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What a Medical Bill Actually Is, with Amy Stillman · The Clinical Realist

• 0:00
  SPEAKER_01: Somewhere north of 600,000 times, an American patient has had a conversation about a medical bill with something that's not actually a person.
• 0:07
  SPEAKER_01: That's Cedar's number, and for an AI agent called Cora.
• 0:11
  SPEAKER_01: And here's a part that stopped me.
• 0:13
  SPEAKER_01: So some of those patients left feedback afterward that was like, I appreciate you so much.
• 0:17
  SPEAKER_01: My heart is so grateful.
• 0:18
  SPEAKER_01: And this is about a machine handling a medical bill.
• 0:21
  SPEAKER_01: So my guest today is a person who's been in charge of building that, Amy Stillman, chief product officer at Cedar, where she has run product design, research, and data science since 2019.
• 0:32
  SPEAKER_01: And so she's owned this product through a$3 billion valuation, a hard market correct, and the entire pivot into agentic AI.
• 0:39
  SPEAKER_01: So the thing that I love is that she didn't come into it as an engineer.
• 0:43
  SPEAKER_01: She's an industrial designer by training, and she's not a rev cycle person.
• 0:47
  SPEAKER_01: So she's somebody whose discipline is how an object behaves in a person's hands when they're under stress.
• 0:52
  SPEAKER_01: So that's exactly what a medical bill is.
• 0:54
  SPEAKER_01: And it arrives usually after a frightening part is over.
• 0:58
  SPEAKER_01: So the question I want to spend our time on today is what does the 600,000th conversation do that that first one could not?
• 1:06
  SPEAKER_01: And who is it doing it for?
• 1:07
  SPEAKER_01: So, Amy, welcome to the Clinical Realist.
• 1:09
  SPEAKER_00: Thank you for having me.
• 1:10
  SPEAKER_00: I'm really excited to be here.
• 1:12
  SPEAKER_01: Absolutely.
• 1:12
  SPEAKER_01: Have this conversation.
• 1:13
  SPEAKER_01: Yeah.
• 1:14
  SPEAKER_01: Well, I'd love to understand a little bit more about CEDAR.
• 1:17
  SPEAKER_01: CEDAR is the patient financial experience space.
• 1:21
  SPEAKER_01: So what does that actually look like?
• 1:23
  SPEAKER_01: Can you define that for me?
• 1:24
  SPEAKER_00: Yeah, definitely.
• 1:25
  SPEAKER_00: It's a great question.
• 1:26
  SPEAKER_00: It's really interesting too.
• 1:27
  SPEAKER_00: And that I think so many people just think about billing when you say revenue cycle management.
• 1:32
  SPEAKER_00: And that is the function of what we do.
• 1:34
  SPEAKER_00: But if you think of a bill, oftentimes if you if you've ever gotten a bill, and I'm sure you have, we we all have often so many bills.
• 1:40
  SPEAKER_01: Don't worry.
• 1:42
  SPEAKER_00: So many bills, right?
• 1:43
  SPEAKER_00: Um when you get a bill, there's an assumption that that that you know what it is and you're gonna pay for it, right?
• 1:50
  SPEAKER_00: It's like when I get my Verizon bill, it's like, yep, I remember I signed that contract and it costs this much, and it's time for me to pay monthly, and I probably have an auto plan, auto pay plan on that.
• 2:00
  SPEAKER_00: I think what's crazy in healthcare is that you get a bill and it looks the same and it acts like it's a payment reminder, almost like maybe you have forgotten to do this thing that you're supposed to do.
• 2:12
  SPEAKER_00: And so now please, please give us all this money.
• 2:14
  SPEAKER_00: But what really is happening in healthcare is a lot of confusion, a lot of anxiety.
• 2:20
  SPEAKER_00: And it goes from people not being able to afford the bill, but also not even understanding what just happened to them and what and what the next steps are.
• 2:28
  SPEAKER_00: And so I think for me, as I, you know, I've I'm very patient focused, kind of started more in that kind of design and user research and in patient understanding area, in that I I'm really like, what's someone, what is the the actual end user, what is their experience right now?
• 2:42
  SPEAKER_00: And their experience is that they're confused, they're scared, they're not sure what to do.
