Latest / Becker’s Healthcare Podcast / Driving Hospital Turnarounds and AI Strategy in Revenue Cycle with Sunitha Reddy

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Driving Hospital Turnarounds and AI Strategy in Revenue Cycle with Sunitha Reddy · Becker’s Healthcare Podcast

0:00
When it comes to today's RCM, we know
0:02
the challenges,
0:03
complexity of claims, talent shortages,
0:05
low funding, and lagging tech.
0:08
That's why we built MedMetrix.
0:10
We have the expertise and advanced tech to
0:13
give you that edge on your revenue cycle.
0:15
We're a partner who will relentlessly raise your
0:17
yield, a partner who's on your side because
0:20
they've been operator side, who knows your battles
0:23
and will make sure you win from start
0:25
to finish, end to end. MedMetrix,
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be exceptional.
0:30
This is Alan Condon back with another episode
0:32
of the Becker's CFO and revenue cycle podcast.
0:36
And today, I'm thrilled to be joined by
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Suneetha Reddy, chief revenue officer and vice president
0:42
of operations at Prime Healthcare.
0:45
Prime was founded in 2001
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and has grown rapidly
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since then. One of the largest health systems
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in the country. It is both a for
0:53
profit and non profit arm now operating, I
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believe, 54
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hospitals and more than 360
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outpatient facilities
1:01
across 15 different states. So, Anita, an absolute
1:05
pleasure to have you make your your debut,
1:06
Becker's podcast appearance today.
1:09
For those who are listeners on the podcast
1:11
who might be well acquainted with you, fantastic
1:13
work that you and your team do at
1:15
Prime Healthcare, do you mind sharing a little
1:16
bit more about your role and your background
1:17
at the health system?
1:19
Sure, Alan. Thank you for having me. It's
1:21
great to be here.
1:22
I always appreciate the opportunity
1:24
to talk about the work we're doing at
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Prime and broader trends shaping health
1:29
care. As you mentioned, I serve as chief
1:31
revenue officer and vice president of operations for
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Prime Healthcare,
1:35
where I oversee end to end revenue cycle,
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managed care strategy, and operational performance,
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across our 54 hospitals and more than 360
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outpatient locations nationwide.
1:48
And,
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my background is in health care finance and
1:52
policy.
1:53
I earned my MBA from Harvard and a
1:55
master's in public health during the rollout of
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the Affordable Care Act,
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which really shaped how I think about the
2:01
intersection of health policy, finance, and and access
2:05
to care.
2:07
And prior to my role at Prime, I
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worked in health care banking and consulting
2:11
focused on hospital financial performance and reimbursement.
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And, and I think that's what reinforced for
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me early on that, you know, financial sustainability
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and access to care are so deeply connected.
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And,
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when hospitals are under financial pressure, it directly
2:27
impacts their ability to serve their communities. And,
2:30
at Prime Healthcare, our mission is centered around
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saving hospitals,
2:34
delivering high quality care, and improving access in
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underserved communities.
2:39
And we view revenue cycle as the core
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strategic driver of that mission. So it's been
2:45
incredibly meaningful to be part of that work.
2:47
Yeah. No. Absolutely. I'm excited to dive right
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in. So, obviously, deep, deep experience, Anita, in
2:54
health care finance from your experience in the
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banking sector, your MBA from Harvard,
2:58
master of public health, and what we're gonna
3:00
be talking about today,
3:02
in terms of the revenue cycle, finance operations,
3:04
AppPrime, health care.
3:06
There's so so much we could go in
3:08
this direction. So many so much going on
3:10
in terms of challenges, trends, and whatnot. But,
3:13
if you could kinda break it down, what
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are kind of the two or three
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trends that you're paying most closest attention to
3:18
today in health care?
3:20
Yeah. There's a lot happening right now, but
3:22
I guess I would highlight three major kinda
3:25
interconnected trends.
3:27
And the first is the financial pressure facing
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hospitals today,
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especially community hospitals,
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serving these vulnerable populations.
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So labor costs continue to rise.
3:38
Medicare and Medicaid rates are, you know, not
3:40
keeping up with the cost of inflation,
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and recent legislation,
3:44
including HR one, represent some of the most
3:47
significant
3:48
Medicaid funding reductions in decades.
