Latest / Becker’s Payer Issues Podcast / Transforming Reimbursement Strategy: How AI and Insights Are Powering Value-Based Care Readiness

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Transforming Reimbursement Strategy: How AI and Insights Are Powering Value-Based Care Readiness · Becker’s Payer Issues Podcast

0:00
Hi, everyone. This is Erica Spicer Mason with
0:02
Becker's Healthcare. Thank you so much for tuning
0:04
into the Becker's Healthcare podcast series.
0:07
So today, we're going to talk about how
0:09
AI and data driven insights are transforming reimbursement
0:12
strategy, pair contracting, and value based care readiness.
0:17
And joining me for this discussion are two
0:18
leaders from the Crane Ware Group. We have
0:21
with us Brian Werkinger,
0:23
senior vice president of revenue intelligence,
0:26
and Laurie Hanlon, vice president of reimbursement policy.
0:30
Brian and Laurie, welcome to the podcast. Thank
0:32
you so thank you both so much for
0:33
being here today.
0:35
Thank you for having us. Thank you.
0:38
Yeah. Thrilled to have you both. And before
0:40
we get into our conversation,
0:42
would you both like to say just a
0:44
little bit more about yourselves, your role, your
0:46
organization?
0:47
Brian, maybe you could get us started there.
0:50
Happy to, Erica. So Brian working here, senior
0:53
vice president of revenue intelligence at the Crane
0:55
Ware Group. Group. Me, myself, I've actually been
0:58
in the health care industry for for over
1:00
twenty years at this point,
1:04
coming with a a background
1:06
in heavily in the area of pricing and
1:09
payer analytics
1:11
in the healthcare industry, but that is not
1:13
all
1:14
what the Crane Ware Group does. That's just
1:17
me, myself.
1:18
And the Crane Ware Group as a whole
1:21
that we're here representing,
1:23
they they run the gamut of the revenue
1:25
cycle, what is historically known as the revenue
1:28
cycle within a health care organization.
1:30
Speaking of the provider side that is,
1:34
meaning we we get into making sure that
1:36
the bill is completely accurate from a coding
1:39
standpoint
1:40
via what we were founded on from a
1:42
CDM management standpoint about over twenty five years
1:45
ago,
1:46
to
1:47
making sure that we're modeling your payer information
1:50
appropriately into our platform in order to help
1:52
organizations
1:54
make decisions,
1:55
based on how they're being reimbursed,
1:57
doing medical necessity, charge capture. We also have
2:00
a whole other arm beside the the revenue
2:03
cycle side, which is the pharmacy, business of
2:05
pharmacy,
2:06
getting into helping organizations with the three forty
2:09
b side
2:10
and making sure they're tracking those appropriately
2:13
and optimizing
2:15
areas in the supply chain realm.
2:18
Wonderful. Brian, thanks so much. It's really helpful
2:20
to know a bit more about the Crane
2:21
Ware Group as well, some important work your
2:24
organization is doing.
2:26
Laurie, would you like to say a little
2:27
bit about yourself as well?
2:29
Sure. Thanks again for having us. My name
2:32
is Laurie Hanlon. I'm currently the vice president
2:34
of
2:35
reimbursement policy at the Craneware Group.
2:37
And as with Brian, I've been in the
2:39
industry now for quite some time, over twenty
2:42
years approaching well, actually, twenty five plus years
2:46
at this point.
2:47
And I've been in the space,
2:49
focused around reimbursement,
2:51
coding, billing, revenue cycle.
2:53
I've been in the academic world as an
2:55
adjunct
2:56
instructor,
2:57
for a a large university in Central Ohio.
3:02
But, you know, it's near and dear to
3:03
my heart as I continue
3:05
to go down this path of understanding how
3:08
hospitals,
3:09
providers are paid
3:10
and what can we do to support them.
3:13
Laurie, thank you so much for rounding us
3:15
out with the intros, and great to know
3:17
a bit more about your background and your
3:18
work in the academic space too.