• 2:46
  SPEAKER_00: And so if we just start with like, hey, pay your bill and this is the amount, we've kind of missed it.
• 2:50
  SPEAKER_00: And so I really think it's a conversation.
• 2:53
  SPEAKER_00: And I think that's a lot of what we've been trying to design at CEDAR for the for the last decade is a conversation.
• 2:59
  SPEAKER_00: So we how do we have a conversation with you?
• 3:01
  SPEAKER_00: Um, and if what's between you and paying your bill is a question, can we answer that?
• 3:04
  SPEAKER_00: Can we get you a great answer and help you understand what needs to happen next?
• 3:08
  SPEAKER_00: If there is an issue, can we detect that and resolve that and help make that really efficient for you?
• 3:13
  SPEAKER_00: Um and if it is time to pay and you're looking for ways to pay, can can we also make that easier and know that there's more than just one path on that too?
• 3:20
  SPEAKER_00: There's many things that we can provide.
• 3:21
  SPEAKER_00: And so I think that when we say patient financial experience, it's really us taking a step back and saying, what is the experience of needing to be able to afford your health care?
• 3:31
  SPEAKER_00: And what are those problems that we can help you solve?
• 3:34
  SPEAKER_00: And that's not just pay your bill today right now, or uh you're gonna get a red collections note in your email box.
• 3:42
  SPEAKER_01: So it sounds great because I always love putting the patient at the center.
• 3:45
  SPEAKER_01: But when we think about the business ball behind Cedar, the patient is the user, but who's the customer here?
• 3:52
  SPEAKER_00: That's a great question.
• 3:53
  SPEAKER_00: And that the customer is still the health system.
• 3:56
  SPEAKER_00: And I think a lot of this happens because it's it's difficult to navigate.
• 4:01
  SPEAKER_00: I think if you're a health system and you think about, you know, you used to collect 80 to 90% of your dollars from directly from payers, and today that's shifted and it's going to continue to shift.
• 4:10
  SPEAKER_00: And it's shifting for a lot of reasons.
• 4:11
  SPEAKER_00: It's a really hard problem for them too.
• 4:13
  SPEAKER_00: Um, the scale and size of being able to talk to this many patients and have a conversation is what's difficult about it.
• 4:21
  SPEAKER_00: It's not that you're in the office one-to-one with a patient.
• 4:25
  SPEAKER_00: A lot of times it's after the patient has left the office, and now you're trying to do this outreach on such a scale.
• 4:31
  SPEAKER_00: And that's really where technology, I think, becomes a really, really good tool to actually help our customer be able to talk have this intimate conversation with a patient as they would want to, but at scale.
• 4:42
  SPEAKER_01: So it's interesting as a patient, I tend to get medical bills like five gazillion times.
• 4:48
  SPEAKER_01: I'm like, I had no idea these were gonna come.
• 4:51
  SPEAKER_01: And it comes from the anesthesiologist and the doctor for this and the whatever.
• 4:55
  SPEAKER_01: And it's interesting because I know the system and I still get surprised.
• 5:01
  SPEAKER_01: And so when we think about the patient billing layer, what's that moment of maximum friction?
• 5:07
  SPEAKER_01: What is the patient doing or holding or feeling?
• 5:09
  SPEAKER_01: Like, where in the system are we losing the patients?
• 5:12
  SPEAKER_00: Yeah, and I I think a lot of it has to go back to what our expectation of the patient is.
• 5:18
  SPEAKER_00: And I think that can also change over time.
• 5:20
  SPEAKER_00: So I'll even say you probably have gotten a bill that you know exactly what it's for, and it's a$25 copay, and that feels really normal.
• 5:28
  SPEAKER_00: And maybe you just didn't swipe your card at the office, and so now you're gonna pay it.
• 5:32
  SPEAKER_00: But I think what we have to remember is that that also changes over time.
• 5:36
  SPEAKER_00: You can have another bill that you can get to your point, like an anesthesiologist, that you'd even realize wasn't paid yet, and that can be surprising.
• 5:43
  SPEAKER_00: So I think part of it for the patient is us just understanding that the same patient can actually have a very different reaction and a very different experience.
