Latest / Becker’s Healthcare Podcast / Nick Barcellona, Chief Financial Officer, WVU Medicine

Transcript

Nick Barcellona, Chief Financial Officer, WVU Medicine · Becker’s Healthcare Podcast

• 0:02
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• 0:30
  Hello, and welcome to the Becker's Healthcare podcast.
• 0:34
  My name is Will Riley with r one.
• 0:36
  I'm joined today by Nick Barcelona. Nick is
• 0:39
  the chief financial officer for WVU Medicine. Nick,
• 0:42
  welcome to the podcast. Thank you, Will. Nick,
• 0:45
  start us off by telling us a little
• 0:47
  bit about yourself, your role. Tell us about
• 0:49
  WVU and the communities you serve. Happy to
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  do so. Yeah. So as you said, I'm
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  the chief financial officer for WVU Medicine.
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  Been in the role for almost three years
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  now. Exciting to to be part of that
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  team. So we are a large,
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  health care system that serves,
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  four states,
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  predominantly in West Virginia, but we also have
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  hospitals
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  in Ohio, Pennsylvania, and Maryland.
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  We started our own health plan, back in
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  2023.
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  And so we're we're growing pretty dramatically. We've
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  we've
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  almost tripled in size over the last four
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  years or so. So Wow. Pretty exciting times
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  for us. That is exciting. Yeah.
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  So with that growth, what are some of
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  the things on your mind as you go
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  into 2026
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  for the some of your priorities? Yeah. So
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  we we continue to,
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  invest,
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  in, you know, different geographies,
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  and we're really you know, we call it
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  investing in breadth and depth. Right? So we're
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  sort of the traditional hub and spoke model
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  where we have a large academic medical center,
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  you know, in Morgantown, which is where our
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  headquarters is, you know, almost 900 beds there.
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  And and it's it really is the hub
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  of our health system, certainly,
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  from an academic perspective.
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  But, really, over the last few years, you've
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  seen us grow and expand in in other
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  geographic regions around the state and beyond, as
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  I said before. And so for us right
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  now, it's about investing in those other regions.
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  So it's it's really the Martinsburg region in
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  the Eastern Panhandle of West Virginia, kind of
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  a bedroom community at DC. It's up the
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  Northern Panhandle for us. That's Wheeling and Wheaton.
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  That's kinda just West of Pittsburgh in the
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  Pennsylvania area. We have the center center part
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  of our state in Charleston,
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  and then the sort of western part of
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  our state in Parkersburg. And so it's investing
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  in those hubs so that we can keep
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  that care closer to home. Mhmm. It's better
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  when those patients do not have to travel
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  four or five, six hours to come to
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  Morgantown for everything they need. So we're really
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  focused on investing in that breadth and depth,
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  and that's been a lot of our growth
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  certainly on the provider side the last few
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  years. And as I said, it's also on
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  the insurance side. So we started peak health
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  care back in 2023.
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  We went live in Medicare Advantage,
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  back in 2024,
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  and we've seen really dramatic growth. And and
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  we're very excited about being an integrated delivery
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  network.
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  And, you know, we think that that really
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  strengthens our investment and commitment to serving our
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  population better, that focus on population health. Our
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  mission is to improve the health trajectory of
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  West Virginians and all those we serve. And
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  so being both on the payer side and
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  on the provider side, we think that gives
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  us the best opportunity to do so. Fantastic.
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  Yeah. Okay. I'm sure we'll come back to
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  to that a little bit later on in
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  our conversation. So,
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  that's a great setup.
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  Let's talk a little bit about technology, if
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  we can. So health care has historically moved
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  pretty cautiously with technology,
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  not necessarily been at the the the the
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  front of the curve or whatever you wanna
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  whatever you wanna call it.
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  It feels a bit different with artificial intelligence
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  right now, and it feels like health care
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  is taking much more of a driver's seat,
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  perspective on this new technology.
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  Do you agree with that? How is it
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  playing out for you? Yeah.
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  I think I agree with that.
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  You know, I it it it's convincing.
