Latest / Becker’s Healthcare Podcast / Byron Glasgow, MBA, Vice President of Finance at Temple University Health System

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Byron Glasgow, MBA, Vice President of Finance at Temple University Health System · Becker’s Healthcare Podcast

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This is Alan Condon back with another episode
0:37
of the Becker's CFO on revenue cycle podcast.
0:41
And today, I'm thrilled to be joined by
0:43
Byron Glasgow, vice president of finance for Temple
0:47
University Health System at the five hospital academic
0:50
system
0:51
headquartered in Philadelphia
0:53
and anchored by Temple University Hospital. That's one
0:56
of the most reputable and most distinguished academic
0:58
medical centers in the country.
1:01
Byron, a real pleasure to to have you
1:02
back on the podcast with us today.
1:04
For those of our listeners who mightn't be
1:05
as well acquainted with you or the work
1:07
that you do at Temple Health,
1:09
do you mind sharing us a little bit
1:10
more about your role and your background?
1:12
Absolutely.
1:14
So thanks, Alan. I really appreciate you taking
1:16
the time to speak with me today, and,
1:19
hopefully, your audience, enjoys the conversations.
1:23
So my name is Byron Glasgow. As Alan
1:25
said, I am the vice vice president of
1:27
finance
1:28
over at Temple Health.
1:30
I've been at Temple Health for
1:32
fifteen years.
1:34
Over those fifteen years, I've had eight different
1:37
roles.
1:39
I came to Temple right after I graduated
1:41
college, moved to Philly, got my MBA there
1:44
while simultaneously working. So MBA at Temple University
1:48
and really haven't looked back since.
1:51
Temple is a very special place, and I've
1:54
really enjoyed my time there.
1:56
Give you a little background on Temple.
1:58
Health systems around 3,500,000,000.0
2:01
in revenue.
2:03
We have
2:04
1,200 licensed beds, around 10,000 employees, 1,000 physicians,
2:09
and we have seven facilities across
2:12
Philly. One facility is our Fox Chase Cancer
2:15
Center. It's a PPS exempt cancer hospital,
2:18
one of 11. It's NCI designated,
2:21
and it's credible outcomes,
2:24
really well established brand in the oncology market.
2:28
We have our new women's and family campus
2:30
right in North Philadelphia,
2:32
recently opened over the last few months.
2:34
We have our Episcopal campus,
2:37
which is behavioral health,
2:39
has crisis response center,
2:42
and really is on the forefront
2:43
of fighting and, combating
2:46
the opioid epidemic that plagues our city
2:49
of Philadelphia.
2:51
We have Jean's Community Hospital, which is,
2:54
a community hospital as I stated. It's right
2:56
across the street from Fox Chase, and it
2:58
has a robust,
2:59
bone marrow transplant department.
3:02
We have our Northeastern campus outpatient community facility,
3:05
Chestnut Hill Hospital, which is a community hospital.
3:09
And then we have our flagship, which is
3:11
Temple Maine on Broad Street.
3:14
As Alan stated, it's a academic center,
3:17
but it's a pretty unique place.
3:19
Philadelphia is the largest city in the country
3:22
without a public hospital.
3:24
So Temple, Maine on Broad Street really comes
3:27
in
3:28
and fills that void.
3:30
So to put into context what this academic
3:33
center,
3:34
while, again, you know, being an academic center,
3:36
it also
3:38
operates as the community hospital in North Philadelphia.
3:41
And
3:43
we sit there. Our inpatients recently
3:46
last year, seventy two percent of our inpatients
3:49
are Medicaid eligible. So either have Medicaid as
3:51
the primary insurance or they're, dual eligible patients.
3:54
So it is a void we, fill, and
3:57
we're really proud of that to serve the
3:59
community.