3:20
And I know the the basis of our
3:22
conversation today, you know, we're we're talking a
3:24
lot about
3:25
payment processes
3:27
and and payer contracting,
3:28
reimbursement strategy.
3:30
And a lot of those areas, we're seeing
3:32
greater and greater use of technology
3:35
by health care organizations
3:37
to really better facilitate those processes and hopefully
3:40
see,
3:41
more robust reimbursements.
3:43
So my first question to you both is
3:45
how can AI and predictive modeling help providers
3:48
better understand the impact of current utilization patterns
3:52
within the context of those payer contract terms?
3:56
Yes. Yeah. So we're actually seeing AI and
4:00
predictive modeling becoming increasingly central
4:03
to how health systems evaluate their payer contracts,
4:06
especially
4:07
as utilization patterns shift in this post pandemic
4:11
world and care really continues to, migrate,
4:14
as we've seen it over the years, migrate
4:17
to the outpatient settings, and it's increasingly doing
4:19
so.
4:20
Traditionally, analyzing contract performance required that manual review
4:21
and retrospective
4:22
claims
4:35
reimbursement.
4:36
And that's changing. It's exciting, but it it
4:39
is changing. And today, organizations are starting to
4:42
use
4:43
artificial intelligence, as we all know, to interpret
4:47
the terms that are embedded in those payer
4:49
contracts.
4:50
So things like reimbursement logic,
4:53
carve outs, or even those tiered payment structures,
4:56
and and you pair that with real time
4:59
or recently utilization data.
5:02
This shows providers it allows providers to model
5:05
those what if scenarios.
5:07
For example,
5:09
what happens if orthopedic cases shift to ambulatory
5:12
settings? Or what if emergency department volumes spike
5:15
unexpectedly?
5:17
The models can forecast the financial implications
5:20
across multiple payers,
5:22
which obviously will give leaders
5:25
much more information and a clearer view of
5:27
where their exposure lies.
5:29
And importantly,
5:30
AI also supports being more, efficient with benchmarking.
5:35
It streamlines that process of comparing an organization's
5:38
performance to internal targets,
5:41
historical baseline,
5:43
or even if you went as far as
5:44
looking at external peer groups.
5:47
This is critical not just for identifying variances,
5:50
but also for guiding conversations around strategy,
5:54
air delivery optimization,
5:56
and
5:57
really looking at that contract refinement.
5:59
Another really important use as I think we're
6:02
all starting to hear more about is
6:04
detecting patterns.
6:06
So using AI to to do that pattern
6:08
detection.
6:09
And by analyzing
6:11
utilization alongside those contract terms, that we're talking
6:14
about, organizations can identify
6:17
underperforming
6:17
services
6:19
or utilization trends that aren't aligning with how
6:22
the contracts are structured.
6:24
And, really, this is especially relevant as more
6:26
payment models introduce complexity,
6:29
if you think of, like, those bundled payments
6:31
or tiered rates or even site neutral payments.
6:34
So as industry moves towards value based care,
6:36
which I know we're gonna get into,
6:39
as as we believe it's essential for providers
6:41
to build those internal capabilities around contract modelings.
6:44
And it's really not just for finance teams,
6:47
but for those clinical and operational leaders as
6:49
well.
6:50
And the goal is to shift from reactive
6:53
to proactive.
6:55
Using that data
6:57
to inform service,
6:59
line strategy,
7:00
maybe understanding risk better,
7:03
and preparing for those negotiations,
7:06
with much more informed position.
7:08
So ultimately, the health care system is heading
7:10
towards a more dynamic reimbursement structure.
7:13
Providers can combine
7:15
that AI driven contract intelligence
7:18
with real time utilization insight, and they're gonna
7:20
be better positioned to respond
7:22
to those market challenges and policy shifts before
7:26
they impact that bottom line.
