Latest / Becker’s Healthcare Podcast / James Heilsberg, CFO, Tri State Health

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James Heilsberg, CFO, Tri State Health · Becker’s Healthcare Podcast

• 0:02
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• 0:31
  Hello, and welcome to the Becker's Healthcare podcast.
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  My name is Will Riley from r one.
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  I am joined today by Jim Heilsberg.
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  Jim is chief financial officer at Tri State
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  Health. Jim, welcome to the podcast.
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  Thank you. Jim, I'm looking forward to talking
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  to you. Can you to start us off,
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  can you tell us a bit about yourself,
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  Tri State Health, and the community that you
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  serve?
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  Yeah. I'm Jim Heilsberg. I'm from Tri State
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  Health in Clarkston, Washington.
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  We're a larger rural critical access hospital,
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  full service for,
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  all hospital services along with physician,
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  practices, both specialty and large primary care,
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  presence in the valley.
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  The hospital's been there since the
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  mid fifties and, continues to be a very
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  independent,
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  entrepreneurial type facility.
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  They have,
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  continued to
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  provide services to the local community in a
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  a spirit that you don't always see in
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  the current environment.
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  We, work with other area providers.
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  It's a primarily rural environment, but, it's a
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  great environment to be in, and we look
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  forward to the future. Cool. Yeah. Tell tell
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  us a bit more about the environment, the
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  community that you serve. Tell us about some
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  of the key priorities that you have in
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  for 2026
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  in terms of meeting their needs.
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  So try the, Valley is, Lewiston and Clarkston.
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  So we're right on the Idaho border.
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  Lewiston Clark came through there and
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  and, notoriously,
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  they,
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  identified, went all the way down to the
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  ocean down the Snake River and which meets
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  the Columbia.
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  So it's a long history of,
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  both port activity,
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  a lot of agriculture.
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  As far as serving the community, we serve
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  not only the agriculture,
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  rich in,
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  an agriculture area that goes north, south, east,
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  and west,
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  both,
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  grains and cattle. So there's a lot of
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  historic
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  and,
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  traditional values that are there.
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  Our main focus is to continue to provide
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  for those,
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  needs that are in the valley as best
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  as we can. We don't do everything, neither
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  does the other larger
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  for profit hospital, but we do provide a
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  lot of services that are needed for the
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  valley. Our real goals are to continue to
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  be able to provide all the services possible,
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  expand where appropriate so that we can meet
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  the needs of the community.
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  As far, for the future, one of the
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  things that's happening is that we are
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  expanding our surgery services.
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  The local
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  orthopedic presence has made a change. The for
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  profit hospital has purchased that orthopedic group along
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  with, an ASC,
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  and we're involved in, creating our own orthopedic
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  group now where we were, both hospitals just
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  used the one. We will continue to serve
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  those that are,
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  physicians that are part of that orthopedic group.
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  They'll continue to do services at our hospital,
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  but we we have almost 50% of the
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  primary care population.
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  Over time, it's become clear that
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  we both need our own presence and ability
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  to serve our physicians and our community. We
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  are the provider of choice in the Valley.
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  The other thing that's happened that we're having
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  to deal with is a primary care group
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  was also part of that orthopedic group. They
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  did OB,
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  and they were also purchased as part of
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  the, for by the for profit.
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  Our goal really is to continue to serve
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  all the patients that want to come our
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  way, Clarkston and Lewiston
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  and the surrounding area.
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  Our general surgeons,
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  we are expanding from,
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  basically two to two and a half, physicians.
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  We because the OB providers with this transition
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  decided that they didn't necessarily wanna go work
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  for the for profit, they've come to work
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  for us, with the exception of one. We
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  don't deliver babies, but we're providing those services
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  to the community,
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  for both OB and OBGYN because it's a
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  needed thing to do.
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  A lot of great opportunities that that we
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  see. And,
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  on the other side of that coin,
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  nothing's free. So we are investing in,
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  infrastructure. We did remodel two clinics,
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  that we had on-site,
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  for both OB and then Ortho.
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  And, we're continuing to look to the future
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  to say what to do what do we
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  do with our
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  surgery building, our sterilizing,
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  and processing area. We're expanding into that, and
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  we'll be adding, an SPD in the near
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  future. Looking at a surgery building, but we're
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  trying to figure out how do we fund
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  all that. Some of our big challenges are
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  saying, how do we
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  fund in this, time where there's nothing that's
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  certain. All all of our revenue streams are
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  at risk with the big beautiful bill act,
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  relating to Medicaid and changes there. Everything seems
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  to be in flux. Yeah. Okay. So you've
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  got big capital projects. You've got workforce projects.
