Latest / Becker’s Healthcare Podcast / Stephen Rinaldi, SVP and Chief Revenue Officer of UNC Health

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Stephen Rinaldi, SVP and Chief Revenue Officer of UNC Health · Becker’s Healthcare Podcast

0:00
This is Alan Condon with the Becker's CFO
0:03
and Revenue Cycle podcast.
0:05
And today, I'm delighted to be joined by
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Steven Rinaldi,
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senior vice president and chief revenue officer of
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UNC Health. That's a nonprofit system with 16
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hospitals across 20 campuses
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in North Carolina.
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Steve, a real pleasure to have you on
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the podcast with us today.
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For those who are listeners who might be
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as well acquainted with yourself,
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the role that you do at at UNC
0:28
Health, do you mind giving us a little
0:29
bit more information about your background and your
0:30
experience?
0:32
Oh, sure. I'd be happy to, and thank
0:34
you so much for, giving me the opportunity
0:36
to, meet with you today.
0:39
So as you mentioned, I'm the chief revenue
0:40
officer for UNC Health.
0:42
We are a $12,000,000,000
0:45
health care system spanning North Carolina from the
0:48
mountains to the coast,
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with our headquarters in Chapel Hill.
0:52
In my role,
0:53
I'm responsible for our managed care program,
0:58
reimbursements, and that includes our supplemental programs, net
1:00
revenue recognition, cost reporting, things of that nature,
1:03
and then,
1:04
end debt revenue cycle for both, professional
1:08
and hospital operations.
1:10
I've been with UNC since 2014.
1:14
I joined the system as a CFO at
1:16
one of our entities
1:18
and, served previously as a CFO when, I
1:21
was working in New York State.
1:24
Later moved into corporate finance and, have been
1:27
really thrilled by the opportunity
1:29
to help build out and
1:31
sustain our revenue strategy and some of our
1:34
financial operations at the health care system level.
1:37
I'm an accountant by trade, so I tend
1:40
to, approach health care finance,
1:43
broadly and,
1:45
from that lens, if you will.
1:47
Yeah. Fantastic. And excited to have you on
1:49
and pick your brains a little bit. Like
1:51
you said,
1:52
$12,000,000,000
1:53
health system, fantastic academic system at UNC Health,
1:56
16 hospitals, of course, headquartered at Chapel Hill.
1:59
I know you know the system very well
2:01
from the inside and out at this stage,
2:03
eleven years at UNC Health, most recently serving
2:05
in that chief revenue officer role. So,
2:08
Steven, I guess the first question I have
2:10
for you,
2:11
so much going on, a very challenging time
2:13
in health care as we know.
2:15
What are the the two or three trends
2:17
that you're paying most closest attention to in
2:20
your seat as chief revenue officer at UNC
2:22
Health today?
2:24
I think the trends that are most
2:26
front of mind for us are,
2:28
I think, can be separated into a couple
2:30
different categories.
2:31
One would be market headwinds.
2:35
We continue to see some substantial pressure
2:38
from
2:39
our,
2:40
payers
2:41
across the landscape,
2:43
as they
2:44
respond to cost and inflationary pressures in the
2:48
market,
2:48
as well as we do.
2:50
That includes some of the pressure from, OB
2:53
three and from some of the,
2:55
related legislation.
2:57
Secondly,
2:58
would be
2:59
challenges that we see with
3:01
sustaining and assuring an adequate workforce to meet
3:04
the needs of clinical care delivery as well
3:07
as sustained administrative functions over the next
3:10
several years.
3:11
And,
3:13
thirdly, would be the excitement around tech enablement
3:17
and the adoption and implementation of both sort
3:20
of,
3:21
augmented and then Genetec AI across our operations.
3:26
Got it. So, certainly, market headwinds across the
3:28
board is your first some payer pressure related
3:30
to denials, whatnot we're seeing in in terms
3:32
of payers and funding. So some of those
3:34
ubiquitous challenges,
3:36
OB3 and related legislation like you've had like
3:38
you've noticed as well, workforce challenges across the
3:41
board and tech enablement.
3:42
I'd love to could I just dive a
3:44
little bit deeper into the first trend that
3:47
you mentioned around market headwinds. No doubt,
3:50
we just received word of policy level. Okay.
