← Becker’s Healthcare Podcast
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- [00:00]
A
Hi, everyone. This is Lukas Voss with Becker's Healthcare. Thanks so much for tuning in to the Becker's Healthcare podcast series. It's great to have you. An exciting topic today, wide ranging, certainly why managing denials isn't enough. It's really time to eliminate them. And I'm so excited to talk about this with Patrick Diangelo, president of Coral Health. Patrick, so excited to have you. Thanks for being here.
- [00:22]
B
Happy to be here, Lucas. Great to be a part of this.
- [00:27]
A
Yes. There's a lot to talk about and I'm going to age you here. I apologize. You have more than 20 years of experience in this space.
- [00:37]
B
Again, that's being kind, actually.
- [00:40]
A
There you go again. That positioning is so important because you're not just with one specific health system. You have this view of what's going on across the country, across dozens of health systems.
- [00:54]
B
Right.
- [00:54]
A
I'd love to start off with just sort of the patterns that you're seeing from where you're sitting that health system leaders right now might not be able to see from where they're at.
- [01:06]
B
Yeah, I think that's a great place to start because being on more of the service and a service provider, you're able to look across the spectrum of all healthcare institutions, be it a large health system, be it a small private physician practice, be it even payers and what they're dealing with. So seeing that spectrum kind of gives you a different light of exactly, you know, or somewhat of what, what's going on in, in the, in the healthcare space. You know, and I think when you, you represent providers, which is what I represent at, at Coral Health and support them, you know, you just see this constant trend and it's, it's almost, it's turning into like a broken record of, you know, denials, managing denials. How do I get the right people? The shift in the workforce, you know, today is way different than it was, you know, pre pandemic. Right. You have, you know, employees that, you know, pretty much, you know, work from home. We've never had that in our space before. Right. So being able to, you know, manage that shift of employees, knowing that, you know, your lifeline is it has always been reliant on your resources or your vendors. And now you have the, you know, the, the parallel track of AI and, and how that can support, you know, each, each individual and improve overall results and so forth. So, you know, it isn't, it's a true, interesting time, but I will say the themes are pretty common across, you know, health systems, across practices, physician practices, you know, across the board and where they struggle. And it's, you know, it's having the, the right people, the right amount of people, having the right partner or vendor, if you will, to support them in different areas. You know, do you, do you outsource everything? Do you complement, do you use staff? Aughow do you work this? And it's different depending on, you know, the health system and how they want to approach things. And then like I mentioned, you got AI and what are the decisions there? Where do I start? Do I start big? Do I start small? Do I trust it? Do I have to have an overlay to keep a close eye on it? And I think there are just a lot of questions that the organizations are truly trying to work through and understand and so forth.
- [03:40]
A
I want to touch on something that you just briefly mentioned, which again is the importance of technology. We'll talk about AI here in a little bit, but in a recent conversation that we've had in a webinar that I hosted, Coral Health, that you should definitely also check out if you haven't done so, you said something that really stuck with me in that conversation, which is that things have changed to where we're. It used to be people process technology. So that three prong piece that a lot of folks still mention today and it changed to technology people. What's driving that shift right now? If you want to talk just a little bit about what you mean by that. And again, for leaders that are still early in that journey, what is that first move to get there?