3:51
I think you kind of posted about it,
3:53
in in your other articles, but, you know,
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the congressional budget office estimates over 900,000,000,000
3:58
in Medicaid cuts over the next decade with
4:01
millions, you know, potentially losing coverage.
4:03
And that that creates a real sustainability
4:05
challenge,
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particularly for community hospital,
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and just makes it increasingly difficult to operate
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without strong operational discipline
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and the ability to operate at scale, honestly.
4:17
And I think second is just the growing
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complexity in peer behavior.
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Denials have become one of the most significant
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operational and financial headwinds we see today.
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Health plans are becoming
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increasingly aggressive,
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whether that's through prior authorization
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denials or level of care downgrades,
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and retrospective reviews and,
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truly just finding more ways to delay, deny,
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or underpay claims.
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And, you know, recent data from CMS and
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OIG,
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show that initial denial rates are around twenty
4:50
percent, for Medicare Advantage and,
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even up to forty percent for some managed
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Medicaid plans.
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And, what's especially concerning is that a majority
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of patients never appeal these denials, you know,
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due to lack of due to the complexity
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or lack of resources.
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And this is just creating significant administrative burden
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on providers and putting real pressure on hospital
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financial sustainability.
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And then I guess the third trend, which,
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you know, everyone's talking about is is really
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just automation and the acceleration of AI in
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health care.
5:23
I think this is being
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largely driven
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by both labor constraints and,
5:29
the general need for greater efficiency,
5:32
in health care. And, you know, there truly
5:34
is a real opportunity to, you know, automate
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repetitive workflows,
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improve accuracy,
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and proactively manage denials.
5:43
But, you know, at Prime, we're really focused
5:45
on using these tools,
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to reduce administrative burden on clinicians, whether that's,
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you know, helping with prior authorizations or appeals
5:54
or or documentation,
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but, you know, with the focus so that
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they can really, you know, focus on on
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patient care.
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And I think when you step back, you
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know, all of these trends reinforce that revenue
6:05
cycle is no longer just a financial function.
6:09
It's central to ensuring access to care and
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the sustainability of the health care system.
6:14
Yeah. I think I think really key breakdown
6:17
so eloquently put and obviously those three trends
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that you mentioned do tie so closely into
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one another in terms of the financial pressure
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facing hospitals, specifically community hospitals like you've mentioned.
6:28
No doubt, eye eyes transfixed on some of
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those Medicaid reductions coming down the pipeline end
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of this year, indeed into next.
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Denials, like we hear from so many leaders
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like yourself, is just so such a challenging
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environment. And then automation acceleration of AI and
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health care, which I'd love to kinda touch
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on a little bit a little bit more
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down the line. But quick follow-up, Suneeth, in
6:47
relation
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to the first trend you've mentioned in terms
6:50
of no secret to you, myself, and many
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of our listeners at Becker's, in terms of
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that financial pressure facing hospitals.
6:58
I believe the latest we've seen from Kaufman
7:00
Hall is around about one third of nonprofit
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hospitals continuing to operate in the red.
7:05
Certainly, big challenges coming down the pipeline, like
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you said, in terms of Medicaid funding cuts.
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I know a big part of Prime's strategy
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is indeed to acquire a partner with some
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of these community hospitals.
7:15
Because you maybe
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put together
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the the benefits that community hospitals see with
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a large health system or financial partner like
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a Prime Healthcare
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in terms of combating some of those pressures
7:27
and trends that you just touched on?
7:30
Sure. Yeah. And I can kinda maybe speak
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to, a little bit more about just Prime
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and and and and revenue cycle,
7:36
as it relates to these kind of turnarounds.
7:38
So,
7:39
at Prime, our mission is centered around saving
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hospitals and ensuring continued access to care, particularly,
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in these underserved communities that are so impacted.
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And many of the hospitals we acquire are
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financially distressed. So our focus is on stabilizing
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them quickly
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while maintaining
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high quality care.
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I think one of the key differentiators at
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Prime is just how we view revenue cycle.
8:03
It's truly not a back office function. It's
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a core transformational engine
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that helps drive hospital sustainability.
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I think that mindset shapes how we operate
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every day,
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particularly as we continue to grow through acquisitions
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and scale best practices across the system.
