look forward to over the next coming years as it no doubt does become more embedded, more deeply integrated across the revenue cycle. Certainly a big opportunity there across the landscape. I wanted to shift gears a little bit here. Sham. I think I know what your headwinds are as a safety net system in California, it's arguably the most challenging time. I'm from a reimbursement landscape I imagine, particularly for California safety net providers like yourself. Recently spoke with the CEO and CFO of Scripps Health about everything that they're facing in terms of ACA subsidy lapses, the medical cuts coming down the pipeline and end of this year and into next. No doubt a very challenging landscape. But I guess to elaborate specifically on the headwinds that you're focused on combating this year and kind of what your ultimate priorities are there.
- [11:56]
C
Yeah, I mean for us, again, you Know, you already kind of hit the nail on the head. You know, we're, we're a public health system. We're safety net. We're facing one of the biggest financial challenges in the history of California. I mean, as far as I can remember, just even in healthcare, you know, HR1 represents for us almost a $1 billion shortfall by 2028. And I'm going to be very direct when I say this. There's no sugar coat. I mean, I again, someone who has a public health degree, I mean, studying all of this, you know, public health care across the country, I mean, it's under attack, it's being gutted left and right, whether it's Medicaid, whether it's other programs. I mean, this for us, it's an assault on the SAF net and the millions of people that depend on the safety net. At the end of the day, we're going to serve everybody who walks through the door, whether they're able to pay or not. That's just our mission. We're not going to turn people away. We're going to probably absorb even more of that as the subsidies lapse and people become uninsured because prices are going to skyrocket. Times are tough. But I am someone who thinks positive, who's very optimistic even in tough times. Maybe it's that military background in me. Right. I think for me, tough times are where collaboration comes in, creativity comes in, you know, innovation comes in. At the end of the day, the patients are the mission and that's where we're going to head. So for us, my big kind of priorities right now is how can I make sure the teams that support us in revenue cycle have the support they need. So really focusing on revenue cycle transformation. You know, my finance team, operational teams collaborating more, really focusing on that facility anchored business partner model, service line kind of development areas, targeting technology when it comes to, you know, denial management, AR reduction, pretty much trying to capture any and every dollar we as a system earn. So trying to reduce those denials. Right. Big focus for me is going to be against strategic payer provider partnerships. I'm hoping, you know, with my background on the payer side, I'm able to bring that lens forward and you know, kind of have a seat at the table with the peers and talk about it, how we can collaborate better. And the last part is really focusing kind of on the technology part of IT technology to support my teams. I think workforce investment is very important. But having that technology making their lives easier, making their jobs easier, setting them up for success, for the future is what my focus is. Like I said, constraint breeds innovation and obviously when the traditional approaches don't work, we're forced to think differently. And I think this is where I am kind of. Yet in the face we're facing all these challenges. But I think for me this is where I feel like the breakthrough is going to happen. We're going to get the innovation, we're going to get the technology and we're going to get creative because mission doesn't stop for us as a safety net health system.
- [14:41]
B
Yeah, I'm particularly interested in kind of what you said in your points around revenue cycle transformation, leveraging technology there for your finance teams. We already talked quite a bit about kind of AI and revenue cycle. But outside of AI, do you mind the kind of drilling one bit deeper into kind of specific areas of transformation of the revenue cycle or kind of how you're, how you're using technology and which technology to benefit your teams?
- [15:05]
C
Yeah, I think my focus right now is thinking through technology about revenue cycle. I mean denial management, AR reduction, I mean we're, we're relying heavily, EPIC as our go, our EMR system here. So we're relying heavily on epic, the dashboards and the tools that are given to us to start with that to make the lives easier. But then we're also looking into specific technology and specific AI partnerships when it comes to denial management. Again, you know, AI, a lot of health systems are using it across the country for those areas. But for us right now we are taking a little bit slow because we want to make sure, you know, patient safety is protected and all of that. So for us we are taking our time, but we're starting to get the teams excited about it, make sure we're thinking and talking about it. So really focusing on the denial management area more of like real time kind of decision making when it comes to clinical teams. The other part that I'm doing a little bit and I'm sure other health systems are already thinking about is too, is really embedding clinical leaders in revenue cycle matters. I think for a long time going in the health system space, you know, I've noticed that clinical leaders were not, and even finance specific leaders were not involved in revenue cycle. Revenue cycle is its own solid function, but I'm trying to break that barrier because if we don't talk to our clinical leaders, if we are not talking to our operational leaders and we don't see what's happening and what they're seeing, you're going to continue to see have those misses you're going to continue to have denial. So even before I think technology and AI comes, it's really about the process of how we set up our teams for success and that's really with collaboration, open communication and making sure our clinical and operational leaders are involved and working together so they have a say on how things are done and the different processes we're building.