4:00
Yeah. Fantastic. I think really appreciate the the
4:03
kind of breakdown of yourself, your history of
4:05
Temple Health, obviously, the makeup of the health
4:07
system as well. Certainly helpful to know as
4:09
we dive a little bit deeper into our
4:10
conversation here. Dollars 3,500,000,000.0
4:13
in revenue, seven facilities, hospital facilities, I believe,
4:15
across Philadelphia,
4:17
the largest city in The U. S. Without
4:19
a public hospital is not something I was
4:21
aware of. But, Byron, I guess, at the
4:24
time of recording,
4:26
it's December, we're at the 2025,
4:29
going into 2026.
4:31
Like you said, I guess, ubiquitous challenges, but
4:33
it sounds like a lot of growth as
4:35
well going on at Temple Health.
4:37
What are the two or three kind of
4:39
key trends that you're paying most closest attention
4:42
to health care today in your seat as
4:44
VP of finance?
4:46
So the big trends
4:48
I've been looking at
4:50
is I'd say the first two kind of
4:53
bounce off one hand washes the other, which
4:56
is the rising cost of health care
4:59
as well as,
5:01
in concert, the value based care that we're
5:03
all moving towards. And the the third one
5:05
will be AI.
5:07
Obviously, can't can't miss it. It's at your
5:09
dinner table, in your house, on signs everywhere.
5:11
So, of course, I'll touch on that.
5:13
But
5:14
as far as costs go and the rising
5:17
cost of health care, we've it's getting close
5:19
to 18% of g GDP.
5:22
We've seen
5:23
a response from the federal government with HR
5:26
one. And, obviously, there's many implications of that
5:29
for a health system like Temple, University Health
5:32
System with our flagship hospital
5:35
on Broad Street.
5:36
When it comes to provider taxes
5:38
and all of the other
5:40
redetermination,
5:41
things like that.
5:43
But even if you take that and put
5:46
it over to the side and just talk
5:47
about the actual rising cost and
5:50
why that's such a hot topic.
5:52
You really have to consider the place hospitals
5:55
are in, and
5:57
they're really on the forefront and on the
5:59
front line
6:00
of,
6:02
health care. And a lot of the focus
6:04
is on hospitals, on how do you reduce
6:07
costs.
6:07
And it's pretty unique to
6:10
kind of all other products and services out
6:12
there in the country.
6:15
Hot button issue in the election was grocery
6:17
stores and the Verizon cost of groceries. And,
6:20
really, it was, well, what are the government
6:22
gonna do about it? Years ago, it was
6:24
gasoline. And what's OPEC? And the government, how
6:26
are they gonna combat these rising costs?
6:29
But often when health care costs come up,
6:30
it's, hey. The hospitals have to figure this
6:32
out.
6:33
And I think the difficulty for hospitals
6:36
and executives in the in the field
6:39
to try to wrap their head around is
6:41
how thin the margins are when you compare
6:43
it to the total, the entire ecosystem of
6:45
health care. So if you walk down the
6:46
halls of the hospital
6:48
and you see robots and you see pharmaceuticals
6:51
and implants and all these product,
6:53
electronic medical records, all of consulting firms,
6:58
And you step back and say, well, we're
7:00
making
7:01
hospitals are one to 3% in margins, and
7:04
you're under for safety net, you're less than
7:06
one.
7:07
And then all these other parts of the
7:10
continuum of health care are you get to
7:12
the insurance companies and the next layer, and
7:14
they might be
7:15
5% or depends on the service line they're
7:18
in, whether it's Medicaid managed care or Medicare
7:21
commercial.
7:22
And then you get out to that next
7:23
layer, which is, like I said, pharmaceuticals,
7:25
robots, and all those kind of things,
7:27
and they're over 20%.
7:29
So
7:30
I think to combat the rising cost of
7:33
health care, we need to look at it
7:35
from
7:36
a more broad level
7:38
and understand what hospitals can do and what
7:40
they can't do.
7:42
And in my mind, you always need to
7:43
keep your side of the street clean in
7:45
a lot of ways. So we do, of
7:47
course, need to internally look and say, what
7:50
can we do to fix this?
7:52
And we've been taking steps with our Medicaid
7:54
managed care partners.
