Latest / Becker’s Healthcare Podcast / Clay Ashdown, CFO at Intermountain Health

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Clay Ashdown, CFO at Intermountain Health · Becker’s Healthcare Podcast

0:02
This is where health care leadership comes together.
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Becker's sixteenth annual meeting brings more than 3,500
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hospital and health system executives and nearly 800
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speakers to Chicago April.
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This year's event includes keynote conversations with Dallas
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Cowboys legend Troy Aikman and former president George
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w Bush. For the agenda and event details,
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visit beckershospitalreview.com
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and click on the events tab in the
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upper right. We're looking forward to hosting you
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in Chicago.
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This is Madeline Ashley with the Becker CFO
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and revenue cycle podcast, and I'm excited to
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have Clay Ashdown, CFO of Intermountain Health in
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Salt Lake City with me on the podcast
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today. Clay, thanks for joining me.
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Thank you for the invitation.
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So, Clay, I know we had you on
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the podcast back in March with my colleague,
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Alan. But before we kick things off, for
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our listeners who might not have had a
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chance to catch that episode, do you mind
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sharing just a little bit about yourself and
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and Intermountain Health?
1:00
You bet. So I have actually had the
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pleasure of being at Intermountain for a little
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over twenty five years, actually.
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I've been in the CFO
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role for just over two years, but I've
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had a variety of
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financial leadership roles over my career.
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Prior to that, I was in public accounting
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at KPMG
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and, just really fortunate to be part of
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this organization.
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Wonderful. Well, it sounds like you've had a
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a nice strong run with Intermountain, and, sounds
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like,
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you know, everything's going really smoothly. Two years
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in, how do you feel in your in
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your CFO role?
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You know, I don't know that I'll ever
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feel entirely comfortable,
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but I would
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say I am I am blessed with a
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really high performing team. And I would extend
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that not only to the financial leadership, but
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the senior leadership of the organization,
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which is just fiercely committed to the the
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mission
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to constantly improving. And so
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that makes my job a little bit easier.
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Although Yeah. As we all know in in
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this industry, it is immensely challenging. But,
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again, being part of a a team like
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what we have here is is incredibly helpful.
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That's amazing to hear, and that's actually exactly
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what I wanna get into. You mentioned you've,
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you know, been with the system for twenty
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five years. You've probably seen a lot of
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ebbs and flows in the health care industry.
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So could you share some some broader challenges
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that you're closely keeping an eye on right
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now from your financial perspective as we head
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into 2026 and and why?
2:32
Yeah. I would say we're in a period
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right now
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of
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pretty significant uncertainty, and I know that's not,
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you know, too revolutionary or anything. But, you
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know, as as we've been going through
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our planning cycle and we just wrapped it
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up, looking at not only
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our our annual plan for 2026,
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but obviously as we're looking at on the
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horizon beyond that,
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there are just a lot of unknowns.
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And there are always variables that are hard
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to predict
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as we look at our forecast. But I
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would say this
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this time,
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it's perhaps more uncertain than any other time
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that I can recall.
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And so that that relates to certainly, you
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know, government payments and the level of of
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those and and how significant of an impact
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those will have.
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We have workforce
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redesign uncertainty
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as we look at
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the the implications
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for technology,
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automation,
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AI,
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and what will that mean in health care.
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We we see tremendous opportunity there, but we
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also know that there will likely be disruption.
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And so trying to really capture
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how that will will affect us.
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And then I would say the more
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typical
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dynamics. It's looking at the inflationary
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pressures of our expense cost
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relative to
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the increases that we see on the the
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revenue side and how it is just very
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challenging to
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keep pace with with those revenue
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pardon me, with with the expense
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increases and what we're forecasting
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both from a supplies perspective, from a labor
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perspective,
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and and goes on from there. So I
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would say some of these forces are are
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more,
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acute than than perhaps would otherwise be the
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case.
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And others are just kind of the the
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constant changes
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that occur in health care and and trying
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to be a an efficient
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model while still delivering,
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you know, extraordinary care.
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Right. And and you just said, you know,
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times right now are you you said unknowns,
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and this is, you know, a time of
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uncertainty
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more than you can even recall from the
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past. So what are some ways that you're
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really maybe some solutions that you found have
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been helpful in terms of working with your
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finance team just amid all of this uncertainty
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that we're seeing? What's been your, you know,
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your strong point?
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Yeah. I
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think what it requires
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is enhanced collaboration
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Yeah.
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Really
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trying to be a partner focused on
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solutions
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and not just
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being a preservationist
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of saying, well, you know, let's let's hunker
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down. Let's let's be,
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even perhaps more judicious in terms of of
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protecting our resources and our assets and that
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sort of thing. I think it requires
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an added level of of courage and innovation.
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Now that's not to say that we don't
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need to be incredibly
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disciplined because I think this requires,
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perhaps even a level of discipline that we
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haven't seen in the past.