3:53
We're out of the federal shutdown now. There's
3:55
gonna be a vote on the ACA subsidy
3:57
sometime we gather in December.
3:59
But we do know definitively
4:01
2027
4:02
to late twenty twenty six in terms of
4:04
Medicaid costs coming down the pipeline, A lot
4:06
still up in the air in relation to
4:08
ACA subsidies.
4:09
I'm wondering if you could maybe dive one
4:11
bit deeper into kind of how you and
4:13
the financial leaders at UNC Health are thinking
4:16
about 2026
4:18
and beyond.
4:19
As of right now, in terms of what
4:21
we know coming down the pipeline in terms
4:23
of Medicaid and whatnot, and then also still
4:25
a bit of in limbo in terms of
4:26
what we what we might know in terms
4:28
of the ACA subsidy next year?
4:30
Yeah. So I think great question. I think
4:33
that those headwinds are front of mind for
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a lot of finance leaders right now.
4:38
From our perspective,
4:40
payer strategy and market strategy are probably
4:43
at the top of that list,
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in in different ways. With Medicaid,
4:48
the
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pressure from the federal government in o b
4:52
three that will reduce supplemental
4:53
payments represents
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a particular concern.
4:58
Ourselves and other entities are particularly
5:01
dependent upon those supplemental programs to invest
5:05
appropriately in people process and technology and within
5:08
the communities.
5:09
So that represents a, a challenge that we
5:12
have a couple strategies to address. That in
5:15
addition,
5:16
as you know, Medicaid expansion,
5:19
is part of that dialogue. And so some
5:21
of the
5:22
confirmation,
5:23
workflows around
5:25
proof of employment
5:27
and reenrollment,
5:29
are areas from a Medicaid perspective that we're
5:32
we need to lean in. So,
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with that, the first one would be
5:37
partnering and trying to connect with the state
5:39
around the best way to assure that the
5:42
patient population we serve are compliant and participating
5:46
in
5:47
the revalidation processes necessary
5:50
under the new Medicaid
5:52
rules so that they are not losing their
5:54
access to care and of course we're not
5:56
losing
5:58
a reimbursement source.
6:00
Lots of data points to the loss of
6:03
health insurance or accesses obviously being negative to
6:06
socio
6:08
determinants of health and,
6:10
health equity. So we want to be cautious
6:12
to make sure that we're continuing to support
6:13
that population.
6:14
We do that with financial navigators and with
6:17
technology and, and outrage during,
6:20
scheduling and immediately following.
6:23
On the ACA side,
6:25
certainly,
6:26
a reduction in subsidy and an increase in
6:28
premiums
6:30
for our patients that are in ACA plans
6:32
represents a concern,
6:34
twofold. One,
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possibility of more
6:38
participants in those plans
6:41
stepping away from insurance due to affordability
6:44
and moving into the ranks of the uninsured.
6:47
Again, that could have some substantial impacts both
6:49
in their health and,
6:51
and our ability to,
6:53
to sustain,
6:54
serving them in the way in the best
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way possible.
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Secondarily,
7:01
the increased cost of their premiums
7:03
will put pressure on their ability to satisfy
7:06
their out of pocket
7:08
liabilities, deductibles, coinsurance, co payments, things like that
7:11
that are a critical component of those plans.
7:14
So one of our big concerns is is
7:16
that the number of insured will decline. And
7:18
for the portion that remain insured,
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it'll actually result in them,
7:23
presenting more as if they're under insured,
7:26
due to those financial limitations.
7:28
Again, what we're trying to do in that
7:29
space is be proactive with,
7:32
supporting them with payment plans, with estimates,
7:36
from a revenue cycle team perspective and connecting
7:39
them with our financial assistance program so that
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we can assure that we're continuing to serve
7:44
that important portion of the community
7:47
as we sort of work through that change.
7:50
Yeah. No. It's certainly interesting to get the
7:53
hear your perspective, how you're proactively addressing some
7:55
of these
7:56
challenges on the insurance side for your patient
7:58
population.
8:00
And Stephen, I'm wondering if you could just
8:01
maybe share a little bit of insight into
8:03
that other trend that you mentioned in terms
8:04
of market headwinds on the payer side in
8:07
terms of payer pressure. We know denials have
8:09
been through the roof across the board in
8:12
recent quarters,
8:13
really big burdens in terms of prior authorization
8:16
or whatnot.