7:56
Obviously, that's big for us at Temple.
7:59
And we've had conversations about how do we
8:01
get claims processed quicker,
8:03
how do we minimize denials, how do we,
8:07
minimize touches on clean claims? Things like that.
8:10
You know, where are we doing what is
8:12
there way too much administrative burden? And we've
8:15
made a lot of progress in the contracting
8:17
world on that.
8:18
And, obviously, there's more to be done, but
8:21
there is
8:22
only so much you can really do,
8:25
without all those other inputs
8:27
being
8:28
evaluated.
8:29
And recently, in the last couple weeks, we
8:31
have seen the federal government take a
8:33
much
8:34
needed look at all of the inputs across
8:37
health care and say, hey. We need to
8:38
have some type of level of containment outside
8:41
of the hospital and the insurance companies.
8:43
And I think that really
8:45
moves into the next layer for me, which
8:47
is value based care. And those two things,
8:49
cost containment,
8:51
rising costs,
8:52
those kind of run-in concert together. Because for
8:55
me, when I think about value based care,
8:57
I think about the opportunity,
8:59
and the need or the focus of a
9:01
lot of people with
9:03
risk based arrangements.
9:05
And one of the things that's really important
9:07
to note when you talk about risk
9:09
based arrangements or taking up upside or just
9:12
or downside risk or being at full risk
9:14
with insurance companies is
9:16
the level of predictability in the MLR.
9:20
And I think year over year,
9:22
you see pretty big swings,
9:25
at least on the Medicaid front, whether it's
9:27
disenrollment or
9:29
sick the sick folks staying on the plans
9:31
when it came to the epidemic and healthier
9:33
people leaving.
9:35
And it's really hard to for a safety
9:38
net such as Temple
9:40
to enter some type of full risk arrangement
9:42
with a Medicaid plan
9:44
because there is not those guardrails that exist
9:48
on those other externalities that are going into
9:50
the spend,
9:51
of health care in general. And it would
9:53
be irresponsible
9:55
for us to
9:56
take a full risk agreement, which, like I
9:59
said, it's kind of a trend when you
10:00
talk about value based care because we can't
10:03
deal with a $10,000,000
10:04
swing
10:06
based on a big shift in an MLR.
10:09
It would shut, you know, shut our hospitals
10:10
down.
10:11
So I think until we have some type
10:15
of guardrails around cost and more predictability,
10:19
It's gonna be tough to align ourselves with
10:21
value based care,
10:22
particularly in the safety net front, just because
10:26
it's not sustainable and razor thin margins and
10:30
just not being able to sustain huge losses
10:32
one year and then a big swing up
10:34
on the next following year.
10:36
Really, really appreciate the level of detail, specificity
10:40
on some of those trends watching. I guess
10:42
my my immediate question in terms of, as
10:45
we start to see more health systems
10:48
enter more of these full risk arrangements in
10:50
terms of value based care, what are some
10:53
of the guardrails
10:54
that will be beneficial, that will be helpful
10:56
for safety net providers
10:58
like Temple Health to engage in some of
11:00
these full risk arrangements in Medicaid.
11:03
Is there anything that's worked on the commercial
11:04
side maybe that may might potentially be beneficial
11:07
down the road for for some of these
11:09
Medicaid value based care programs?
11:11
On the commercial side, it's a little bit
11:14
different,
11:14
for us.
11:16
Most of the patient populations on the commercial
11:18
products,
11:19
are a large corporation
11:20
that are self funded. When it comes to
11:23
our Medicaid
11:24
products,
11:26
I think there's opportunity
11:27
if they had,
11:29
you know, ceilings on losses and things like
11:31
that.
11:32
Hey. Here's the the most you can lose
11:34
in any given year.
11:36
But one of the, I would say,
11:39
hurdles for that type of arrangement
11:41
is
11:43
the fact that
11:44
you would have to you partner with the
11:46
MCOs to let the state
11:48
understand how expensive it is to make the
11:50
for care. Right? This is how expensive it
11:52
is to treat patients, what we need for
11:55
capitation. You're partnering and championing these things together.