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  Where does, so where does technology fit in
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  that agenda too? Right? Because that's moving quickly,
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  and you probably, wanna use that to expand
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  access and make life better for your providers
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  as well.
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  It's interesting,
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  in listening at this conference and others, one
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  of the big challenges I've seen over, my
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  career,
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  of thirty five, close to forty years has
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  been related to, how many times we've talked
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  about reducing revenue cycle cost.
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  Mhmm. At the same time, we've had conversation
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  of how do we it's evolved to how
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  do we allow all of our, physicians and
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  our nurses, technologists, etcetera, to work up to
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  their license.
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  To me,
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  technology is gonna have to solve not only
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  the revenue cycle, it has to solve all
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  of our our issues.
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  I think that there are many initiatives,
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  that are out there that could be helpful.
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  AI is certainly evolving quickly.
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  Three years ago four years ago, we implemented,
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  Experian,
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  and that product allowed us to
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  rejuvenate our revenue cycle. We have Meditech Expanse
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  as our main EHR.
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  And with Experian, it allowed us to move
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  a lot of manual workflows that we didn't
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  find solutions completely in Meditech to a much
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  more automated and streamlined
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  solutions.
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  They were partial AI. We just implemented one
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  of their modules, which is,
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  denial,
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  AI, which allows for,
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  work to be done prior to a claim
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  going out. A AI tool tells the things
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  that need to be fixed.
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  The, the claims go out. If they're denied,
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  they come back, and that that tool then
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  builds both an understanding of what happened, looks
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  at the needed fix, and puts that back
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  into the initial engine so we can fix
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  them,
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  fix the new claims that have been denied
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  with different reasons and uncover new trends.
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  It gives us a way to categorize all
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  of our
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  claims that came back in both
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  a financial strategy, so the largest claims and
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  those that have the highest propensity to pay.
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  That's a great example of what I see
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  will develop. I think right now, we're still
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  in the infancy of AI. We're still having
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  people
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  tell what's gonna happen. Mhmm. I listened to
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  a solution yesterday, which is about automated calling.
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  It still has a pause when it thinks.
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  Mhmm. And just like we do, but different.
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  And, I think people pick up on that.
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  I have listened to another one where, it
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  was, related to a follow-up for insurance.
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  It was much more seamless. So I think
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  in the next twenty four months, we're gonna
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  see major changes in in both the language
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  models that are out there and the other
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  solutions that allow us to be much more
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  efficient
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  and find ways to manage the the revenue
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  cycle. But what I think we really have
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  to find ways to deal with is how
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  do we help all of our clinicians work
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  up to license to eliminate those tasks that
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  they don't have to be doing anymore that
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  the AI can do for them? Yeah.
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  Okay. Maybe let's talk about both of those
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  examples a little bit more. Let's go to
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  revenue cycle first. Revenue cycle's been an area,
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  historically, that has always been very labor centric.
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  Right? It's always been human
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  powered with technology aids and supports that have
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  got sort of better and better over time.
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  It does feel like based on what you
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  were talking about and what we've seen that
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  it that the equation is flipping, and it
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  can now be technology
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  driven and human supported. Right? It's a complete
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  reversal of how it's been. Do you do
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  you agree with that? Do you see do
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  you see it going that way? That it
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  will be essentially autonomous
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  with human aid and human support? I I
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  think that we're beginning to see that. I'll,
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  cite a couple projects that we're working on.
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  One is related to bots. So not AI
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  where it is more of a programmatic
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  workflow redesign and rediscover
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  with electronic solution.
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  Payment posting is a notorious issue. Where do
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  the payments go? How do you get them
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  posted? There's clicks that people have to do,
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  keystrokes they have to do. In the end,
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  they provide no limited value.
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  Right. A human has been needed because we
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  wanna make sure it's right.
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  We've just implemented a payment posting bot solution,
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  which is nothing more than an Excel macro
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  from the past that allows for keystrokes to
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  not have to be done. The information can
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  be both typed in and then copied into
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  Meditech by a bot.
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  That eliminated
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  50%
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  of a workflow.
