Latest / Becker’s Healthcare Podcast / Shelly Schorer, FHFMA, MBA, California CFO at CommonSpirit Health

Transcript

Shelly Schorer, FHFMA, MBA, California CFO at CommonSpirit Health · Becker’s Healthcare Podcast

• 0:02
  This is where health care leadership comes together.
• 0:04
  Becker's sixteenth annual meeting brings more than 3,500
• 0:07
  hospital and health system executives and nearly 800
• 0:11
  speakers to Chicago April.
• 0:14
  This year's event includes keynote conversations with Dallas
• 0:17
  Cowboys legend Troy Aikman and former president George
• 0:20
  w Bush. For the agenda and event details,
• 0:23
  visit beckershospitalreview.com
• 0:25
  and click on the events tab in the
• 0:27
  upper right. We're looking forward to hosting you
• 0:29
  in Chicago.
• 0:32
  This is Laura Dierdahl with the Becker's Healthcare
• 0:34
  podcast.
• 0:35
  I'm thrilled today to be joined by Shelley
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  Shorer, chief financial officer of the California division
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  at CommonSpirit Health. Shelley, it's a pleasure to
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  have you on the podcast today.
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  Thank you, Laura. It's a pleasure to be
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  here. Thank you for having me.
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  Oh, absolutely. And, you know, Shelley, it's been
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  such a pleasure to get to know you
• 0:52
  over the last few years. I know you've
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  been on our podcast and spoken at our
• 0:56
  events, and we just truly appreciate that. So
• 0:58
  looking forward to continuing the conversation and learning
• 1:01
  a little bit more about how you're thinking
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  about the next twelve months or so. But
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  before we dive into that, I know, for
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  those who are just starting to listen to
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  the Becker's Healthcare podcast,
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  could you tell us a little bit more
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  about yourself and, CommonSpirit Health?
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  You bet.
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  So I serve as the CFO for CommonSpirit
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  Health California region.
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  For anyone unfamiliar,
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  excuse me, Common Spirit is the third largest
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  health system in The United States and the
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  largest nonprofit.
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  We operate across 28 states.
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  In California,
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  our division is substantial. We generate over $12,000,000,000
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  in net revenue. We encompass 29 hospitals, 125
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  ambulatory
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  care sites,
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  and more importantly, we're powered by nearly 40,000
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  dedicated employees.
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  We support 8,500
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  aligned physicians. We employ 1,200
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  physicians and advanced practitioner providers
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  along with 600 GME residents.
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  And currently, our organization serves one in every
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  four Californians.
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  And so it's it's quite a big part
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  of the common spirit footprint,
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  and I've been with the organization for almost
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  nine years.
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  That's amazing to hear. And, you know, what
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  a a huge growth that CommonSpirit has had
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  over the last few years and truly amazing
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  to see the expansion,
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  within the region of California as well. From
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  your perspective, when you're looking through the last
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  year or so, what was the most important
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  initiative that you led? What did you do,
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  and what were the results?
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  You know, it,
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  it was it was
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  not
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  a,
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  a light bulb moment. It was really the
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  blocking and tackling
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  was
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  through literally
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  disciplined, granular focus on our core operational and
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  patient care metrics.
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  We zeroed in on everything,
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  meeting stringent quality standards,
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  fostering our people and culture goals,
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  to meticulously
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  managing discretionary spend, optimizing our labor force, improving
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  our revenue cycle, and reducing length of stay.
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  That was significant work.
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  I mean, it sounds like something I'm just
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  saying, but we had teams.
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  We
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  the daily blocking and tackling,
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  we had revenue cycle is so many different
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  facets. It's payer strategies.
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  It's our payer
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  relationship. It's our revenue cycle partners.
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  Literally having all of those conversations in every
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  market that we have in California and making
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  sure that we understood
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  all of the obstacles which change because I
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  always say revenue cycle is living and breathing
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  thing.
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  Managing our patient care is also really important
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  just because,
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  you know, when you often think about finance,
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  we have to remember that the patient care
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  is the most important thing. But actually, good
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  quality care leads to better financial metrics too.
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  So that's really important to me as a
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  chief financial officer.
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  And
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  we, we keep trying to show patients ways
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  for new access,
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  improved,
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  resource utilization across the board. And by having
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  more access to for our patient care, we
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  can treat them in a better way where
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  they live. And it actually is, more cost
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  effective
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  delivery of care. So literally, the most important
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  initiative I think we did last year was
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  making sure that everybody understood what drives our
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  performance.
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  What metrics and what levers do we look
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  at to say, how can we improve in
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  our financial situation?
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  Are we slipping in anywhere in quality?
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  And we were very lucky last year. We
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  hit all of our goals in every one
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  of those facets.
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  That's amazing to hear. And, you know, bringing
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  back to the fundamentals in the last year
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  is,
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  so fascinating because I I think especially as
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  folks are are looking at all the changes
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  in the,
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  health care system, technology, and more, it seems
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  like there's often a push to try new
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  things to transform, but actually, it sounds like
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  you were able to meet your metrics and
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  meet your goals by really focusing on that
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  blocking and tackling, as you said,
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  in in bring stringing together some of those
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  core wins, which is really cool and
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  a helpful reminder, I think, for leaders as
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  they're looking at, you know, what do what
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  is the most important for the next year?