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I think our approach at Prime starts with
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the true end to end view. We're we're
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not just focused on billing and collections.
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We're looking across the revenue cycle continuum.
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So patient access, utilization
8:34
management, appropriate clinical documentation,
8:37
coding, revenue integrity, denial management, and managed care.
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And, you know, all of those functions,
8:44
kinda come together and, are looked at, collect
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you know, collectively and holistically.
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And, importantly, we manage all of these functions
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in house,
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which is kind of unique, and it creates
8:55
strong alignment between operations and financial performance.
9:00
And we also have really strong corporate teams
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that are able to support these functions,
9:04
at scale.
9:05
I think, you know, kind of the the
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second piece
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is really the the speed and standardization,
9:12
at at Prime. So the majority of our
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system, 34 hospitals now are on Epic, and
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we built a defined revenue cycle playbook for
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these new acquisitions.
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And so that allows us to quickly implement,
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standardize workflows and reporting,
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especially in those kind of critical first six
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to twelve months after an acquisition.
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And we've also come a long way in
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just standardizing our revenue cycle management technologies and
9:37
vendors,
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so we can implement these tools and,
9:41
and vendors and scale efficiently.
9:44
I think the third, and I think this
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is really, unique to Prime, is our clinical
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alignment.
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We're a physician founded and physician led organization,
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and our clinical leaders
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are actively engaged in revenue cycle
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operations,
9:58
denial management, and care delivery decisions.
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That alignment improves both quality and financial outcomes,
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honestly, for the organization.
10:07
You know, another key focus is managed care.
10:09
Most of the hospitals we acquire have challenging
10:12
payer mixes, you know, mostly Medicare and Medicaid.
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So,
10:16
ensuring appropriate reimbursement
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is critical.
10:19
And we take a data driven approach to
10:21
evaluating contracts,
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to ensure those rates are sustainable, competitive,
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and aligned with the cost of care.
10:28
You know, often when you first acquire these
10:30
hospitals, the issue isn't just operations.
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It's that reimbursement
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from managed care hasn't kept up with the
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true cost of care.
10:38
And then I'd say, you know, finally, we're
10:40
we're really data driven and and monitor performance
10:43
rigorously.
10:44
We track metrics like denials,
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cash collections, underpayments very closely,
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and I think that makes Prime unique in
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that revenue cycle is a shared responsibility
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across leadership.
10:55
It's not siloed within one department,
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and it's not, you know, fully outsourced. So
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I think that level of integration and accountability
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across operations,
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clinical teams, and revenue cycle leadership is a
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key differentiator for Prime and has been so
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critical to executing
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turnaround strategies at scale.
11:13
So I think when you put it all
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together, it's really about, you know, standardization,
11:16
alignment, and defined operating playbook that allows us
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to kind of stabilize these hospitals at scale.
11:22
Yeah. It kind of aligns to what I've
11:24
heard exactly from, your colleague,
11:26
Steve Aylman, CFO, of course, of Prime Health
11:28
Care recently.
11:30
And and, obviously,
11:32
Prime, to your point, has has acquired multiple
11:34
hospitals recently, expanded into Illinois, expanded into Maine.
11:38
You talked quite a bit about what really
11:40
differentiates
11:41
Prime's revenue cycle playbook there in terms of
11:44
integrating some of these financially distressed hospitals.
11:47
For for we're seeing a ton of growth
11:49
m and a across the across the spectrum
11:51
at the moment. I guess, is there anything
11:53
in terms of lesson learned or a kinda
11:55
key takeaway for your peers at other health
11:58
systems who are looking to acquire and integrate
12:00
some of these hospitals into their own systems
12:03
from a revenue cycle standpoint? What's the kinda
12:05
key lesson that you might have learned through
12:07
some of these previous acquisitions?
12:09
Yeah. You know, I I I think one
12:11
of the, you know, key lessons is is
12:14
is just, we've we've been through this now,
12:17
with 38 hospitals,
12:19
with these three upcoming hospital acquisitions in in
12:22
Maine.
12:23
And I think honestly, you know, truly,
12:25
at Prime, we believe, like, health care is
12:27
local,
12:28
and we really try there there is no
12:31
you know, I talked about all of these
12:32
different levers, I think, that we focus on,
12:34
when we do some of these transitions.