8:18
As as payers
8:19
begin to use
8:21
AI in their coding and revenue cycle, whatnot,
8:24
more and more, we know at a point,
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it seems like, where providers are now playing
8:28
a little bit of catch up in terms
8:30
of automation,
8:31
AI agents in the rev cycle, pushing back
8:34
against some of these
8:35
ubiquitous challenges we see on the commercial payer
8:38
side.
8:39
Is there anything that UNC Health has found
8:42
particularly
8:44
effective maybe from a strategic standpoint in terms
8:46
of protecting your financial performance in the current,
8:49
in the current age?
8:51
Yeah. That's a great question. Certainly, lots of
8:53
headwinds in that area. We have a couple
8:55
strategies that we are deploying.
8:58
So at the the highest level, denials
9:00
certainly continues to be a challenge. And to
9:02
your point, we're seeing
9:04
a number of
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payer partners,
9:08
across the country,
9:10
major payers and and even,
9:13
those that are less often in the media,
9:15
deploy technology
9:17
to
9:18
deny claims or to create administrative burdens that
9:23
extend the time line and the effort necessary
9:26
to collect reimbursement.
9:29
As we take a look at that,
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from a provider perspective, it it it feels
9:34
quite intentional,
9:37
whether or not it is
9:39
subject to debate.
9:40
What we're trying to do there is
9:43
appeal as much as possible, work as much
9:46
through our analytics process on,
9:49
our authorization
9:51
procedures
9:52
and then to increase and automate the volume
9:55
and the quality of our denials and appeals
9:58
while we work with the payers through our
10:00
contracts
10:01
to work toward negotiating a better protections for
10:03
the health care system
10:05
to, achieve the
10:07
yield and or the the rates that we
10:09
negotiated when we when we set out those
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contracts.
10:12
Mhmm. Yeah. So, Steven, the big question I
10:15
have top of mind, when I when I
10:17
think about
10:18
AI in the revenue cycle, no doubt payers
10:20
have been using it for quite some time,
10:22
providers paying catch up. As AI becomes more
10:25
integrated into the revenue cycle and this
10:27
AI arm was raised, for lack of a
10:29
better term, how do you see that evolving,
10:32
in this push pull dynamic with payers and
10:34
providers over the coming years?
10:36
Yeah. That's a great question. So spending a
10:39
lot of time in this space, I think
10:40
it's it's one of the most exciting opportunities
10:42
that we have.
10:44
You've probably seen some statistics. Lord knows there's
10:47
there's lots of them out there. But from
10:48
an AI adoption perspective, the adoption curve that
10:52
we're seeing is is so much steeper than
10:56
almost anything in history, certainly more steep than
10:59
the adoption of the iPhone, for example, which
11:02
which surprised
11:03
everyone.
11:05
And I think that when we step back
11:07
and look at this, the question I always
11:09
like to ask is,
11:11
how many of your friends or colleagues were
11:14
talking about or using,
11:18
a ChatGPT,
11:19
a Grock,
11:21
Copilot or some similar technology, either at work
11:23
or personally,
11:25
six months ago. And and you'll find that
11:28
if you look back, you think, jeez, you
11:29
know, no one was really talking about it.
11:31
So I think the curve is really high.
11:33
And if we think about it, I would
11:35
say that
11:36
early on, you know, the the techies, the
11:39
visionaries were leaning into that back in 2022,
11:42
2023,
11:43
sort of that early adopter phase. I think
11:46
we've now moved through the maturity portion of
11:49
the curve
11:50
of what I would call the pragmatists in
11:52
the early majority
11:54
adoption cycle. I think that that's about where
11:56
we are. And so I think we have
11:58
a lot of additional,
12:00
growth and
12:02
opportunity to learn in this space. So while
12:05
we're doing that in health care, that's a
12:07
really critical thing because there's two parts to
12:10
this. One is technology that we develop ourselves
12:13
in house,
12:14
around,
12:15
large language models and machine learning. We've got
12:18
a wonderful
12:19
ISD team that that's doing a lot of
12:21
that work. But we're also partnering with a
12:23
number of vendor partners in this space.
12:25
And when we look at them, they're all
12:28
at various stages of
12:30
being,
12:31
fully market ready in various stages of product
12:33
development as they work to leverage the technology
12:36
as well as scale.