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  Yeah. That's significant. There are many workflows like
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  that in the revenue cycle that if you
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  can discover them
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  and you can program that in a way
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  that don't that it doesn't regularly break, one
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  of the big challenges is
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  any macro
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  anybody that has ever done a macro in
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  Excel knows that it can break if you
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  bring new data, a new
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  data set, new other,
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  factors in. We see that, and so we're
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  experimenting with old tools in a new way.
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  AI, in theory, is going to provide a
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  different set machine learning. So the ability to
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  merge
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  bots with AI that in the future can
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  make it much more efficient, that's where we're
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  gonna see a change. Right now, we're having
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  to create,
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  which is timely and its highest potential to
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  break. Right. Yeah. Okay. And how about on
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  the clinical side? You talked about that too,
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  using technology to make clinicians' lives better. Obviously,
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  you've got some advantages as a as a
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  local independent, not for profit,
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  provider that clearly are attracting providers to you.
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  But, like, how are you trying to enhance
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  their experience of working with you?
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  I I think that they're we're doing a
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  lot of things to work to expand in
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  traditional ways, which is to,
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  look at their workflows and understand,
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  what can we do within Meditech.
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  What I think we will see in the
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  next twenty four to forty eight months is
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  something that allows us to take they're no
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  less manual than other people's. They do typing,
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  etcetera, but there's the algorithm or the perspective
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  that they're different.
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  What they do is is it is special,
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  but what they do is in a way
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  that it can't be
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  duplicated. I think that there are many things,
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  when we look at, the new,
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  solutions that are relating to their dictation, relating
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  to listening in on their conversation, creating coding
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  that could not be done before. I I
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  think we're starting to see the opportunity where
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  we can help our physicians, where we can
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  help our nurses. We can eliminate
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  manual work that they do to allow,
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  them to be much more efficient,
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  see more patients,
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  allow for,
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  our nurses to actually work up to their
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  license. Maybe at some point, there will be
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  less in the same way if there's less
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  steps,
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  but it it's it's yet to be discovered.
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  Yeah. Okay. Okay.
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  And let's let's round it out then, Jim,
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  with a view on patients and how do
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  you continue
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  to put the patients at the heart of
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  the experience.
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  What are some of the things that you're
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  doing to make patients' lives
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  better and easier? Yeah. Like every hospital, we
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  have Prescaini. We have other solutions that record,
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  you know, what they felt about the experience.
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  I I think that as we continue down
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  the AI path, we will be able to
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  help more of our caregivers be more,
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  more consistently focused with the experience during the
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  stay. Yeah. We work at trying to get
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  that connection now. It's what allows us to
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  have,
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  our ratings that we do. We're one of
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  the few that received the CMS rating as,
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  you know, a five star,
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  for the state of Washington.
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  So we're doing a number of things right
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  on the outpatient side. We have a lot
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  of our,
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  staff that is equally as focused, but it's
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  not as easily seen as some of the
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  ratings. But we work hard both to connect
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  with them with AI,
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  call them ahead of time,
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  provide opportunities for fitting them into schedules. We
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  have a large minor care presence that allows
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  people to get in if they can't get
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  into physician,
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  through a traditional way. There's many different ways
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  that work. We continue to work to try
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  to
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  allow the patients to be seen when they're
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  most ill, when they need to see somebody
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  along with them, how do we get when
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  they're trying to get in to get see
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  a specialist, do you have their their time
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  be valued and, place them in a spot,
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  in a queue that's more efficient for them
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  and us? Wonderful. Jim, bring us home. Is
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  there anything else that you, want to bring
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  up that we haven't talked about?
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  I I think that, in general, as we
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  look at health care,
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  we always have to make it personal.
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  If we don't experience health care individually,
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  it's hard to make it personal. Our caregivers
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  are on the front line. They're able to
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  see that,
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  every day. As support staff, one of the
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  challenges I've seen is how do we continue
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  to to gain that experience.
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  I fell into health care. I never sought
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  it out. It's been a great journey that's
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  allowed me to,
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  actually make a difference where I don't see
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  that I would have in other industries.
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  I'm not producing a widget. We're not. We're
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  producing,
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  solutions that allow people to get, at times,
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  healed, to have their life better than what
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  it was before. And, I don't know of
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  a greater,
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  career than you could have than doing that.
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  Jim, thanks so much. Thank you. Thank you.