12:37
But, you know, really, I think what makes
12:38
Prime unique is that we really look at
12:40
each hospital individually. We assess the market.
12:44
We kinda figure out what are the key
12:46
service lines that are needed. We try to
12:48
do the same thing on the revenue cycle
12:50
side to really make sure that we're kinda
12:52
supporting,
12:53
you know, supporting the teams that are there,
12:55
supporting the operating model, and there's no really
12:57
one size fits all kind of revenue cycle
12:59
solution that we implement. We really work with
13:02
the teams. We work with the communities. We
13:04
work with the hospital leadership and kinda figure
13:05
out how to best support them kind of
13:07
financially and operationally.
13:09
Yeah. It's such a interesting unique kind of
13:12
playbook that Prime has. Ton of growth, like
13:14
I said, physician founded, physician led now, I
13:16
believe, 13 different states, 54 hospitals.
13:20
But so I need the, the the conversation
13:22
that we're always gonna get to in this.
13:24
You touched on it earlier in terms of
13:25
the trends that you're following.
13:27
Of course, it wouldn't be an AI a
13:29
CFO revenue cycle podcast without coming to AI.
13:32
So I'm so, so curious to get kinda
13:34
get your thoughts, your your expertise in terms
13:36
of what you're seeing.
13:38
In terms of this, for lack of a
13:40
better term,
13:41
AI arms race we're seeing evolving in the
13:43
coming years. As AI becomes more deeply
13:46
sophisticated, more deeply integrated
13:48
into the revenue cycle by both payers and
13:51
indeed providers.
13:52
How do you see this
13:54
again, AI arms race really evolving in the
13:56
coming years,
13:57
as this technology becomes more sophisticated.
14:00
Yeah. That's a great question, Alan. And I
14:02
and I do think arms race is a
14:04
fair way to describe it. You know, we're
14:06
really seeing both payers and providers invest so
14:10
heavily in AI,
14:11
but it seems like with very different objectives.
14:13
Right? Like, payers using AI to scale claims
14:17
review,
14:17
they're, you know, automating denials, and there's payment
14:20
scrutiny at
14:21
much higher speed and and volume.
14:25
And, you know, providers, on the other hand,
14:27
I think, are using AI to improve
14:29
accuracy and efficiency,
14:31
particularly in areas like documentation,
14:34
coding, and denial prevention to, you know, really
14:37
push to ensure appropriate reimbursement.
14:40
So I think, you know, as peers become
14:41
more automated,
14:43
in their processes and that and and I
14:44
think they're a little ahead in this process,
14:46
we're just seeing increased volume,
14:48
and speed of denials, which is creating, you
14:50
know, additional pressure on providers to to, you
14:53
know, implement this technology and and kinda catch
14:55
up.
14:56
And so I think that, you know, that's
14:57
happening. I think another thing that we're seeing
15:00
is just the potential
15:01
shift towards a more predictive,
15:04
and eventually more autonomous revenue cycle.
15:07
So, you know, we're instead of reacting to
15:09
issues
15:11
after the fact, we can, you know, try
15:12
to identify documentation
15:14
gaps upfront, you know, predict denial risk before
15:17
submission, you know, resolve authorization issues earlier. But,
15:21
you know, I think that being said, there's
15:22
still a long way to go, for providers
15:25
to kinda seemingly seamlessly,
15:27
adopt these tools.
15:29
I think AI in health care is not
15:31
plug and play. It requires thoughtful integration,
15:35
strong operational teams, and ongoing governance,
15:38
especially, right, with all of the new introduction
15:40
around,
15:41
agentic AI.
15:43
So, you know, at Prime, we're really focused
15:44
on using AI to kinda support our teams,
15:47
not replace them, and,
15:49
and ensuring we have the appropriate oversight and
15:51
and accuracy and compliance, you know, especially on
15:54
the on the, you know, patient facing side.
15:56
So,
15:57
you know, looking ahead, you know, I believe
15:59
success will come down to, you know, kind
16:01
of three major things.
16:03
The first is how well AI is integrated
16:05
into workflows across the end to end revenue
16:08
cycle.
16:08
Second, you know, how are organizations
16:11
adapting their operating models,
16:13
right, to to inter to introduce and implement,
16:16
AI? Because this is as much about people
16:18
and processes as it is about technology.