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  Yeah. I mean, maybe not.
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  You know, I I look. I think AI
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  is revolutionizing
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  a lot of different industries, and I think
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  health care is certainly one of them. I
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  I suspect probably why you hear, you know,
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  those types of comments is because, frankly, health
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  care has been a bit behind the curve,
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  I think Yeah. From a lot of other
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  sectors that have embraced,
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  you know, activity based cost accounting and and,
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  you know, really customer centric and customer focused
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  tools and technology.
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  You know, you walk by the coffee shop
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  and it knows you're there, and it says,
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  hey. Why wouldn't you come in and, you
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  know, order a coffee and just click a
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  button to do it? We've we've been a
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  little slow, you know, to adopt those types
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  of things in health care. And I think
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  AI,
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  you know, is
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  is finally something where everybody's getting excited about
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  it. So there's benefits for certainly the the
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  consumers or the patients. I think there's a
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  lot of benefits for the physicians and the
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  clinical staff, and that's what I'm most
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  excited about, certainly from an efficiency perspective, especially
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  when you think about the workforce challenges and
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  burnout, you know, finally having something that can
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  hopefully help Yeah. Alleviate some of those challenges.
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  And, obviously, I think there's some opportunities
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  and and some exciting things from a cost
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  savings perspective. So being the CFO, you you
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  know, I think leveraging technology to be able
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  to be more efficient, that's certainly something that
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  I'm excited about. So When you think about,
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  pursuing some of those innovations,
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  how are you how are you doing it
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  at WVU? Because
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  you can we we talk a bit about
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  incumbents and insurgents. Right? So incumbents being the
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  well established providers or the well established technology
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  vendors. They have the data. They have the,
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  the the scale, the infrastructure, and so on.
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  Or insurgents,
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  the up and coming, you know, disruptors, people
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  coming in with a with a natively technology
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  or native AI driven approach.
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  How how we how do you think about
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  innovation at WVU? Who do you do it
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  with? Yeah. I I love this question.
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  And and
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  so first off, and this is, you know,
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  I think
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  something that similar kind of language, although maybe
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  a little different in our case, but we
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  we think of it, you know, being West
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  Virginias, we think of it like pioneers and
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  settlers. Right? So so do you wanna be
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  a pioneer sort of on the Oregon Trail?
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  Right? Or do you wanna be a settler
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  and maybe sort of follow after those pioneers
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  come in and the the technology is a
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  little bit more established? And I think in
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  many instances, we we kinda wanna be the
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  settler. Right? Like, we don't wanna be that
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  pioneer,
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  because we don't need to be. Right? And
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  and so I think, for us, that's maybe
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  a little bit of a conservative view to
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  take, but but that's kind of the way
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  we think about it. And we've we've formed
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  an interdisciplinary
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  committee. Right? So we have a data governance
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  committee, and we have an AI governance committee.
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  So similar you know, data governance been around
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  for a while. Yeah. AI governance,
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  relatively new, but pretty similar from a structure
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  perspective. So you have clinical leaders. You have
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  financial leaders, you have certainly IT and technology
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  leaders at the table for that. And, you
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  know, I I think having a balanced view,
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  from all those perspectives is is really important.
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  So that that's kind of our view of
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  the world of how we're you know, we're
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  not trying to, you know, always be leading.
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  Look. We're open minded. And if there's something
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  that's transformational that is gonna be right for
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  us and for our patients, we're, you know,
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  we're we're willing to try it,
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  but perhaps in a in a relatively small
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  setting so that we can make sure we're
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  managing that, you know, safely, and and we
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  can understand what the implications are gonna be
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  for our patients.
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  Totally.
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  Tell me a bit about how that governance
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  group works. You mentioned some of the participants
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  in it. What what do you do? What
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  are some of the issues that you that
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  you run through is that in that team?
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  Yeah. So this is a great question, and
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  I think a big challenge for lots of
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  organizations,
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  because there's no shortage of A good idea.