12:38
And so I think that,
12:40
because it's early in the process, we're learning
12:42
a lot. We're learning
12:44
how we have to leverage these models and
12:47
assure that we're protecting health information,
12:50
within a secure environment.
12:53
We're learning how to,
12:56
escalate and build these models to align with
12:58
our,
12:59
human in the loop,
13:01
expectations
13:02
of our operation.
13:03
And it's enabling us to do a couple
13:05
things. One, you get a good look at
13:07
some aspects of your operation that maybe have
13:09
been on autopilot, and it gives you a
13:11
chance to improve those areas, retool things, add
13:15
some additional controls.
13:17
And then secondarily,
13:19
it enables you to handle a whole lot
13:21
of volume at a pace,
13:23
that you couldn't handle previously. Denials is a
13:26
great example.
13:27
When we appeal an inpatient denial, our success
13:29
rate is close to seventy percent. But because
13:32
the process is so onerous and time consuming,
13:34
it's very difficult to appeal more than twenty
13:36
percent through our physician advisor and our denial
13:39
management program. So leveraging technology will be able
13:42
to appeal
13:43
closer to one hundred percent of those. And
13:45
so you only need a
13:48
a modest
13:49
increase in in volume and certainly at the
13:52
same win rate to to shift the table.
13:55
So over the next several years, I think
13:57
we're gonna see a great increase in the
13:59
leverage of technology in that space, authorization, denials,
14:02
estimation from a revenue cycle perspective.
14:06
At the same time, I see the payers
14:08
building
14:09
their technological solutions
14:12
to protect their business model and in some
14:15
ways to,
14:17
combat, if you will, what we're trying to
14:19
do. So, I don't know if it's, you
14:21
know, the Clone Wars or the Bot Wars
14:22
that will happen overnight, but
14:25
at some point, these models are all training
14:27
each other. So I think we're gonna learn
14:29
a lot over the next couple years,
14:32
and your guess is as good as mine
14:34
as to as to as to where we'll
14:36
land.
14:37
Yeah. No. I was just fascinated to get
14:39
your perspective on to your point, just how
14:41
how deeply embedded AI has become, not just
14:43
in health care health care, but really across
14:45
the board over the last six, twelve, eighteen
14:47
months. So kinda curious. I get excited to
14:49
hear what's coming down the pipeline, but we've
14:51
kind of interesting thoughts there.
14:53
Steven, we talked quite a little bit about
14:55
the challenges there. That's one area, no doubt,
14:57
of excitement for for providers, but also we
14:59
see some challenges with PERS two.
15:01
When you think about the future of UNC
15:04
Health in particular,
15:05
is there one area that you're particularly excited
15:07
about, whether it be on the tech enablement
15:09
side or something else?
15:11
Couple of things I'm really excited about. Certainly,
15:13
on the tech enablement side, in addition
15:16
to implementing the technology and revenue cycle, we're
15:19
implementing
15:20
technology to support our providers in terms of
15:25
using solutions for ambient listening to help complete
15:28
documentation during office visits, of course, with patient
15:31
consent.
15:32
And we're adding clinical decision supportive tools,
15:36
built on our platform in Epic to help
15:39
increase,
15:40
and and and prompt ideas around data and
15:43
data aggregation.
15:44
We think about the electronic medical record as
15:47
being,
15:48
electronic, but there's still a fair portion of
15:49
material that is scanned into or paper that
15:53
ends up as part of the medical record.
15:55
And some of this technology will help,
15:57
collect the information that is in
15:59
those sources as well as the information that
16:02
is in the electronic record and help create
16:05
a profile to help our providers. So definitely
16:07
excited about that.
16:09
Really excited about our ability
16:11
to see what that technology will do. And
16:13
one of the very important goals of UNC
16:16
Health is to be, an
16:19
international and national leader in
16:21
research and in our academic mission. And so
16:24
I think we're going to see
16:26
some exciting use of that technology in that
16:28
space,
16:29
maybe helping us get to clinical
16:32
therapies or drug development or other insights
16:36
quicker,
16:37
based on the ability to process a lot
16:39
of information and work through variables and Monte
16:41
Carlo analysis, if you will. I think that's
16:43
gonna be great to supplement the the outstanding
16:45
minds that we have,
16:47
at the School of Medicine and in our
16:48
university program,
16:50
and in our provider group that that are
16:52
engaged in in research. I don't think that
16:54
that's unique for you and say I think
16:56
that that would be a wonderful thing for
16:58
for all R and D,
16:59
and academic institutions in this space, which I
17:01
think will be will be great for society.