16:21
And then, you know, the third is just
16:23
around governance and accountability,
16:25
because ultimately, you know, it's not just about
16:28
efficiency.
16:29
It's about access to care and trust in
16:31
the system. You know? So I'd say AI
16:33
is accelerating the revenue cycle and and definitely
16:35
has potential to reshape it, but it really
16:37
has to be implemented
16:38
thoughtfully
16:40
and,
16:41
and, you know, to truly deliver on that
16:42
promise.
16:44
A a lot there to unpack. I guess,
16:45
is there a
16:47
something that you're most excited about when you
16:50
think about AI and automation and the revenue
16:52
cycle? Or maybe a specific initiative that hasn't
16:55
isn't here yet, but you're working on a
16:57
prime, whether that's in the area of agentic
16:59
AI, automation,
17:00
or anything else that you'd like to highlight?
17:03
Yeah. You know, I I think, at at
17:04
Prime, we're really looking at, you know, where
17:06
all the opportunities,
17:08
that we can kinda implement,
17:09
AI,
17:11
in in the process. And, you know, I
17:13
I think it's kind of taken part, at
17:15
least in the revenue cycle side, you know,
17:17
mostly in phases. I think the first is
17:18
kind of, you know, how do we integrate
17:20
how do we integrate
17:22
some some more of these,
17:24
you know, RPA or robotic process automation opportunities,
17:27
right, to take some of that manual work,
17:29
and more kind of transactional,
17:32
kinda areas.
17:33
And,
17:34
and then, you know, I think now we're
17:36
really thinking, you know, where are ways that
17:38
we can kind of better integrate it into
17:39
the system. And so it, you know, kinda
17:41
all ties back to, you know, where where
17:43
areas that we can more seamlessly
17:45
implement and integrate these kinda AI solutions throughout
17:49
the, you know, RCM continuum.
17:51
Yeah. Got it. Certainly,
17:52
seeing where AI was maybe a year, two,
17:55
three years ago and then seeing where it
17:56
might be one, two, three years ahead, certainly,
17:59
exciting. A lot of challenges wouldn't deal. A
18:00
lot of great opportunities there as well.
18:03
Sunita, last question for you before I let
18:05
you go. It's something you kinda touched on
18:07
a little bit earlier. In terms of the
18:09
the revenue cycle workforce and Deepgram and Asaf
18:11
has said, using AI, using auto automation, things
18:14
like RPA to to support your team, support
18:16
your workforce, not replace them. With that in
18:19
mind, I guess, how are you seeing
18:22
revenue cycle teams evolve as AI does become
18:25
more embedded in their workflows? And then what
18:27
skills do you see as really defining that
18:29
next generation of revenue leaders?
18:32
Sure. You know, I think we're already seeing
18:34
a meaningful shift, honestly, in how revenue cycle
18:37
teams operate. You know, historically,
18:39
as I mentioned, the work's been very transactional.
18:41
Right?
18:43
Focused on billing and collections. But as automation
18:46
and RPA take on more of that work,
18:47
I think the function is becoming much more
18:50
analytic
18:50
analytic and strategic.
18:52
So teams are, you know, now focused on
18:54
understanding what's what's really driving performance.
18:58
You know, is it denials, payer behavior, documentation,
19:01
and, addressing those issues more proactively.
19:05
And so at Prime, I think this is
19:06
showing up in a few ways. I think
19:07
first is,
19:08
a stronger focus on data driven decision making.
19:12
So using data to drive action, not just
19:15
reporting.
19:16
I think, you know, the second is just
19:18
deeper alignment and understanding and integration with clinical
19:21
teams,
19:22
since documentation
19:23
and care delivery directly impact revenue cycle performance.
19:27
And third, I think, is the growing importance
19:29
of technology leadership.
19:32
So I think what that means is just
19:33
really understanding how to evaluate and implement tools
19:36
like in a like AI in a way
19:38
that actually improves outcomes.
19:41
So, you know, I believe that that,
19:43
that shift in kind of the the use
19:45
of AI is really,
19:47
just driving,
19:48
a different skill set for for leaders, and
19:51
and all of that is is kind of
19:52
evolving. So I think you need data literacy,
19:55
cross functional leadership, and adaptability
19:58
because, you know, this environment is changing so
20:00
quickly.