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But at the same time,
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we can't be so risk averse and cautious
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that we aren't willing to take
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necessary chances and and risks. And so as
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we as we look internally at our organization,
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we have been very well known for pursuing
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proactive care, which is how we label value
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based care
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and really thinking about how can we
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fundamentally
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change
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how we not only deliver care to make
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sure that we're being more proactive in that
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delivery,
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but also
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how can we modify the economics in a
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way
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to make sure that those incentives are aligned
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so that
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we are fairly compensated for the services that
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we offer while we're also driving down the
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cost of care to the populations we serve.
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Yeah. I've heard some some system leaders say,
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you know, I'm we don't wanna take those
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risks right now. Other system leaders say, you
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know, take those risks. Are you kind of
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in the middle? Are you, like, safely take
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those risks?
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You know, it's a great question. I I
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don't know that I would characterize it as
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safe. I think, ultimately, it's making sure that
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you have the right
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arrangements,
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the right partners, the right agreements. So Yeah.
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You know, it's it's not a matter of,
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well, as soon as we get to a
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certain percentage of scale in risk based contracts,
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then, you know, from then on, it it's
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it's, you know, easy easygoing. I think,
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ultimately, it's being very thoughtful and pragmatic and
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and not not being safe in our approach,
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but being thoughtful in how we partner and
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engage and execute on these contracts to make
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sure that they are really,
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well orchestrated.
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Yeah. And and again, amid amid amid all
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these changes, could you dive a little deeper
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into how Intermountain is kind of deciding right
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now where to invest in in its revenue
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cycle?
7:37
In revenue cycle? Yeah. So,
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that's
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it's a great question. So as you may
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know, and and I'm sure,
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many of the listeners are not aware,
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we actually just transitioned on September 6 so
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that our entire enterprise
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is on a single instance of Epic.
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And prior to that time, we had parts
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of the organization
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in Epic, part of the organization in Cerner.
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Actually, the majority of our organization in Cerner.
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And then we had some ancillary areas
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that were even on some different EMRs. And
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so now we're all on one consistent platform.
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So that that was obviously a massive investment,
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a
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large undertaking to make sure that we have
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a consistent platform.
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So we're still even though things have gone
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well, we're still obviously digesting some of those
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changes.
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But what I would say is,
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although that is a large investment
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that has significant ramifications
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for revenue cycle,
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that is not the only thing we're doing
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with revenue cycle. And,
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through our partnership with r one, particularly
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in in Utah and Idaho.
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They have been aggressively
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investing
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in in technology.
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They've been partnering with other organizations
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to really see how we can implement
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technology and AI
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and to really streamline
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some of those processes. So some of it
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we're doing through through our r one affiliation
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and some of it we're doing independently as
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we look at
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really innovative technologies
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that can enhance and simplify the way that
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we approach our revenue cycle.
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And I'm sure keeping an eye on all
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of these incoming, you know, technologies,
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AI,
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it's a lot to consume. So how do
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you kind of sift through
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what's best, what what works best for Intermountain?
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What's that thought process like for you?
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So we have I would we have a
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strong governance
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structure, and I would call that from both
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our board governance perspective and our
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our audit compliance committee is very
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attentive to the sorts of technologies that we're
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evaluating and how we're incorporating those.
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From an internal perspective,
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we have a council
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that really takes a strong look at
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AI and other automation solutions
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to make sure that, one,
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we're not just
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kind of buying into the noise,
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that's that's out there and and any innovative
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solution that someone might hear about at a
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conference and just jumping on board, but having
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a thoughtful
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circumspect approach to saying,
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alright, where do we just want to lean
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on our key platform?
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So Yeah. So think Epic, think Microsoft, etcetera.
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And where do we see opportunities that are
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truly differentiated
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that can speak to those platforms,
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but perhaps can bring in some niche solutions
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that otherwise wouldn't be available. But having a
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very, very robust process to make sure that
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we are thoughtfully reviewing those
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and incorporating those because,
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you know, the last thing we wanna do
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is
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create so much confusion and chaos
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in our in our interest of innovating
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that ultimately it slows us down because there's
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just too much noise.
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Yeah. And and like you said, it's it's
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been a little over three months since that
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that major epic integration into Intermountain. So
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any lessons learned here? Any anything that you,
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you know, would like to share with listeners?
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Any updates you can give?
11:20
Yeah.
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So as you can imagine, we
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we really
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thought long and hard about whether to phase
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in the implementation or whether to go all
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at once. Mhmm. And,
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and as I mentioned,
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we had parts of the organization that were
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already on Epic.
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But for those for those that weren't,
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we ultimately opted to do a one day
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transition on September 6.
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And there was a fair amount of trepidation
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about that as you might expect.
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But It was a busy day. Yeah. But
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in retrospect,
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I'm I'm very pleased that we went this
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way,
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and and ultimately allowed us
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to transition quicker.
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I think there were obviously a number of
12:05
of tickets and issues that needed to be
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addressed, and we're still in the process of
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of mitigating some of those things.