11:58
A lot of that time, that's gonna lead
12:00
to an increased burden on the state or
12:03
the federal government, which was kind of one
12:05
of the things that HR one and
12:07
other legislation is about is how do we
12:09
reduce the costs. So
12:11
I think it's difficult at this time unless
12:14
there are massive protections
12:16
on the downside risk for health systems
12:18
to be in any type of risk arrangement
12:20
until, you know, out of pocket spend,
12:25
for insurance companies on the drug front, pharmaceutical
12:29
front are are are really combative. And, you're
12:32
seeing that on a day to day basis
12:34
right now in, at our federal level and
12:36
our state level.
12:38
Got it. No. That's certainly helpful to understand.
12:40
And and then one quick follow-up, Byron. Just
12:42
going back to your initial point around just
12:45
the rising cost of care across the board,
12:47
health care now approaching 18% of GBP, like
12:51
you've mentioned, I believe around about 35%
12:55
or 40% of nonprofit hospitals
12:58
still operating in the red, have been inching
13:00
their margins back towards a breakeven level.
13:03
Again, no respite sounds like no respite coming
13:05
next year and the year after when we
13:06
think about some of these Medicaid quotes coming
13:08
down the pipeline, the impact of the ACA
13:10
subsidies that may expire December 31. But is
13:13
it fair to say vice president of finance,
13:16
CFOs, health care finance leaders like yourselves have
13:19
had to this year take arguably a harder
13:21
look than they've ever had to take at
13:23
the cost structure,
13:24
through no fault of their own, of course.
13:26
But granted no silver bullet, but has there
13:29
been anything
13:31
that has been particularly effective for Temple Health
13:34
in terms of reducing costs, whether it's on
13:37
the vendor side, whether it's on the supply
13:39
side, the labor force, anything that has been
13:42
significantly
13:43
effective in in bringing down some of your
13:45
costs this year or maybe into next?
13:48
Yeah. We have some supply chain adjustments with,
13:51
large scale partnerships to reduce acquisition cost of,
13:56
certain implants and supplies.
13:58
That's a big piece that we're seeing.
14:01
I think we've seen
14:02
less on the cost side. It's it's hard
14:05
for me to answer of one silver bullet
14:07
because when you're in the shoes of Temple
14:09
where you're operating on razor thin margins like
14:12
we are, we're always with our back against
14:14
the wall. So we're constantly looking on how
14:16
to get the most out of every dollar.
14:19
So that's a that isn't really just
14:23
just because of this
14:25
everything that's happening in the Medicaid market. It's
14:27
a day in day out thing that we
14:29
live with routinely.
14:31
But we are always constantly trying to get
14:33
out what we can.
14:34
And like I said, we have a big
14:36
supply chain, initiative,
14:38
within plants that we're looking forward to. But
14:42
I think more of the revenue opportunity
14:45
and minimizing
14:46
of unnecessary
14:48
burden of administration.
14:50
And that would kinda lead me into the
14:51
topic of the AI piece.
14:54
Mhmm. So
14:55
I think on the AI front, it's gonna
14:57
be a pretty large capital investment that we're
15:00
gonna see or could potentially be.
15:03
So I have that one piece, that fear
15:04
that's inside of me that, you know, just
15:06
being a risk mitigator and thinking through those
15:10
processes
15:11
of how much is it gonna cost to
15:13
get fully functional with AI, and is it
15:16
gonna lead to a gap between the haves
15:18
and the have nots?
15:19
That's a that's a little bit of a
15:21
fear of mine, but then I've also seen
15:23
and talked to, yeah, 30 plus vendors or
15:27
so about different AI products out there, and
15:29
I've seen some that I'm really excited about.