• 5:51
  SPEAKER_00: And they're not gonna, it's not gonna be the same for them that each time they encounter a bill as it is for the health system, too.
• 5:58
  SPEAKER_00: And so the kind of flexibility in meeting someone where they are in that moment and trying to anticipate maybe what that question is, there's a lot of clues that we can that we can actually know as a health system, right?
• 6:08
  SPEAKER_00: There's a lot of data that might give us an insight into what the patient's reaction might be.
• 6:13
  SPEAKER_00: And I think we can help ensure that we're delivering some of those experiences with some of those clues, like, hey, they used to have insurance and they and they don't have it now.
• 6:22
  SPEAKER_00: Like instead of just asking them to pay, like, should we just double check and make sure we have the insurance?
• 6:27
  SPEAKER_00: Or um, this bill is is very large and uh, you know, our expectations for this patient in the past haven't, you know, they haven't paid something this large.
• 6:35
  SPEAKER_00: Do we need to start a conversation around affordability and some other options there?
• 6:38
  SPEAKER_00: So I think the first thing is just like knowing that it changes over time and the same patient might have a very different experience, bill to bill, um, but also knowing that we can anticipate some of what someone might need and making sure that the experience is also isn't just kind of one size fits all uh from that angle too, I think is is kind of the keys to that.
• 6:58
  SPEAKER_00: Is that helpful?
• 6:59
  SPEAKER_01: It is.
• 7:00
  SPEAKER_01: So you know, I'm a product and design person too.
• 7:02
  SPEAKER_01: And so when I think about how we would do the research to understand these patients best, tell me a little bit about how Cedar has really dug into the user experience and what you've found out that surprised you about actual patients.
• 7:17
  SPEAKER_00: Yeah, and actually this might be kind of a fun time for a story, but I think we think of a couple things.
• 7:21
  SPEAKER_00: I will say a lot of what we do is is based in research, and I believe in quantitative and qualitative research.
• 7:27
  SPEAKER_00: So I do think it's great for us to actually see test results.
• 7:31
  SPEAKER_00: We do a lot of A B testing, a lot of things to actually see what people actually respond to, but I also really think it's key to talk to uh patients too.
• 7:38
  SPEAKER_00: And so we do spend time talking to patients and hearing about their experiences and understanding that and making sure that's built in.
• 7:44
  SPEAKER_00: Um, the third lever we have today, especially with all the technology with AI, is even having even more ways to understand what's happening within every single call and being able to analyze that data.
• 7:55
  SPEAKER_00: And I think that's really insightful as well.
• 7:57
  SPEAKER_00: But I think you have to kind of have a multi-approach between qual and quant to actually get the signal on a user.
• 8:02
  SPEAKER_00: Absolutely.
• 8:03
  SPEAKER_00: So we do that.
• 8:04
  SPEAKER_00: But I think, you know, the thing that I've been thinking so much about right now is I remember um when I first started Cedar, I was talking to some other friends in in the health and in life science industries, and I was talking to someone that was a brand strategist for 23andMe.
• 8:17
  SPEAKER_00: And she was telling me the story how she was working on, you know, what how what target markets they thought would be great for 23andMe to work with.
• 8:26
  SPEAKER_00: And one hypothesis was around adoption and that folks that either were adopted or were adoptive parents might want to have some biological, you know, information and that would be really, really interesting.
• 8:37
  SPEAKER_00: But what she actually realized is when she was talking to users, the insight that she shared with me that has really stuck with me is this idea of knowing and not knowing.
• 8:46
  SPEAKER_00: And it was way more behavioral.
• 8:49
  SPEAKER_00: And what she said is actually she talked to people, there's were some people that just had this need and want to know information.
• 8:58
  SPEAKER_00: And there are some that just actually did not and preferred to like live in this world.
• 9:03
  SPEAKER_00: And I think that's so interesting.
• 9:05
  SPEAKER_00: And I think as I look at health right now, I see that behavioral trait play out in how health, how patients are becoming consumers.
• 9:15
  SPEAKER_00: And so if you think about like the aura ring, you know, that is blown up in terms of like they're offering not only their users, but also they're offering blood panels along with that.