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But the fact that we went through it
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all at once,
12:16
we are cleaning things up as a system
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as we go. Yeah. I I think it's
12:21
it's actually been quite a success story. It
12:23
was a little antithetical to, I think, what
12:26
a lot of people thought initially
12:28
we should do because, like, well, let's test
12:30
it out in a location, and then let's
12:32
just incrementally
12:33
roll it out. But this this has really
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been, I think, a successful implementation.
12:39
What I would say is from a rev
12:41
cycle perspective,
12:43
I'd say we,
12:44
perhaps based on a lot of other Epic
12:47
peers,
12:48
got off to a little bit of a
12:49
slower start because there was so much emphasis
12:53
as as it should be on patient safety,
12:55
on continuity of care.
12:58
And although
12:59
the the
13:00
sort of the coding and the billing was
13:02
certainly important,
13:04
we wanted to make sure that those other
13:06
key areas were were addressed first.
13:09
So we I would say we got off
13:10
to a bit of a sluggish start on
13:12
the rev cycle space. But since then, we
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have not only passed through what Epic,
13:19
gauges as their, I guess, median expectation,
13:23
but we we continue to to outperform. Now
13:26
we're not, I would say, exactly where we
13:28
wanna be yet, but we have already seen
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the results of that coordination. And and I
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would say the other thing from a lessons
13:36
learned perspective,
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there has been such tight collaboration
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between
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our business operations folks, our revenue cycle leaders
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and caregivers,
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and our clinical leadership
13:49
that it's not
13:51
a, you know, who's whose responsibility is this?
13:55
Who who should we point to to make
13:57
sure this is happening? It's really been a
13:59
collective desire
14:00
to work together and come together and and
14:03
find these solutions and to really make sure
14:05
that there is accountability and ownership, and that
14:08
has been fairly remarkable.
14:10
Yeah. No. I mean, like you said, even
14:12
going all in on September 6 like that,
14:14
it sounds like, you know, everything is really
14:16
paid off and and the integration, you know,
14:18
was very successful. Just now something to kinda
14:20
keep an eye on and watch as things
14:21
continue. Correct?
14:23
Absolutely. No. We certainly have not declared victory.
14:26
We it is a an ongoing effort. So
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Yeah. Yeah. No. Definitely. Thanks for sharing those
14:32
lessons there. Final question for you here. And,
14:35
again, we the the theme of our discussion
14:37
today, we've definitely talked on a lot of
14:39
unknowns, challenges across the industry.
14:41
So could you share maybe over the years,
14:43
you know, the last few years in your
14:44
role CFO, how it's even evolved during that
14:47
time just beyond finances and and maybe the
14:50
importance of some some communication, different leadership skills
14:53
that you're experiencing and what also will be
14:56
important in the next few months?
14:59
It's a it's a really terrific question. And
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I think
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the ability to adapt
15:05
is more important arguably than it ever has
15:08
been. Technology is evolving so quickly. The industry
15:11
is evolving so quickly
15:13
that I think
15:15
clearly people need to bring their own unique
15:17
sets of skills,
15:19
their training, their expertise to the table
15:22
because that is a a really necessary data
15:25
point to inform these decisions.
15:28
But
15:29
the siloed approach that perhaps existed in in
15:33
prior iterations in the past,
15:35
where
15:36
you have a finance leader,
15:38
really specifically looking through a finance lens, an
15:41
HR leader looking through an HR lens, a
15:43
communications person looking through a communications lens, etcetera,
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etcetera.
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I think ultimately, people need to bring those
15:50
unique perspectives,
15:52
but really problem solve as a collective.
15:56
And I think that willingness to collaborate, look
15:58
beyond your own sort of stereotypical
16:01
area of expertise,
16:03
and really come together to say what is
16:05
in the best interest of our organization and
16:07
more importantly, the best interest of the people
16:09
that we serve.
16:11
I think that ability is more important
16:14
than it ever has been. And I think
16:17
the ability to continue to evolve,
16:20
you know, I I look at the CFO
16:22
role, and I've had the privilege of of
16:24
working for some some really good ones.
16:28
And and I see other leaders that have
16:30
have served in different capacities.
16:33
I think
16:34
the those lines of accountability
16:37
continue to blur.
16:38
And and so it's
16:40
so important that people bring good collaboration to
16:44
the table that they can communicate effectively, not
16:47
only
16:48
with their peers,
16:50
but with those that they lead to to,
16:53
you know, drive an inspiring vision. Now I'm
16:55
the first to admit,
16:58
I wish I were a stronger communicator than
17:00
I am, but I think that is something
17:02
that we need to continue to work on
17:04
because
17:05
it it's never been more important.
17:08
Yeah. No. Communication is definitely always key, but
17:11
those are some really strong insights. I appreciate
17:13
you sharing, Clay.
17:14
And I'm sure I'm really looking forward to
17:16
connecting again down the line, and I'm sure
17:18
we'll have lots more to discuss. Never,
17:20
never a dull industry, health care.
17:23
It is not. Yes.
17:25
Well, thank you again, Clay. Always a pleasure.
17:27
And, yeah. Look forward to chatting soon.
17:30
Thank you, Madeline.
17:31
Thank you.