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  Yeah. I agree. Sometimes it's just back to
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  basics. You know?
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  Absolutely. Absolutely. So speaking of 2026,
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  looking ahead, what are some of the big
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  priorities as well as headwinds that you're focused
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  on?
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  We have, obviously, significant headwinds. Healthcare is in
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  a really challenging space right now, and we've
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  been here before. We've been through the balanced
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  budget act. We've been through affordable care act,
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  the invent the changes to the way we
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  got paid in the eighties. So we know
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  what this is like. This just seems a
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  little bit more.
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  We have the legislative challenges of HR one,
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  the big one big beautiful bill.
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  We have persistent inflation
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  that really is outpacing our revenue cycle and
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  our reimbursement.
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  So trying to manage that, dichotomy
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  is always challenging.
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  We have continued clinical ongoing labor shortages.
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  We have we continue to have challenges with
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  post acute placement
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  and this will continue to pressure our health
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  system.
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  And I think it's just imperative that we
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  remain incredibly engaged,
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  highly strategic,
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  and relentlessly innovative.
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  And what that means to me is constantly
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  exploring new models of care and forging strong
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  impactful partnerships to navigate these complexities successfully
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  and thinking about the way that we deliver
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  care in a different way. You know,
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  we are seeing more and more shifts to
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  the ambulatory setting, and I think that we
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  just need to be able to be,
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  bold and,
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  acceptance of change
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  and move with faster
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  vision
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  and than we've ever had before. But I
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  think we're poised to do that.
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  That's great to hear. And I I think,
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  critically, when you look at, figuring out how
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  to force some of those strong impactful partnerships
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  and
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  figure out how you want to deliver care
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  in a different way. I mean, those seem
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  like really big
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  things on the horizon that many leaders within
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  the health system have to figure out. And
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  then from your perspective as a CFO to
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  I could imagine there's pressure in some ways
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  to,
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  you know,
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  say yes to the things that need to
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  be done, but also
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  understanding,
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  from the dollars and cents side, you know,
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  there there's a lot of, challenges in in
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  that space. And so how do you really
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  decide what you want to prioritize when you're
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  looking at limited budgets or limited dollars, you
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  know, that you have to spend as an
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  organization?
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  You know, we we have to be really,
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  really,
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  mindful of everything, every decision that we make.
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  Obviously,
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  in health care, the one of the most
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  expensive things that we have is our labor
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  force because they're all highly educated, highly talented,
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  so they're expensive.
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  So we have to be very mindful of
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  how we hire, who we hire, and then
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  we don't over employ or underemploy.
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  Right? So it's that perfect balance.
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  We also have to be very careful about
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  how we do not only human capital,
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  but physical capital.
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  And where do we where do we put
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  our dollars where the most need is for
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  quality and growth and access?
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  And are there ways that we can increase
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  growth and access without,
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  massive capital spends? And I I that's this
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  ongoing strategic
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  conversation that we have in our leadership
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  meetings, really monthly.
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  Are we looking at the right things? Are
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  there new opportunities? How can we shift our
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  focus? How can we shift our funding?
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  And in California, we also have the Office
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  of Healthcare Affordability that's,
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  trying to manage our spending caps. So we
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  have additional challenges in our state to make
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  sure that we are not over,
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  we're not spending too much because they're gonna
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  put cost caps on our health care spend.
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  And so and that, is something that we
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  have to watch constantly, and
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  there is no way to fund 29 hospitals
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  at the same time. You know? I always
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  often refer
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  to a personal budget. You have to figure
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  out what is your priority,
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  and then you,
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  then you stage your spend for the best
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  for the, for the comp the communities we
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  serve, for our facilities and our ambulatory care
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  sites, and how can we do the best
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  for our patients,
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  and how can we fund the best things
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  and continue to grow and thrive and be
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  sustainable.
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  Absolutely. That's no easy task. And, you know,
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  to that point, when you're looking at the
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  next twelve to twenty four months, what do
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  you think is the hardest decision or hardest
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  thing you'll have to do in the coming
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  year?
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  I think it's gonna be ensuring we have
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  sustainable financial viability.
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  Making sure that we are reimbursed for the
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  care that we get. I talked about revenue
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  cycle,
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  payer relationships.
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  Those things are getting more and more difficult.
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  People are more sophisticated.
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  We see many of the bigger payers, the,
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  companies using, AI
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  to manage claims, and we have to make
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  sure that we're technology
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  equal to them so that we can manage
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  and we don't get behind in that space.
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  That's also expensive.
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  But we also need to grow,
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  our revenue cycle and make sure that we're
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  continuously,
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  reimbursed for the care that we give so
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  we can outpace
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  our inflationary pressures that we get. Obviously, the
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  inflation's outpacing our reimbursement, so we have to
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  be very careful on all of our spend.