- [04:19]
B
Yeah, well, I think it's really in the age now of AI, right? Technology was always a critical part, but it wasn't the first part. It was always driven mainly by people. And now as you look at the shift, technology is really the process. You're going to load technology, it's going to tell you everything you want it to do. Even your epic work lists are really built around how do you want your process set up. I think fundamentally every workflow is driven by technology of some sort. And that technology then has some pretty intelligent work listings or intelligent areas that can drive the workload based off demand, based off skill, based off need, you know, that ultimately help reduce what you're trying to do or what you've done in the past manually. So, you know, I, I think on our call last week, Lucas, you know, the ladies that we had on, you know, said, yeah, we still use people and the technology, right? They were really people focus. And I don't disagree with that at all. I think that's Actually the right approach for sure. But you gotta meet have that technology I think today, drive where people are or drive where you want your people to be and be able to focus on areas or what I would call pits within your AR process or within your entire revenue cycle flow it, be it front end, mid cycle and back end, have that technology drive where you need to focus on and be able to report upon it. Because I do think you're not going to eliminate the people aspect. Right. But when the technology identifies routine denials, routine areas, routine fail points, you're going to have to go up and re engineer or tinker the technology to improve that feedback. Now unfortunately, I think it's going to be a cat and mouse game with payers and providers that you're constantly been tweaking. They'll make their change on their end and so forth. But the goal ultimately is if you have poor registration on the front end and you're not fixing it through resources or technology, you're going to be in a, you're going to, it's going to continue to snowball if you will. So having technology be that first one and the people that really drive the feedback to improve the technology, that's where we've evolved and that's where we are today.
- [07:14]
A
Speaking of these processes, I do want to get a little bit more granular and maybe also use this as an example to illustrate what we've just touched on.
- [07:21]
B
Right.
- [07:21]
A
You talk often about the distinction between self pay after insurance and pure self pay.
- [07:26]
B
Right.
- [07:27]
A
When it comes to AI, specifically in patient financial conversations. Very, very crucial. It's a very important topic for patients, obviously for providers as well. Again that's however also a nuance that a lot of folks don't necessarily talk about. Can you walk through that distinction a little bit more and what it means for health systems that where they should be deploying that AI on the patient facing side.
- [07:50]
B
Yeah, and we, we talked about this a little bit last week as well. You know, in, in where I look at it from a self pay perspective, we, you carve out your pure self pay versus your self pay after insurance. And you know, in most cases other than, you know, mostly Medicare, but your self pay after insurance, these are more of your working class if you will. Nothing against the self pay or the non working class or people who are working there, but they're more tech savvy. Right. They are more likely to pay their bills, they're more likely to use your online pay, your things like that and sometimes they just need that little nudge or that little reminder and utilizing AI to make that call or send that message, that email, that text is what gets it done. And me personally, just because I'm in the space, I'm the one that waits to see if I get a balance after. I actually wait to see the technology because I want to learn, I want to see what they're doing. So I'm the type of guy that doesn't pay right away and I wait till really the end just to catch the dunning cycle. What is the process, how long between calls are they really doing it? So it help gives me the actual feedback to either get back to that client or to my customer to say, hey, this seemed to work for me or I've seen it work a little bit better. So I look at the self pay after as being more they'll adapt to the change in trends of AI and just trying to get the bill paid. On the self pay side, I don't speak for all of them, but most of them will use that AI as a way, well, it didn't get through or I didn't hear it or yeah, my checks in the mail. And it's a lot easier to do that with a pure self pay because they're either going to pay or not going to pay. And based off their current situation, likely use that not to pay. You'll need more of a human touch to hopefully keep them on the phone, get them the assistance they need, find out what charity care is, can we offer a prompt, a discount altogether? But one of the things I did talk about last week, which goes over self pay and self pay after, even with AI, you have to be sensitive to the patient you're calling or guarantor you're calling depending on the type of illness or why they've had this bill. Right. So if you have a family member or yourself that's going through a horrible health issue and you're struggling with work, you're struggling with making payments and you having a robot constantly call you, it I think impacts the community and the ethic of the hospital. Right. And I think having a human still call in those situations. For example, a children's hospital, right. There's so much sensitivity going there and, and you don't want to lose that. And I think a lot of children's hospital promote themselves as being the forefront and being the provider for those families during these hard times and having an AI just constantly ping them, you sort of lose somewhat of the sensitivity. And I just want everybody to realize that that could be a hard barrier that will take longer for the community, the patients, the guarantors, the sufferers, the ones who are struggling to understand having a human touch versus an AI robot, if you will.