- [16:48]
B
Yeah, no, absolutely. I really appreciate the kind of level of specificity and diving deeper into kind of some of the key, key areas you're working on. The revenue cycle betting those clinical leaders. No doubt. So significant advantages and benefits may come from that too. Sham. Not to get all doom and gloom, but I think. Next question. No doubt to your point, a lot of our conversations resolved around the HR one. I believe you said $1 billion federal funding cliff in California this year alone. No doubt some hard, tough decisions being made by leaders like yourself across the board. What do you anticipate the hardest thing you'll have to do in the coming year will be?
- [17:26]
C
Yeah, I think it's really about resource allocation for us. I mean decision. Our goal is to be able to think through those decisions. Protecting our missionary capacity serve. I mean we are just, even our health system loan is we're heading for a billion dollar funding cliff. Right. I mean it's, it's really kind of changing the dynamics of how we look at safety net, how we look at, you know, public health systems. Because right now, as I mentioned earlier, I mean to us it truly feels like it's an attack on the public health system. So my approach right now is transparency. I think everything we do needs to have the right stakeholders involved, clinical leaders, operational partners and always asking how do we preserve our ability to serve our community? And not just today, five years from now, ten years from now. For me, tough decisions really come with how we look at a supporting our teams but also making sure we are thinking about proper resource allocation. I think I said that earlier but to me that's, that's key. We're facing unprecedented times and we have to navigate them strategically. During my military service, you know, and across health system, I one thing I always keep that in the back of my head is, you know, leadership isn't about avoiding the difficult decision, it's about making them decisively and with full transparency and clear rationale. For us it's really about the responsible thing is if we have to make tough calls, we make it with clarity and transparency and making sure it doesn't impact the clinical workforce and it doesn't impact the Teams that we work with. So for us it's really focusing on resource allocation but making tough calls without hindering our ability to serve our patients and not veering off of the mission that we're headed towards.
- [19:13]
B
Yeah, no, absolutely. And of course with such challenging circumstances, there are of course some great opportunities out there. When you think about the future of county of Santa Clara health system, where do you see the biggest kind of opportunities for organizational growth over the coming years?
- [19:31]
C
Yeah, that's a great question. I mean I'm very much a people person. I love collaboration on the people. So for me, I think I afford major opportunities that I see coming in the future. One of the big things, as I mentioned, I want to bring that model, the business within the business model type of mentality. You know, for me that's cross function, cross functional operations and finance training. That's how I learned the health system. When I started, when I became a cfo, it just made me a better CFO because I got to understand how operations happen behind the scenes. And I cannot sit in my office all day and try to think about data and financial decisions because some decisions have to be bigger than the finance when it comes to the mission. So right now I'm developing a training program that embeds finance leader within operation and clinical teams so they develop that same operational mindset. I think when finance understands how clinicians works together, you know, with the clinical leaders and operations, they understand how to make smart decisions together. And that cross functional fluency is going to drive real performance. The other areas I'm focused on is revenue cycle excellence. You know, I think we talked a lot about AI and technology, but when you're facing, facing up billion dollar cut coming your way, you cannot afford any type of preventable denials, coding gaps or process inefficiencies. You know, building out the team to the best of their capabilities, building them up, providing them the tools that they need and freeing them up so they can kind of think through other areas of focus. Strategic partnership across our supply chain and vendor ecosystem. We're one of the largest health systems in California that Public health Systems California. You know, our partners have that opportunity to be part of the transforming community health and be part of that mission. So my other focus really right now is building better relationship with these vendors and investing in our future success. We innovate together and make sure we're creating value for our patients and still aligning with our missions. The other part is talent development. This is our edge and people here in this county are so mission oriented. People have been here 30, 40 years as I get to meet the different teams all the way from nursing teams that have grown up since they were like 18, 19, and now in their 40s, 50s, 60s, working through the system because they believe in the mission. So for me, I'm invested in my team's development, whether it's finance, operations, revenue cycle, supply chain, you name it. I want to create career pathways and develop the future leaders and make sure the leaders that are here, we are taking and learning from them because they've done it all. They've seen it all. From when this was a one hospital system to now four hospital systems are almost 16 clinics. All our questions are, it's as simple as that. We have to answer, are we here for the mission? Let's serve the people together. And for us, that's our strategy and that's my focus for the next years to come. Because this right here, we're in a crunch. But this does give me and my team, the leadership team here, the opportunity to develop a strong system team that focuses not just of what's coming our way now in the short term, but what do we do five to ten years from now?
- [22:35]
B
Yeah, I think fascinating to hear. I think it sounds like a challenge that no doubt you're relishing, but I think is the largest public safety net system in California. A real shout out to you, the team that you work with at the county Santa Clara Health System. Real been a pleasure. I've learned a lot from this podcast. I'm really looking forward to meeting you in person and have you speak on a panel here in April in Chicago. And no doubt it'll be a little bit warmer than it is today, but sham, it's been a real pleasure. Thank you so much. I really appreciate your time.
- [23:07]
C
Awesome. Thank you so much, Alan. Thank you.