• 9:25
  SPEAKER_00: And that folks want to own and have their own patient health data.
• 9:29
  SPEAKER_00: I think uh you also see that in other places like PRNO, right?
• 9:33
  SPEAKER_00: You're paying$2,500 for a scan so that you can own your own patient data and biomarkers.
• 9:40
  SPEAKER_00: I think this shift in people wanting to know more is only growing.
• 9:46
  SPEAKER_00: And I think that's a big piece that's hard about patient healthcare and finances, is it does feel like this black box and it doesn't feel like you know, and you want to be able to ask questions.
• 9:57
  SPEAKER_00: And so a lot of what we've thought about as we've kind of matured our experience is not just thinking about the qualitative and quantitative data that we see, but also kind of this consumer trend and where we think people are going and what their expectation is.
• 10:12
  SPEAKER_00: And so this is, yeah.
• 10:13
  SPEAKER_00: So, like you think about would you buy a flight today without knowing what the cost was for like the last 30 days?
• 10:20
  SPEAKER_00: Like we all have this expectation of kind of having a little bit more data to really know and feel good about the decision that we're making.
• 10:27
  SPEAKER_00: Um, I think that's what's pushed us into being even wanting to be more conversational with Cora is how do we have an information, how do how do we have an interface that you can actually talk to and ask and actually give data to or give questions, insights to, and over time kind of have this financial advisor in your pocket that you can either call or text or interact with, but really knowing that patients are moving towards wanting to know more and be more informed and own that data.
• 10:53
  SPEAKER_00: And the interface can't just be a black and white email or um uh paper mail.
• 10:58
  SPEAKER_01: Yeah.
• 10:58
  SPEAKER_01: I uh lost my aura ring yesterday and I have no idea what's going on now with my life.
• 11:03
  SPEAKER_01: So I totally understand that completely.
• 11:05
  SPEAKER_01: Are you even sleeping?
• 11:06
  SPEAKER_01: I mean, right?
• 11:07
  SPEAKER_00: Like I don't even know if I slept.
• 11:09
  SPEAKER_00: I don't even know if you slept.
• 11:11
  SPEAKER_00: Yeah.
• 11:12
  SPEAKER_00: So I think that's like a big shift we're seeing.
• 11:14
  SPEAKER_00: I think the consumer trends influence so much too of like what patients' expectations are from their healthcare companies uh that it's not, you can't just even look at it just from from healthcare problems.
• 11:25
  SPEAKER_00: But what are consumers wanting to do right now, too?
• 11:28
  SPEAKER_01: Well, you know, it's interesting.
• 11:29
  SPEAKER_01: The revenue stack and cycle is so fragmented for healthcare.
• 11:33
  SPEAKER_01: I mean, we've got payers, EHRs, clearinghouses, you name it.
• 11:36
  SPEAKER_01: So where does Cedars sit in that stack without just getting crushed?
• 11:41
  SPEAKER_00: Yeah, I think that's really interesting.
• 11:43
  SPEAKER_00: And and I actually think that's where a lot of the problems originate is that each kind of stack solves a different problem and has this different relationship with the patient.
• 11:53
  SPEAKER_00: I think what we try to do is look at that data and we have kind of our own context layer that puts that together and tries to deliver like one holistic patient experience all the time.
• 12:03
  SPEAKER_00: But we do believe in integrating with the data, having kind of our own context layer layer that understands the user over time and how they move through it, versus relying on a true or false signal from a single system that may change how you view that person.
• 12:17
  SPEAKER_00: But it it is complicated.
• 12:19
  SPEAKER_00: And I actually think that's the origin of why a lot of systems do have a poor experience, is because they don't actually understand who this is as a human and they just see them as like a single data point or single interaction.
• 12:31
  SPEAKER_01: So financial literacy is a difficult topic, not just for patients, but for humans.
• 12:38
  SPEAKER_01: And when we think about the advent of AI, agentic AI, the speed of transactions, the speed of healthcare and the technology around it, you know, having an advocate as a patient clinically, operationally, financially, it sounds like a great idea.
• 12:54
  SPEAKER_01: So I know that when you're kind of thinking about this for patients, we have C are being paid by providers, the metrics in Quora are launching, you know, collection metrics, so then all the payments can go up for physician offices, et cetera.