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  And it's not just a financial metric, it's
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  fundamentally
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  important to our ability to continue investing in
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  these and ultimately patient care. I think it's
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  gonna be a significant challenge, not only for
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  common spirit, but for all health care facilities
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  because this isn't just,
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  you know, when I started in health care
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  almost thirty years ago,
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  it it was a it was a simpler
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  time and you could focus on one or
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  two things annually. And I think this is,
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  something that we have to look at every
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  day, every week, every month, and it's constantly
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  moving and shifting and changing our vision to
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  match what our pressures are.
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  Absolutely. I think that's, you know, such a
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  a great point. And truly, across the board,
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  these pressures and challenges are coming up for,
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  c suite leaders and and, you know, trying
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  to figure out and navigate all of them,
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  I think is,
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  the the golden question here. If we could
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  figure that out, then, you know, it'd be
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  in such a better spot. But I appreciate
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  you talking too about AI and technology, you
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  know, how the payers are using it, how
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  health systems are, transforming in some ways their
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  revenue cycle,
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  in order to keep up with some of
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  those things.
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  So it's just a lot happening within the
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  health care space today. So before we wrap
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  up, I wanted to ask you about growth
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  as well. Where do you see some of
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  the best opportunities for common spirit and especially,
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  the California division to grow in the next
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  few years or so?
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  I remain,
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  committed to the fact that I think our
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  best growth opportunities are in our ambulatory footprint
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  and enhancing our patient care access.
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  We there's still a need, obviously, for acute
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  care setting, but we are seeing more and
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  more
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  services
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  and,
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  health care procedures moving to the outpatient setting.
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  And I think that we need to expand
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  our ambulatory care footprint.
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  We need to make sure that patients have
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  access to care, that we have all the
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  right entry points for our patients to seek
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  care. And I mean, strategically growing our outpatient
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  services, our urgent care centers,
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  even leveraging our digital health and telehealth
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  to meet patients where they are, leveraging our
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  technology.
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  By making care more convenient and affordable and
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  accessible,
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  we not only serve our communities better, but
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  we position common spirit for sustainable growth in
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  a rapidly
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  evolving health care landscape.
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  And I think that's where you're gonna see
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  us really, succeed in the next year or
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  two.
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  That's amazing to hear. You know, I I
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  think you paint such a great picture of
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  having those outpatient settings, growth in ambulatory,
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  digital health, telehealth, and all of those things,
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  you know, are which, like you said, are
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  better for patient care, can produce higher quality,
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  more accessibility,
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  which is extremely exciting. But I know on
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  the flip side too from the financial perspective,
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  some of that can be a bit challenging
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  just because reimbursement
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  is lower in those settings. And so, you
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  know, it seems that there might be some
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  tension or growing pains in getting to this
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  future where ambulatory is really playing the the
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  right role within patient care for patients.
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  How do you set yourself up or is,
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  you know, the your executive team and and
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  board and everything really see that vision and
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  willing to go, through some of these interest
• 13:27
  growing pains in in transforming the health care
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  system?
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  You know, those are really important conversations. That's
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  an excellent question because what we what we
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  look at,
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  if we start investing in ambulatory care, yes,
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  it's a lower overhead, but it's also lower
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  reimbursement.
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  We have to make sure that we don't
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  over,
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  invest in our acute care. We have to
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  balance that setting. So if we're getting the
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  right if we have the right acute care
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  setting, that's fine. But if we start to
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  see a shift to outpatient, then we have
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  to adjust our overhead and our support for
• 13:57
  the acute care setting. And it's all about
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  balance, making sure that we are where we
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  need to be. And
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  if you can't,
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  you can't invest in everything at the same
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  time. So when we start to expand our
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  ambulatory care footprint
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  or our urgent cares or those things, then
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  we have to look at are there other
• 14:16
  acute care settings that we
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  either need to come up with, a partner
• 14:20
  to fill the space?
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  Do we need to adjust our overhead in
• 14:24
  those spaces? And it's really just about constantly
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  having those conversations and managing
• 14:29
  how we care for our patients and looking
• 14:31
  ahead because there is a need, like I
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  said, for the acute care space,
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  but we can't
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  sustain everything and still grow in our ambulatory
• 14:40
  care setting. We have to start to adjust
• 14:42
  our focus and our spend to make sure
• 14:44
  that it still makes sense for the communities
• 14:46
  that we serve.
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  That is, so helpful to know and understand.
• 14:51
  Shelley, thank you so much for your time
• 14:53
  today. This has been an inspiring conversation.
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  I really truly seems like you've got so
• 14:58
  many great things happening there at CommonSpirit.
• 15:00
  So we'll look forward to connecting with you
• 15:02
  again soon, and I know you're speaking as
• 15:04
  well at our annual meeting,
• 15:06
  in April. It'll be fun to continue these
• 15:08
  conversations to, keep seeing what are are some
• 15:12
  of the best solutions and bright spots within
• 15:14
  the health care space and learnings from each
• 15:16
  other. So I'm looking forward to seeing you
• 15:18
  then.
• 15:19
  Oh, I'm looking forward to seeing you too,
• 15:20
  and I'm really excited. That's my favorite conference
• 15:23
  of the year.