7:29
Yeah. Laurie, thank you so much. Really interesting
7:31
to hear how technology is really driving this
7:34
proactive approach
7:35
to contracting,
7:37
negotiations,
7:37
reimbursement.
7:38
So really helpful overview. I I appreciate that
7:41
so much.
7:42
And you mentioned in your response,
7:44
well, you referenced complexity a few times. And
7:47
I know that we're seeing
7:49
payer and provider contracts becoming increasingly complex. So
7:53
can either you or Brian just elaborate a
7:56
bit more on how AI can help standardize
7:58
information to support better analysis of current payment
8:01
terms and also prepare for future contract structures?
8:05
Oh, absolutely.
8:07
Oh my gosh. And payer contracts today, I
8:11
think everybody could agree,
8:13
are anything
8:14
but uniform, anything but standardized.
8:17
As many out there know, even within the
8:20
same organization,
8:21
same provider,
8:23
terms and contract structures can
8:26
vary widely across their payers.
8:28
You have different methodologies,
8:30
different carve outs, different definitions of how you
8:33
find those carve outs,
8:35
and much more.
8:36
And that variability makes it so difficult for
8:39
providers to truly understand how they're gonna be
8:42
reimbursed and even harder
8:44
to compare performance
8:46
across payers or negotiate with confidence.
8:50
AI is really starting to play a a
8:52
really critical role, honestly, in addressing that complexity
8:56
by helping to standardize the contract
8:58
terms
8:59
in a way that they're the way that
9:01
they're, like,
9:02
essentially interpreted
9:04
and then, of course, how we analyze them.
9:07
So instead of reviewing each contract manually
9:11
and and trying to track down
9:13
dozens of reimbursement
9:15
logistics and and look at different spreadsheets and
9:18
documents,
9:19
AI can take that information
9:21
and extract it and normalize those contract terms
9:24
into a consistent structure.
9:27
This enables providers to be able to see
9:30
side by side
9:31
how similar their services are and how similar
9:34
their those services are reimbursed across different agreements
9:37
and identify where terms might be misaligned,
9:41
with their clinical or operational realities, so what
9:44
they're actually doing.
9:46
And this is just as important as how
9:48
a standardized sets the stage for future planning.
9:52
So as payment models evolve,
9:54
as we see fee for service
9:56
move to more value based, bundled, or perhaps
9:59
even in some cases some hybrid models,
10:02
providers really need to understand
10:04
not only how they're being paid today,
10:07
but how those terms could shift in the
10:09
future.
10:10
AI can help simulate that. It can tell
10:12
us what the impact is going to be
10:15
of different contract structures,
10:17
based on the provider's unique patient population and
10:20
service mix.
10:22
So at the end, it's you know, really
10:24
by building a a standardized view
10:27
of existing payment terms and modeling how future
10:29
contracts could perform,
10:32
providers gain a much clearer path forward.
10:34
It supports stronger financial forecasting,
10:37
more informed negotiations,
10:40
and ultimately ensures that payment structures align again
10:43
with both that clinical priority as well as
10:46
long term sustainability.
10:49
And, Erica, if I can, I mean,
10:51
appreciate everything Lori's saying and and
10:54
so true, but I'm just gonna comment on
10:57
AI as a whole briefly here
11:00
on this? So, yes, AI can do all
11:02
this, and it's interesting when we talk to
11:04
providers
11:06
and we say, you know, all of this
11:09
is possible with AI. Everybody's extremely hesitant right
11:12
now. We heard it at the conference as
11:14
well with people saying that they're starting to
11:16
introduce AI, and it's how accurate is it.
11:20
And it is accurate, and I think it's
11:21
just important that it's gonna be a period
11:23
of time and a phased approach to organizations
11:27
accepting,
11:29
this incorporation of AI. It very much so
11:32
can do it. Laurie and I see it
11:33
with our own hands at the Crane Ware
11:35
Group, what it's capable of doing,
11:37
but it's getting comfortable because it's not a
11:39
human
11:41
completely
11:42
sort of there. At least that's what people
11:44
perceive it to be. But in actuality,
11:46
it very much incorporates
11:49
human that's driving the AI
11:51
and training it to do the things that
11:53
Lori has been referencing here. So it's absolutely
11:56
fascinating from my standpoint what it's capable of
11:58
doing as long as you have the right
12:00
people behind it building it to do the
12:03
items referenced
12:04
by Laurie.