• 13:11
  SPEAKER_01: But what do you think about Quora?
• 13:15
  SPEAKER_01: And what did you do in the product to make sure that the patients weren't getting charged too much and provider organizations weren't getting paid too little?
• 13:24
  SPEAKER_01: Like how does that work?
• 13:26
  SPEAKER_00: Yeah, I think a lot of we I will say a lot of how we develop Quora is actually we focus a lot on skills.
• 13:34
  SPEAKER_00: And so our skills always have kind of multiple metrics within them.
• 13:38
  SPEAKER_00: I think a great example is paper statements.
• 13:40
  SPEAKER_00: If someone asked for a paper statement, you it might just seem obvious to give them a paper statement.
• 13:44
  SPEAKER_00: And if she didn't know that skill, she would escalate and say, hey, uh, we're gonna hand you over to a live agent for you to ask for a paper statement.
• 13:51
  SPEAKER_00: If you do that actually from a cost analysis standpoint, that's a very expensive interaction.
• 13:57
  SPEAKER_00: You haven't helped helped the patient, their patient satisfaction is going down.
• 14:01
  SPEAKER_00: They're now gonna have to talk to a live agent, which is more expensive, they're having a longer interaction on the phone, it's kind of like not great for everyone.
• 14:08
  SPEAKER_00: I think the magic is understanding we kind of look at three things all the time.
• 14:12
  SPEAKER_00: We look at cost to serve, uh, we look at resolution rate, and we look at patient satisfaction.
• 14:18
  SPEAKER_00: And when we try to design a skill, it's the optimization of those three things.
• 14:22
  SPEAKER_00: And sometimes they definitely can be the same thing.
• 14:24
  SPEAKER_00: If, you know, if someone, if the reason why someone's asking for a paper statement is actually because they need a receipt for their HSA, to give them a PDF in that moment is actually awesome because they're solved, they're finished, they can download it, they can upload it to their HSA website, get that reimbursement however they need to, right?
• 14:40
  SPEAKER_00: If what they're actually saying is like, hey, I want a paper statement because I don't trust a lot of these digital interactions, and that's my trustworthy form of content, like we need to be able to do that for them too.
• 14:53
  SPEAKER_00: Uh, but can we optimize that and have Cora actually send that herself versus escalating to a human or knowing that that's a path and try to safeguard the um the health systems from some of these like ballooning costs that happen within these interactions, that's good for them too.
• 15:09
  SPEAKER_00: And also, can we always know that if we want to have a payment conversation and we want to offer options in terms of for affordability or payment plans, that that can also be part of the conversation too.
• 15:19
  SPEAKER_00: But I think it's like knowing that there's multiple goals that could happen in each interaction with Quora and understanding how we optimize for those and that it's never just a single thing.
• 15:30
  SPEAKER_00: And it's really the root cause of the why that we try to figure out and give some options, but in a very agile way that we can also pivot if we didn't get the right thing and do something else for them.
• 15:41
  SPEAKER_01: So I'm pretty sure the paper statements being sent out and asking for people to send a check or use a website that doesn't actually work are probably not doing great for the patients or the provider systems.
• 15:51
  SPEAKER_01: So when folks are using Quora, what's the actual rate at which a core conversation ends with an assistance application or a different payment plan rather than a payment?
• 16:03
  SPEAKER_00: Cora's flexible and that she does have a great containment and resolution rate.
• 16:08
  SPEAKER_00: And so she actually resolves about 40% of her calls.
• 16:11
  SPEAKER_00: She's actually to able to, that means that she's helped the user to the point but that like they don't have another question.
• 16:16
  SPEAKER_00: And a lot of those do end up in payment.
• 16:18
  SPEAKER_00: And so that's a great number and a good thing for patients and for also uh our our operators and healthcare systems too.
• 16:28
  SPEAKER_00: The I think the other piece of that though is that the like we have to acknowledge that not every call is is a payment call.
• 16:35
  SPEAKER_00: Like if there is something else that they need, like they need a piece of documentation or they need to resubmit insurance, like we want to be able to like service those needs too.