15:32
And on the payer contracting front and rev
15:34
cycle front,
15:35
I've seen some,
15:37
and one in particular
15:40
where it really focuses on
15:43
minimizing I don't wanna say it the rev
15:45
cycle war of getting claims processed, but
15:48
the number of FTEs it takes, the number
15:50
of touches on claims, and what I've seen
15:52
in focused on one product is
15:54
essentially have a AI agent
15:56
that is linked to your payer, goes
16:00
through all of your claims. And before they
16:01
even go out the door, it says, hey.
16:03
We're linked to your payer policy. We know
16:04
your contract.
16:05
We've seen
16:07
a 100 denials in the last thirty days,
16:10
and here's what we think you can do.
16:12
And it's either gonna you need to change
16:14
x, y, and z diagnosis code or
16:17
it could be some type of modifier, whatever
16:20
it may be. And then there'll there'll be
16:21
a separate bucket for it that just says,
16:23
hey.
16:24
We don't know why this is claims is
16:25
going to be denied. It's there's no nothing
16:28
in the contract or payer policy that's really
16:30
indicative of what's what's causing this. And that's
16:34
really helpful because
16:36
one of the things that's difficult when you're
16:38
dealing with your Medicaid managed care plans or
16:41
your,
16:41
Medicare plans is
16:43
they can't really process claims or it's really
16:46
detrimental
16:48
for them to process claims two years late
16:50
or, you know, a year later or whatever
16:51
it is. They really need to process these
16:53
claims in real time,
16:55
in their year of
16:58
submitting them to the state to say this
17:00
is how much the cost of care
17:03
how how expensive the cost of care is.
17:05
Because when those claims come in late, it
17:07
really isn't
17:08
accounted for in next year's capitated rates.
17:11
So one of the things these will do
17:13
is say, okay. We have a 150 claims
17:15
that were denied for the same reason. We
17:17
don't know why they're denied.
17:19
And you can hand those claims over in
17:20
real time to the payer and say, hey.
17:22
These all have the same issue. What can
17:23
you do to get these adjudicated?
17:25
Is it a vendor that's processing your claims
17:27
and there's some type of,
17:29
misalignment,
17:30
or is there something we're doing wrong that
17:32
we just haven't figured it out yet?
17:34
And that's gonna differ a lot from traditional
17:37
processes where, you know, people are working claims,
17:41
But you're one off claims, you're getting them
17:43
onto a log,
17:45
then you're working with the payers to try
17:47
to get these claims processed. And, of course,
17:49
you wanna lump up as many claims as
17:50
you can that have similarities,
17:52
but that's a very labor intensive
17:55
process. And you need
17:56
the traditional revenue cycle process to
17:59
commence and work through what it is. And
18:01
I think what AI is gonna do is
18:03
allow us to have
18:06
all of these claims that have similarities
18:08
in real time, get out the door to
18:09
payers, and have them dealt with so we
18:11
can be on the same page and, you
18:13
know, work together and work efficiently.
18:15
So I'm looking forward to that piece.
18:18
Yeah. No. Absolutely. I think the the excitement
18:21
around specifically the revenue cycle opportunities at AI
18:24
is something that no doubt, the finance leaders
18:26
like yourselves are really looking forward to next
18:28
year, kind of combating some of those bar
18:31
offs, slow slow payments, denials, and whatnot that
18:33
that have been such a challenge over the
18:35
last year. So did you have anything to
18:36
add in terms of AI in the clinical
18:38
side that you're excited about, Bart? Yes. I'm
18:40
really excited on that piece. It's obviously not
18:42
my field or the topic at hand when
18:44
it comes to this podcast, but I I
18:47
am looking forward to the minimizing of burden
18:50
on the administrative end for our, clinicians.
18:53
Yeah. I I think there's gonna be an
18:54
increase in FaceTime, and I always tell my
18:57
team, let doctors be doctors, let nurses be
18:59
nurses, and, you know, we're gonna handle the
19:01
rest. And
19:02
I'm excited for the opportunity to that
19:05
for AI to kind of minimize all those
19:07
burdens so we can maximize,
19:10
physician
19:11
and nurse face time with our patient population.