20:01
Yeah. It's fascinating to kinda hear your perspectives
20:04
there. I did tell a lie. I said
20:05
it was last question, but curiosity has gotten
20:07
the better of me. I just have one
20:09
quick last follow-up. Sunita, I'm wondering if you
20:11
could expand on it. I thought it was
20:12
also fascinating in terms
20:14
of how your teams are evolving, be more
20:16
analytical, be more strategic.
20:18
You talked about how you're now more proactively
20:22
addressing some of these denials
20:24
upstream. Can you can you maybe expand on
20:26
that for our listeners in terms of how
20:28
that shows up in practice and kind of
20:29
some of the early wins you might be
20:30
seeing there?
20:32
Sure. You know, I think I think, you
20:33
know, there's a couple of examples, that we
20:35
can kinda speak to, but, you know, I
20:37
think now, you know, we're being we're able
20:40
to kinda leverage all these different, you know,
20:41
tools and technology to kind of pull in,
20:44
you know, denial patterns and trends and identify,
20:48
you know, what what's going on as it
20:49
relates to kind of these underpayments. And so
20:51
we've been able to kinda pull this data
20:53
in a more seamless way.
20:55
I think now we're kind of shifting towards,
20:57
okay, we have this data now. How do
20:59
we,
20:59
you know, the next generation of, you know,
21:02
revenue cycle leaders is now expected to kinda
21:04
take that data and and move forward with
21:06
it. Right? How do we implement,
21:08
how do we implement best practices? How do
21:10
we,
21:11
kind of work to,
21:13
you know, implement, workflows around kind of the
21:16
data? So, you know, that that's happening.
21:18
I think we're also, kinda able to kinda
21:21
leverage,
21:22
some of these tools and functions to, as
21:24
I mentioned, better assist our appeals teams. Right?
21:27
So, you know, how are we kind of
21:29
pulling together,
21:30
kind of essential data into our appeals,
21:33
to make sure that we're capturing kind of
21:34
the core content
21:36
of, kind of the the medical necessity aspects
21:38
and trying to use that to, you know,
21:41
make sure that we're, you know, more successful
21:43
in our in our appeals and and escalation.
21:46
So I think we're we're really, you know,
21:48
taking a comprehensive view and and figuring out
21:50
where are the best places we can, you
21:52
know, integrate AI,
21:54
into our workflows.
21:55
And, you know, as I mentioned, I think
21:57
we still have,
21:58
providers in general have, you know, ways to
22:01
go to kinda implement this to be kind
22:03
of a seamless end to end solution. But,
22:05
I think, again, from the prime side, we're
22:07
really focused on supporting our new revenue cycle
22:09
decision makers, supporting our clinicians
22:12
in their daily workflows, and trying to take
22:14
out some of the administrative burden that's kind
22:17
of embedded within kind of revenue cycle and
22:19
operational workflows.
22:21
Yeah. No. It's fascinating. I think,
22:23
so so greatly greatly appreciate you.
22:26
Curiosity got to better. We had to ask
22:28
a follow-up question. But I I appreciate the
22:30
level of specificity and breaking it down in
22:32
such layman's terms for me as well.
22:34
Sunita, an absolute pleasure. Thank you so so
22:36
much for being a part of the Becker's
22:38
CFO and Revenue Cycle podcast.
22:41
Fantastic leadership there surrounding you and you indeed
22:43
yourself. Thank you so much, and we look
22:44
forward to catching up with you again down
22:46
the line. Yeah. Thank you again for having
22:48
me. It's been truly a pleasure speaking with
22:50
you and and sharing, more about all the
22:53
exciting things and and work happening at Prime.
22:55
I I really appreciate the opportunity. Thank you
22:57
so much, Alan. When it comes to today's
22:59
RCM, we know the challenges,
23:02
Complexity of claims, talent shortages,
23:04
low funding, and lagging tech.
23:06
That's why we built MedMetrix.
23:09
We have the expertise and advanced tech to
23:11
give you that edge on your revenue cycle.
23:14
We're a partner who will relentlessly raise your
23:16
yield, a partner who's on your side because
23:19
they've been operator side, who knows your battles
23:22
and will make sure you win from start
23:24
to finish, end to end. MedMetrix.
23:27
Be exceptional.