• 16:43
  SPEAKER_00: And that if we just assume that everything is immediately a payment conversation, there's a whole group of users that are like, I have more questions and I need to have a conversation or some more understanding before we do that.
• 16:53
  SPEAKER_00: So we I think the important thing is yes, she resolves a lot of calls, but she does it by having a different number of skills that she can deploy to ensure that she's meeting the user and like what they need in that moment.
• 17:04
  SPEAKER_00: And then always, like sometimes you still have a really complicated call.
• 17:08
  SPEAKER_00: We do escalate to a real human if you if that it does seem appropriate.
• 17:13
  SPEAKER_00: And we don't try to make that too hard.
• 17:14
  SPEAKER_00: But we do know that like probably the best interaction is one where the patient feels like that was efficient.
• 17:19
  SPEAKER_00: Um, they helped me with my need.
• 17:21
  SPEAKER_00: And yeah, yes, if we can do payment resolution, I think that's often what the very best solutions are, because then this is one less thing the patient has to worry about.
• 17:30
  SPEAKER_01: So when we think about CFOs trying to, I'd say, contain revenue, contain the ability to keep those co-pays, et cetera, you know, they are under a lot of pressure.
• 17:42
  SPEAKER_01: So what do you think that these CFOs are consistently misunderstanding about patient payment and the financials around it?
• 17:49
  SPEAKER_00: Yeah, I think that we hear this often and that uh we hear our clients say, you know, you can't run a mission on margins.
• 17:57
  SPEAKER_00: It's very true.
• 17:58
  SPEAKER_00: Especially even when we speak to CEOs of health systems, a lot of them were physicians.
• 18:02
  SPEAKER_00: They are now in this seat.
• 18:03
  SPEAKER_00: They really want to be serving their patient population.
• 18:06
  SPEAKER_00: And that's really hard, though, uh, when they don't have the dollars to actually run and execute the programs they want to.
• 18:11
  SPEAKER_00: So it is hard for them to do that.
• 18:14
  SPEAKER_00: And we're we're here to help with that.
• 18:15
  SPEAKER_00: I think a piece of that is that really understanding that cost to collect is actually an architecture problem, oftentimes within their systems and not just a number on the screen.
• 18:25
  SPEAKER_00: And so it's oftentimes that you have a lot of systems and the patient has fallen through and maybe insurance wasn't collected, or that we don't we haven't presented them with the option that helps them afford actually the care.
• 18:38
  SPEAKER_00: And I think it's being able to knit those together as an architecture versus looking at just individual lines of that where these workflows have actually broken down and not actually helped the patient.
• 18:48
  SPEAKER_00: Is that helpful?
• 18:50
  SPEAKER_01: It does, yeah.
• 18:51
  SPEAKER_01: So, you know, as we think about the AI nature of the work that you folks are doing, and we think about from a product perspective, building in features, building in skills versus learning skills, learning features from the actual users, the patients.
• 19:08
  SPEAKER_01: What are you seeing that has been brought back into the product by the system because it's obviously what patients wanted?
• 19:16
  SPEAKER_00: Well, that's one of the most fun parts about developing Quora is the data is so rich.
• 19:21
  SPEAKER_00: So we're listening to oftentimes a call center will give us a readout of reasons why folks called.
• 19:28
  SPEAKER_00: And they're very like big bucketed things.
• 19:31
  SPEAKER_00: And so we have to kind of weed through those and decide like what to develop and what to enhance.
• 19:36
  SPEAKER_00: With Quora, we're getting so much data daily, and we have more nuance on exactly like what the problem was and if we were able to solve that in a way that that was helpful and created both great user satisfaction and resolution rate.
• 19:50
  SPEAKER_00: And so our ability to actually root cause and understand exactly what to solve for and how to fine-tune Quora has been the best it ever has been because of the data we're provided.
• 20:01
  SPEAKER_00: So, an example of that is a lot of questions around insurance.
• 20:05
  SPEAKER_00: If you ever read like an insurance FAQ on a provider's website, it's pretty blanket.
• 20:11
  SPEAKER_00: It's like a deductible is this, your co-insurance, you see it on the back of the card, it's X, it means that.