19:14
Yeah. No. I think,
19:16
opportunities galore on the clinical side. On the
19:18
revenue cycle side, certainly so excited to see
19:20
where we might be this time twelve months,
19:22
eighteen months down the line in those two
19:24
respects.
19:25
Byron, those are no doubt a couple of
19:27
areas that you touched on in terms of
19:28
your excitement for the future.
19:30
When you think about growth,
19:32
growth at Temple Health, I know you mentioned
19:34
at the top of the call some of
19:36
the key areas are growing.
19:38
Cancer hospital and a women's and family campus
19:40
as well.
19:41
How are you thinking about how is your
19:43
health system thinking about growth over the next
19:45
twelve months or so?
19:47
So as far as growth goes and opportunities,
19:51
we have a balance between, you know, the
19:53
growth initiative
19:54
that I think there's that old saying, if
19:56
you're not growing, you're dying.
19:59
And that's shown a lot of industries.
20:01
But
20:02
for health care,
20:03
we really need to be focused on sustainable
20:06
growth and our core competencies
20:07
and being true to our mission.
20:09
So I think there's gonna be growth at
20:10
Women's and Family.
20:12
We built it because of our core mission
20:14
of taking care of the community.
20:16
Since 1996, 13 of the 19 maternity programs
20:19
in Philadelphia have closed.
20:21
Infant mortality rates in North Philly, three times
20:24
the national average.
20:26
So when dealing with that kind of that
20:28
situation, we looked at our service area and,
20:31
there wasn't really a
20:33
facility located
20:35
in the service area where a lot of
20:37
our patients were originating or most of our
20:38
patients. So we put a facility right there,
20:42
and it's exclusively for women's and family.
20:45
And the idea here is to improve outcomes.
20:47
I think we're gonna see increased volumes, and
20:49
it's really gonna stem the standard of care
20:51
for women's centric care in urban centers. And
20:54
I'm hoping that a lot of cities are
20:56
gonna replicate this model.
20:58
As far as other gross initiatives have, we
21:01
do a hundred and seventy five plus lung
21:02
transplants.
21:04
You know, one of the largest in the
21:05
country
21:06
year over year.
21:07
So we're always looking to grow our our
21:10
lung transplant program.
21:12
We have
21:13
our Fox Chase brand, and
21:16
it's such a well known, successful brand, well
21:19
respected that, of course, we're looking to expand
21:22
our footprint in the market.
21:24
And we're doing the same thing with
21:27
our urology departments.
21:29
But while we're growing those products,
21:32
those service lines,
21:33
we're also focused on making sure that we're
21:36
able to
21:38
fulfill our mission and bring those services into
21:40
our community.
21:42
So Fox Chase has a great initiative
21:45
sending clinicians over to Chestnut Hill. So bringing
21:48
those doctors right to your front door. We
21:50
have those clinicians coming to Temple Maine and
21:54
bringing the that extraordinary
21:56
level of care into our community
21:59
and the same thing with our urology group.
22:01
So
22:02
we're focused on growing strategically
22:04
while sustaining our core mission. We don't wanna
22:07
sacrifice
22:09
the quality of care and quality of life
22:11
that our patients are experiencing to grow just
22:13
to grow. We're making sure that our growth
22:15
initiatives
22:16
align with our mission.
22:19
So sustained growth, entering the market,
22:21
new markets, while also bringing those
22:25
expertise to our communities and,
22:27
you know, to North Philadelphia,
22:29
which is really our home.
22:31
Yeah. Absolutely. I think, Byron, I've been looking
22:33
forward to this podcast for so long. Learned
22:36
so so much today. No doubt a lot
22:37
of our listeners will have as well.
22:39
Always a pleasure to speak with such leaders
22:42
like yourself at such really top academic health
22:44
systems doing great work like Temple Health. Again,
22:47
thank you so much for taking the time
22:48
out of your busy schedule. I look forward
22:50
to catching up with you down the line.
22:51
Yeah. Thanks, Alan. It was a a really
22:53
a pleasure. So
22:56
thanks again. When it comes to negotiating fair
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