12:07
It's such a such an important add on,
12:09
Brian. I completely understand where you're coming from
12:12
saying how at Becker's annual meeting just a
12:15
couple weeks ago, we we certainly hear a
12:17
lot of excitement around AI in in the
12:20
reimbursement
12:21
and payment space, but also, of course, hesitation
12:24
concern at the same time. So
12:26
I appreciate that clarification there.
12:28
And I wanna shift just a bit here
12:31
to talk a little bit about Medicare Advantage,
12:33
another topic that at the conference,
12:36
certainly, no
12:37
no shortage of topics and conversations
12:40
around MA. But
12:42
as we see shifts or potential pullbacks in
12:45
Medicare Advantage
12:46
in certain markets, especially, what are the implications
12:49
for hospitals and patients, especially communities that are
12:53
relying on managed care
12:56
models? Oh my goodness. This is
12:58
certainly an emerging and very important issue.
13:02
As as you said, we heard it at
13:04
the conference,
13:05
in several sessions.
13:07
But
13:08
as we look across our our makeup, our
13:11
our footprint of of our providers,
13:13
and in several markets, especially in those rural
13:16
areas or even the underserved
13:19
urban regions,
13:20
Medicare Advantage has filled a a very critical
13:22
gap, by providing managed care structures that help
13:26
patients navigate the system,
13:27
you know, coordinate care,
13:30
and really access services beyond what the traditional
13:34
Medicare
13:35
might offer.
13:36
And when we talk about Medicare Advantage going
13:38
away or plans
13:41
exiting specific geographies, we're not just talking about
13:44
a shift in payor mix.
13:46
We're really talking about the potential of unraveling
13:49
of local care,
13:50
the the management infrastructure.
13:53
So from a hospital perspective,
13:55
the change or disappearance even to an extent
13:59
of Medicare Advantage Plans can certainly
14:02
disrupt the long established patterns,
14:04
care coordination programs, and even
14:07
preventative service models. And many hospitals,
14:11
particularly those smaller or safety net facilities,
14:15
have invested care teams and outpatient supports that
14:18
are tied directly to how those Medicare Advantage
14:20
plans operate.
14:23
So, you know, if those plans exit,
14:26
hospitals
14:27
find themselves managing a more fragmented patient population
14:30
often with fewer resources
14:32
and less predictable
14:34
care pathways.
14:35
For patients, especially
14:38
those with chronic conditions,
14:40
the loss of managed care can mean losing
14:42
access
14:43
to disease management programs,
14:46
perhaps some transportation services, or even
14:48
simple appointment reminders.
14:50
The downstream
14:52
effect is often a return to the emergency
14:54
room
14:55
for those unmanaged or preventable issues.
14:58
And that's a real concern
15:01
in the markets that have already seen a
15:03
strain on acute care settings.
15:06
What we believe the industry needs to be
15:08
doing right now is scenario planning.
15:11
Understand where Medicare Advantage participation
15:14
may be unstable,
15:17
assessing how that affects those local provider networks,
15:21
and identify what safety nets or even policy
15:24
levers can be put in place.
15:27
And, Eric, I'm gonna chime in here again
15:30
and take it from a different sort of
15:32
not a different completely, but just piggybacking on
15:34
some of the things that Laurie was saying
15:36
here, but adding to it a little bit
15:37
and referencing some of the things that,
15:40
we both heard, Laurie and myself and maybe
15:42
yourself, Erica, at the conference, the the recent
15:44
payer conference.