- [11:42]
A
And I want to talk a little bit more about that specific fact. We've touched on it in the beginning of our conversation. Again, you see this work in a lot of cases you see, especially the AI agent piece, make a difference for people specifically when it comes to workload. Unfortunately, you're also part of the other side. Right. You see, when it doesn't work, you have the experience to say, hey, this might not have worked, this didn't work, this needed to be adjusted, etc. Right. I'd love to know what some of the warning signs are that you would like to point to with leaders when an AI implementation doesn't work. What are some of the things that you're pointing to that leaders should be aware of today of like, okay, we need to adjust this.
- [12:24]
B
Yeah, I think there's probably multiple areas you can look at. I mean, you know, financial decline would be like the first one. If you start to see, you know, your metrics starting to slip, you know, be a cash, be it anything, you see your, you know, your AR shifting into higher age buckets, you know something's wrong right now. I'm not saying that would be 100% AI. There could be other shifts in the business that would drive that, but for the most part it would be those AR metrics moving back to the self pay area. You know, if you're making a lot of quote unquote contacts yet you're not seeing the shift or the inflow of cash or resolution rates to those contacts, I think that would be a huge indicator of what you have to do and maybe adjust or think. And that's where we go back to the technology and people. In the past you had to retrain the people, redo that and it was a longer shift to improvement. Now you tinker with the technology and you've changed the process and you can have a quicker impact to improvement and you have the ability to say, okay, hey, this didn't work that well, let's shift it this way, or based off the metrics, let's shift it that way. But again, I think you're going to have to have, if you're using that technology to drive a process or person, you're going to need to make sure you have the right tools or the people that to watch those shifts in metrics to make sure you're on top of it so that it doesn't just keep snowballing into something bigger.
- [14:07]
A
I think again, you've mentioned something very important here. Again, the fact that this is, it's that snowball effect and I like to link this too to the fact that everything is changing all the time, right? This is a fast moving space. Organizations have to be aware of that. One of the things that we talk about quite a lot is the fact that payers are also adapting, right? Health systems are adapting, payers are adapting health systems. Health systems do something, then the payer does something, right. It's sort of this cat and mouse folks are adjusting because this is a constantly moving space. As we just highlighted. What does this race look like from your perspective and as we close our conversation here today?
- [14:50]
B
Right.
- [14:50]
A
How should revenue cycle leaders think about this space with that in mind?
- [14:56]
B
Yeah, I mean if I had an answer to this, Lucas, my goodness, what we could do, you know, it's one of those things because each payer is, is different, right? And they get categorized different. And that's what I think that's a lot of the complexity, right? Is it's not, you know, one size fits all with payers and providers and, and how they work. But you know, I, I do say it's, it's capturing what you know is failing regardless if payer's right or wrong, capturing it, categorizing it as how do I fix this solution bundled, right. Fix this solution for multiple and try to stay on top of it. Right. It's hard to pinpoint where the fixed point would be, right? The chicken and the egg here for the most part. But being able to just categorize where your biggest pain points are and basic blocking and tackling and that's with technology, that's with humans, that's being able to stay on top. And you know, you always like to say you can work with your payer, right? You always like to say that you're big payers, you can sit down and, and figure out how to work it. But if you can't really do that unless you have the data points and the proof points on where you feel they're failing you. Right. And I do think sometimes we just categorize payers as they're just horrible. They're just going to do it because they can. Maybe they do. I'm not going to go there with this conversation. But I would say that if you don't have the data and the factual points, you're not going to improve anything. One with technology, one with your people and most importantly, the payer relation.
- [16:43]
A
Patrick, thanks so much again. It's great to have you.
- [16:46]
B
Same here, Lucas. Appreciate it.
- [16:48]
A
We also want to thank our podcast sponsor, Carl Health. You can tune into more podcasts from Becker's Healthcare by visiting our podcast page at beckershospitalreview.
- [16:56]
B
Com.