• 20:18
  SPEAKER_00: Patients don't speak like that.
• 20:19
  SPEAKER_00: Patients are, but was this my deductible?
• 20:22
  SPEAKER_00: And did this affect my bill?
• 20:23
  SPEAKER_00: Or I thought I already paid that.
• 20:25
  SPEAKER_00: And so having, I think the strength of core is not only that we can fine-tune and make that deductible answer better over time, but also understand the nuance of the deductible question and ensure she's able to over time get better at that too.
• 20:38
  SPEAKER_00: And so, how do we build in either more competencies for her to actually pull more of the insurance data or be able to make sure that as she's explaining your deductible in this way and actually breaking down the math and looking at the bill is very personalized for that, the actual user.
• 20:54
  SPEAKER_01: So when you think about Cora, what's the one number you look at that says this is working for patients?
• 21:00
  SPEAKER_01: We don't look at one.
• 21:01
  SPEAKER_01: We look, we look at three.
• 21:03
  SPEAKER_01: Good answer.
• 21:03
  SPEAKER_01: Good answer.
• 21:04
  SPEAKER_00: We look at three, we look at three.
• 21:06
  SPEAKER_00: One is definitely we look at payment resolution, and that I do believe that being able to resolve your bill is the best outcome for everyone and that no one wants a healthcare payment limit.
• 21:18
  SPEAKER_00: That is a resolution, but that's an okay resolution too.
• 21:20
  SPEAKER_00: I mean, I think we look at that of like your insurance wasn't on here and it should be, and can we resolve that?
• 21:25
  SPEAKER_00: Like, that's good.
• 21:26
  SPEAKER_00: Or like, can we get you redetermined for eligibility for Medicaid?
• 21:29
  SPEAKER_00: Like, that's a great outcome too.
• 21:31
  SPEAKER_00: Or is like, are you actually like, should you not pay this?
• 21:34
  SPEAKER_00: Should we actually find some financial aid for you?
• 21:36
  SPEAKER_00: We can look at that too.
• 21:37
  SPEAKER_00: Or is there some combination of like a deep discount and a payment plan that actually makes an affordable monthly payment for a reasonable amount of months?
• 21:44
  SPEAKER_00: That's great too.
• 21:44
  SPEAKER_00: So I think there, I hear you, like there are options on that, but that's why I often say resolution rate more than collection rate, because I think it's important that the resolution is actually the thing that both parties want to get to.
• 21:54
  SPEAKER_00: And then I think the second piece of that is patient satisfaction.
• 21:57
  SPEAKER_00: I think we have to admit that if we if we don't do that, In a way that's making patients feel like they trust this system and that they can have access to healthcare if we've actually created a divide and then feeling like that uh healthcare is available and that the system is there to support them, like that's not a good thing.
• 22:14
  SPEAKER_00: So I think patient satisfaction is one of our key metrics that we look at as well.
• 22:19
  SPEAKER_01: And when we think about the payment plans and all the other pieces, is that something Core and Cedar is doing on behalf of the provider organizations and you provide those mechanisms?
• 22:29
  SPEAKER_00: Yes, we provide those mechanisms and we try to do more than just there, there are um a lot of organizations have had discounts, but they've also been like very kind of standard, like$10 off if you pay today.
• 22:42
  SPEAKER_00: I think we're trying to actually understand, especially in the self-pay cohort that's growing, what does actually pricing look like?
• 22:49
  SPEAKER_00: And how do we actually find something that makes healthcare available to you?
• 22:53
  SPEAKER_00: And so we're doing it very much in an equitable, equitable way, equity, sorry, equitable way, but at the same time, we also are looking at different factors about how much this is compared to your total income.
• 23:05
  SPEAKER_00: We know that there's a large group of users, there are patients that actually sit right outside the financial aid marker and that they actually have the hardest time paying because they make a little bit too much to actually be.
• 23:16
  SPEAKER_01: Or if you will, absolutely.
• 23:18
  SPEAKER_00: Yes.
• 23:18
  SPEAKER_00: Or we call them, you know, we did some work with the United Way, and oftentimes they're also called Alice patients, asset, limited, income constrained, but employed.