15:47
Beyond just Medicare Advantage, the payer as a
15:50
whole
15:51
is also looking to potentially shift
15:55
maybe the types of plan offerings that they
15:58
provide and put on the table in front
16:00
of the their consumer, which is technically the
16:03
patient that's signing up for the coverage just
16:05
like Medicare Advantage.
16:07
So either one, either of those avenues,
16:11
when you go backwards a little bit in
16:13
terms of sort
16:14
of, not so much, I mean, well, Craneware
16:16
Group does
16:17
help providers
16:19
and moving away from the payer side, what
16:21
this means with this shift
16:24
is these patients
16:26
that Laurie was referencing
16:28
that maybe don't have the coverage,
16:31
where do they end up?
16:33
They end up going to the emergency department
16:36
within the providers. So they don't they don't
16:38
have the insurance that they need that puts
16:40
them on those necessary plans, which ultimately raises
16:43
and increases the cost to the provider to
16:45
provide that care because you're coming in as
16:46
maybe as a self pay.
16:48
Maybe you're a sicker patient.
16:50
So then
16:51
the care that you need at that point
16:52
in time, because you haven't been going along
16:55
the path with coverage and getting the care
16:57
along the way, you're sicker, you go in
16:59
and the cost to provide that care is
17:01
much higher,
17:02
then that burden is shifted to
17:04
the provider to take care of that. How
17:07
do they make sure that they are remaining
17:09
profitable
17:10
from a provider standpoint? Remember, yes, all these
17:13
organizations are not considered not for profit, but
17:15
at the end of the day, organizations
17:17
still need to make money to continue to
17:20
provide the care that is necessary
17:22
for the market that they serve. So if
17:24
these shifts happen that we're talking about, about
17:26
the Medicare Advantage maybe shifting and maybe pulling
17:29
back a little bit, that's gonna shift to
17:31
provide more cost in the organization and sicker
17:33
patients that they're taking care of that ultimately
17:36
can
17:37
lead to an impact on the provider's bottom
17:39
line.
17:40
Mhmm.
17:41
I really appreciate how you both outlined that
17:44
so clearly.
17:45
What a significant domino effect that is,
17:49
both to your points about, you know, how
17:51
this ultimately impacts a provider organization, but more
17:54
immediately patients as well.
17:57
So so really appreciate you both outlining kind
17:59
of the the potential consequences of some of
18:01
these shifts we're seeing in Medicare Advantage.
18:04
And I wanna stick with just for one
18:06
more question, I wanna stick on the payer
18:07
side for just a moment. You know, we're
18:09
seeing growing availability of payer transparency data. So
18:14
how do you recommend providers
18:16
think about using that information to really generate
18:19
meaningful insights and also to support decision making
18:22
with their services?
18:24
Oh, boy. Erica, there's been a lot of
18:26
data put pushed out there at the fingertips
18:31
for for everyone, not only the consumer,
18:33
but also the,
18:36
I guess, vendors,
18:38
the government.
18:38
There's access to both the payer side, the
18:41
hospital side's pushing data out there. But with
18:44
the release of this TIC data, what is
18:46
transparency
18:47
in coverage, what is what people call TIC,
18:50
that's on the payer side,
18:52
where they had to put out all the
18:55
the reimbursement
18:56
information in terms of what how they pay
18:58
the providers across the country.
19:01
It really put it at a whole different
19:04
sort of level from a standpoint of visibility
19:06
into
19:07
what those rates have
19:09
what they've negotiated,
19:11
across the health systems.
19:13
So now, as I was saying, so many
19:16
people have access to an overwhelming
19:18
volume of raw
19:20
rate files from payers
19:22
published to comply with federal transparency
19:25
regulations.
19:27
Although that's a major step forward in our
19:30
industry that we're in,
19:32
the real opportunity lies in what providers do
19:35
with that information.
19:37
And how can it be used to support
19:39
more constructive,
19:40
data informed conversations with payers?
19:43
So I will say, yes, it's out there.