17:04
Another thing that we're really excited about is,
17:07
we're building a 3 plus billion dollar children's
17:09
hospital
17:10
here in, the Research Triangle, which is the
17:13
Raleigh Durham Chapel Hill area. We're
17:16
partnering with Duke Health on this project to
17:18
build the first,
17:20
standalone children's hospital in the state of North
17:22
Carolina,
17:24
which I think is gonna be wonderful for
17:26
the community and, really represents a great opportunity
17:29
for, everyone that cares about,
17:32
that service line and children,
17:34
to come together and do something,
17:37
wonderful for the state, not just for today,
17:39
but for generations to come.
17:42
Yeah. No. Fantastic. I know we recently covered
17:44
the news on on Becker's as well, the
17:45
$3,000,000,000,
17:47
children's hospital in partnership with Duke Health,
17:49
which kind of ties nicely into our last
17:51
question for you, Steve. I know that's obviously
17:54
one huge key area of growth for UNC
17:56
Health,
17:57
but but how else are you looking at
17:59
growing across the health system? Is there potential
18:02
opportunities for m and a? Is it expanding,
18:04
growing service lines? Obviously, the children's hospital is
18:06
a huge initiative. But anything else you'd like
18:08
to highlight there in terms of what's coming
18:09
down the pipeline, over the next twelve months
18:11
or so?
18:12
Yeah. Absolutely. I think one of the things
18:15
that's really
18:16
exciting and helpful about,
18:18
North Carolina
18:19
is is what we're seeing from a from
18:21
a population perspective.
18:24
When we go back and we think about
18:26
where we were
18:27
since 2020, our population has grown by seven
18:30
and a half percent, which is really substantially
18:33
the result of, net in migration of of
18:35
folks moving into the state as opposed to
18:38
births.
18:39
And so as a result, we're really working
18:41
to expand our care model, doing that in
18:43
a couple of ways. One,
18:45
adding and connecting with independent physicians across the
18:48
community to be part of our independent network,
18:51
through the work that we're doing in the
18:52
health
18:53
alliance, identifying areas and communities that need specialty
18:57
practice, and then,
18:59
also the construction of additional,
19:02
new hospitals. We,
19:03
are building another,
19:05
standalone hospital here in the Triangle, which would
19:07
be a
19:08
typical adult,
19:10
and
19:11
acute care,
19:13
facility.
19:14
We've recently,
19:15
applied,
19:17
for a CON
19:18
to, work to build a a hospital in
19:21
the western part of the state.
19:23
And, in so doing, we're really trying to
19:25
meet the population growth and
19:28
the community needs in the areas,
19:30
you know, that
19:32
we are
19:33
both operating in and where the growth is
19:35
occurring.
19:36
So I I think that that's really important
19:38
from a growth perspective.
19:40
When we look at our delivery model across
19:42
the state,
19:44
at some point,
19:46
the conversation of rural health strategy needs to
19:49
come into the discussion. North Carolina, like many
19:52
states, is distinctly rural and,
19:54
we're working with the state and other partners
19:56
to develop the the best strategies and programs
19:59
to,
20:00
address
20:01
care needs that are present
20:03
across our state in rural communities.
20:05
Really excited about that work,
20:07
and and how we approach that.
20:10
Yeah. Fantastic. I so greatly appreciate you you
20:12
taking the time to kind of let me
20:14
pick your brains a little bit what's going
20:15
on in the revenue cycle, kind of some
20:17
interesting growth opportunities coming down the pipeline for
20:19
UNC Health. Such an interesting market in state
20:21
in North Carolina as well. Steven, thank you
20:24
so much for taking the time to be
20:25
a part of our Becker CFO and Revenue
20:27
Cycle podcast. We really appreciate
20:29
Well, thank you. Appreciate the opportunity to, celebrate
20:32
the things that, UNC Health is working on
20:35
and the the tremendous work of,
20:37
of many in our community to to bring
20:40
health and well-being to, to our communities.