• 23:28
  SPEAKER_00: And so it's it's such a hard group that we really, really want to help, but we've got to have more options than just asking to pay in full or have a payment plan for a bajillion months that is actually not working within their means.
• 23:41
  SPEAKER_00: It's interesting.
• 23:42
  SPEAKER_01: Well, you know, at the end of every show, I ask guests these last two questions, and they're the same ones every time.
• 23:48
  SPEAKER_01: So I know you haven't heard these yet.
• 23:50
  SPEAKER_01: So what's the clinical reality or financial reality that most people?
• 23:55
  SPEAKER_01: So I ask every guest these last two questions, and they're the same every time.
• 23:59
  SPEAKER_01: And I know you haven't heard them yet.
• 24:00
  SPEAKER_01: So here's the first one.
• 24:01
  SPEAKER_01: So what is the clinical or financial reality that most people in health tech get completely wrong?
• 24:07
  SPEAKER_00: Get completely wrong.
• 24:08
  SPEAKER_00: I think for the patient financial experience, it's thinking that a standard bill and just it's that it's actually a billing reminder and that we expect someone to pay without any context about who they are or the optionality is not going to be the path that's actually gonna help them resolve their bill.
• 24:24
  SPEAKER_00: And so my hope is that we can have conversations with folks and actually help them be able to resolve their bill in a in a way that fits for both parties.
• 24:33
  SPEAKER_01: So I guess I should stop telling all my friends, if you get that bill, just don't pay it till I send you another one, right?
• 24:38
  SPEAKER_01: Maybe not, maybe not.
• 24:39
  SPEAKER_01: I'm not Cora, unfortunately.
• 24:41
  SPEAKER_01: And then the second question I have is when's the last time you changed your mind about something in this industry?
• 24:46
  SPEAKER_00: Often.
• 24:46
  SPEAKER_00: I mean, I think the industry has changed a lot.
• 24:49
  SPEAKER_00: I think when we started Cedar, it was like it was really hard to log into this portal and even get access to the details of your bill.
• 24:56
  SPEAKER_00: And that was like a problem that we were trying to solve.
• 24:58
  SPEAKER_00: And then today it's much more around this affordability problem that is that is huge and and really hard at for at scale for both our providers as well as the patients.
• 25:09
  SPEAKER_00: And so I think just watching that change over time and even daily the insights of how our users are interacting with our product, I think you've got to be able to understand what's happening in that moment and then create interventions that help folks.
• 25:25
  SPEAKER_01: Thank you, Amy.
• 25:26
  SPEAKER_01: I love that.
• 25:27
  SPEAKER_01: You know, I came into this thinking, all right, I don't know if Cora's really advocating or really helping the patient, but I actually am leaving with a more complicated view of it.
• 25:35
  SPEAKER_01: So that's the best outcome I can ask for.
• 25:37
  SPEAKER_01: So before we go, tell people where to find Cedar and where to find you.
• 25:41
  SPEAKER_00: Yep.
• 25:42
  SPEAKER_00: Cedar.com.
• 25:43
  SPEAKER_00: And so happy to have everyone find us there.
• 25:46
  SPEAKER_00: Yeah.
• 25:46
  SPEAKER_00: And then I'm I'm on LinkedIn, Amy Stillman.
• 25:49
  SPEAKER_01: I love it.
• 25:50
  SPEAKER_01: So for everyone listening, the bill is the last thing your patient touches, and it's part of the encounter that nobody in clinical leadership actually owns.
• 25:56
  SPEAKER_01: So that should bother us more than it does.
• 25:58
  SPEAKER_01: So subscribe to the clinical realist, wherever you get your podcasts.
• 26:02
  SPEAKER_01: Look up Cedar, see what they're doing with Cora.
• 26:04
  SPEAKER_01: It sounds so interesting.
• 26:05
  SPEAKER_01: And if you're working through your live question about patient experience, clinical AI, et cetera, in your own organization, a real one and not just theoretical, the link to Book of Discovery and Clarity Session will be on the show notes.
• 26:15
  SPEAKER_01: So I'm Dr.
• 26:16
  SPEAKER_01: Sarah Matt, and this is the clinical realist.
• 26:18
  SPEAKER_01: See you next time.