19:45
But one of the things that that is
19:47
so important
19:49
to know is how that data is laid
19:51
out. And when I say laid out, how
19:53
it's been pushed out in files,
19:55
it doesn't necessarily
19:57
completely align with how maybe a payer contract
20:00
is structured.
20:01
So it does require,
20:03
some, I guess,
20:05
additional scrubbing to
20:07
almost normalize it and make it so that
20:09
it's usable,
20:11
for individuals to go back and then try
20:13
to figure out what is this saying, what
20:15
does this mean.
20:16
But what it does drive
20:19
is, in my mind, and is a better
20:22
partnership, and we and we heard that, I
20:25
think, at the payer conference as well.
20:28
It's no longer should be looked as an
20:30
enemy. You know, I'm either on the payer
20:32
side or I'm on the provider side.
20:34
This publishing of data is requiring
20:37
or leading us in the direction that they
20:39
actually truly work together
20:41
because
20:42
one can't survive without the other. So they
20:44
can't
20:46
be one-sided and and kinda going against each
20:49
other, which is in a way
20:51
how the industry has,
20:53
I guess, gone
20:54
to date.
20:55
And and both myself and Lori have been
20:58
in the industry for many years and we've
21:00
kinda seen it evolve,
21:02
in that way to a certain extent. So
21:05
that that's what I would say around this.
21:07
It's it really ties to
21:09
what are we gonna do with that data?
21:11
It's out there. So how
21:13
how do you you actually use it and
21:15
put it to good?
21:17
So I don't know, Laurie, if you wanted
21:18
to add anything to that.
21:21
Yeah. I I think that when we think
21:24
about this massive amount of data that's available
21:26
at our fingertips and to Brian's point, you
21:28
know, however it's used, it's gonna be used
21:31
in in different formats and different things and
21:33
interpreting it. But at the end of the
21:35
day, it's about looking at what's been
21:38
published or what's what's out there for for
21:40
folks to to absorb and ingest or whatnot.
21:44
And it really needs to be looked at
21:46
in the sense of it's not just to
21:48
compare rates. Right? We're not looking at just
21:50
to, say, well, this one pays more than
21:53
this one.
21:54
It's really there to help both the payer
21:57
and the provider understand
21:59
and and get the why behind the numbers
22:02
so providers can really approach payers with more
22:05
clear evidence based questions. So coming to them
22:09
and saying,
22:10
well, you know, where are the rates not
22:11
aligned with the market or service intensity or
22:14
maybe even looking into how can we ensure
22:16
reimbursement models reflect clinical realities
22:20
and operational investments.
22:21
So when really when this information
22:23
is used thoughtfully,
22:25
the data becomes a tool for collaboration, like
22:28
Brian mentioned, and and helping to identify those
22:31
shared goals
22:32
across access,
22:34
quality, and
22:35
even sustainability.
22:37
Mhmm. So as health care systems benefit, when
22:40
we're looking at both the provider and the
22:41
payer, when they're working from that common set
22:44
of facts, if you will, you've got more
22:47
information about
22:49
what do we have available to us and
22:51
how can we work together to strengthen
22:53
those relationships.
22:56
Shifting the conversation from reactive disputes to more
22:59
proactive alignment.
23:01
Mhmm.
23:02
Yeah. Laurie, Brian, I really appreciate these insights,
23:05
and it sounds like the data is there.
23:09
It's just perhaps not in a perfect format
23:11
yet, but it's going in a direction of
23:13
supporting this more collaborative relationship between
23:16
providers and payers.
23:18
And and I think that we're seeing that
23:19
in other areas too, especially
23:22
value based care payment models. You know, there's,
23:24
of course, payers and providers alike are interested
23:27
in the in the outcomes and the benefits
23:29
of those models.
23:31
And so my final question for our conversation
23:33
today, you know, as we're thinking about value
23:35
based care and how it continues to grow
23:37
and evolve,
23:38
how should providers be foe what should they
23:40
be focusing on to succeed in those models?
23:42
And how can better analysis and partnership
23:45
to both of your points play a role
23:47
in that success?
23:49
Yeah. So
23:51
value based payment,
23:54
This has been talked about even back when
23:56
I entered,
23:57
different forms of it back when I entered
23:59
the industry.
24:01
Still have a ton of fee for service
24:03
that's out there, although it's shrinking. But when
24:05
you look at value based payment,
24:08
it it really isn't new because, again, it's
24:10
been talked about for many years, but what
24:11
we're really seeing is a broadening and deepening
24:14
of these models
24:17
extending beyond primary care. So it's no longer
24:20
just about hitting a few quality metrics or
24:23
reducing readmissions.
24:24
For providers,
24:26
that means a shift in focus.
24:29
As value based care expands across more services
24:32
and patient populations,
24:34
providers are under
24:37
increasing pressure
24:38
to balance,
24:40
let's say clinical outcomes
24:42
with financial
24:43
sustainability.
24:45
It's no longer enough to manage a revenue
24:47
cycle efficiently.
24:49
Health systems now need to understand the true
24:52
cost of care to maintain competitive,
24:55
to remain accountable under these models.
24:57
And and that's a key piece. So one
24:59
of the things that they heavily talk about
25:01
with value based payment is the payment
25:04
and making sure you're hitting the quality metrics,
25:06
making you sure you're hitting all the different
25:09
levers
25:10
to actually receive the payment. But in all
25:12
actuality,
25:14
there's there's a fundamental
25:15
piece that's being missed.
25:18
That's great that you, as a provider, you're
25:20
getting the payment and you have this model.
25:22
But if you're not managing the overall
25:26
margin management,
25:27
which you're looking at the revenue piece with
25:29
the payment, but if you're you are not
25:31
factoring in the true cost of care that's
25:34
in that model,
25:35
that that's great that we've gone to value
25:37
based payment.
25:39
Hospitals are gonna sink because they're not managing
25:42
their margin and making sure that they're also
25:43
paying attention to the cost to provide that
25:46
care there. And it no longer can we
25:48
rely on the standard RCC model, the ratio
25:51
of cost to charge model, which is a
25:53
true is more of an estimate of what
25:55
it costs to provide the care.
25:57
You need to get down to a true
25:59
cost of care or what would also
26:13
cause it's not because it's not like a
26:15
manufacturing
26:17
industry, healthcare.
26:18
We've lived in a whole different realm
26:21
today
26:23
and still do for the most part. There's
26:25
very few organizations
26:26
that you could go to and say, I
26:28
understand my true cost.
26:31
It's an estimate off of a ratio of
26:32
cost to charge. So it is absolutely fantastic
26:35
that the industry is moving towards
26:38
value based payment. And I'm not sure what
26:40
the numbers are in terms of lives covered
26:43
under a value based payment model. I know
26:46
it's growing to your point, Erica. It is
26:48
definitely going up.
26:50
I think it's still a a ways away
26:52
because
26:53
people have to get that understanding of what
26:55
that cost is in that model. And I
26:57
think that's a missing component to really
27:00
springboard us forward in these payment models.
27:05
Yeah. Fantastic points, Brian. Thank you. And, Laurie,
27:08
before we close, just wanna check-in with you.
27:11
Any final thoughts on value based care or
27:13
anything else from our discussion?
27:15
No. This has been great. I appreciate the
27:18
opportunity to be able to dig into these
27:20
very near and dear topics to our hearts.
27:24
And it so this has been really helpful
27:26
to be able to talk through.
27:28
Yeah. Fantastic.
27:29
Well, Brian, Laurie, it's been great having you
27:32
both and your expertise on the podcast today.
27:34
So thank you so much again for being
27:36
here. And, of course, we'd like to also
27:38
thank our sponsor for today, the Crane Ware
27:40
Group.
27:41
Listeners, be sure to tune into more podcasts
27:43
from Becker's by visiting our podcast page at
27:46
beckershospitalreview.com.