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  Yeah. Literally
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  hundreds of,
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  if not more, of of, you know, groundbreaking
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  ideas and and and new things that are
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  gonna revolutionize the industry. And so, you know,
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  a lot of what that committee does is
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  prioritize. Okay. And so what we've really done
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  in a thoughtful way is is set up
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  metrics so that we can evaluate and kind
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  of rank the projects,
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  so that we can figure out what we're
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  focusing on. And we've more than doubled the
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  size of that of our AI team Mhmm.
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  You know, from four people to eight people.
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  So it's not a huge team. But, again,
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  it's growing. And and, you know, I think
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  that's just a good example of, you know,
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  you you you have to
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  really prioritize what those projects are because you
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  don't have the resources to do everything. No.
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  You know, I'm they kinda make fun of
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  me a little bit being in the CFO
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  seat, but I I always like to say
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  at WVU Medicine, we can do anything.
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  We just can't do everything. Yeah. Right? And
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  the punchline of that is you just need
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  to be able to prioritize. Sure. And so
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  we spend a lot of time looking at
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  those metrics and figuring out how we're gonna
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  prioritize. And I think, you know, in in
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  my past experiences in other organizations, it's pretty
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  true with ours too sometimes. But, like, often
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  you do the project based on sort of
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  the loudest voice at the table. So the
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  the physicians that are most engaged or most
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  interested or the rev cycle leader or, you
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  know, pick your person.
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  And to some degree, you have to have
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  interested parties in order for a project to
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  be successful. Right. But you also have to
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  be able to step back and say, you
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  know, how many patients is this gonna impact?
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  Or, you know, what's the dollar hard dollar
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  implications of this service line that we're gonna
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  try to focus on or or whatever?
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  And, you know, I think sometimes you get
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  lost in that when you might have a
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  squeaky wheel, so to speak. And so we
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  really try to be objective about how we
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  prioritize those those opportunities. You've talked about efficiency
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  being a big driver for you as naturally
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  probably is from a CFO perspective.
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  You also talked a bit about,
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  the provider experience.
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  Are those the two key dimensions for you
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  around which you make these evaluations? I think
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  so.
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  You you know, I I think in rev
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  cycle, like, a revenue cycle, right, so sort
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  of my team, I I I think it's
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  a bit of an arms race. Right? So
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  you have the payer side and the provider
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  side, and it yes. We have our own,
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  health plan as well.
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  And, you know, I think that's an interesting
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  lens for us to sort of be able
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  to see from both perspectives, like, how are
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  you implementing and leveraging this technology to improve.
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  That's all about efficiency, though. Efficiency from a
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  patient experience perspective or from a covered life
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  experience perspective, also efficiency from how you just
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  get administrative cost out. Yes. The provider side,
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  I think, is a little bit of the
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  harder nut to crack,
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  you know, because a lot of the things
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  that we've done
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  historically have added time or added stress to
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  the nurse's life or the physician's life. And
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  and I think we're we're what's most exciting
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  to me is is when you look at
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  some of the technology that we're using now,
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  so ambient listening for documentations, we've we're working
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  with a bridge,
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  and that's going
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  exceptionally well. And I think, you know, the
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  ROI looks good and the physicians are excited
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  about it.
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  And so to be able to see some
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  technology that's actually having a really positive impact
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  in the physicians coming and kinda saying thank
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  you. Yeah. You know, that's meaningful. Right? And
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  and having an impact in their sort of
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  their their health and well-being is is is
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  important to us.
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  You know, and I think we've we've done
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  a lot of things over the years that
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  have added sort of burden to the physicians
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  and the nurses. And to be able to
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  try to limit that, maybe even take some
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  away, that's something I'm really excited about. Yeah.
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  Right. Right. Right.
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  Creates that groundswell of enthusiasm as well, doesn't
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  it Yeah. For for more widespread use of
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  technology.
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  Yeah.
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  You mentioned revenue cycle a couple of times.
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  That seems to be an area, obviously, that
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  can benefit a lot from some of these
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  new technologies.
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  Revenue cycles traditionally been a a very labor
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  first
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  paradigm, right, or or or world.
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  People using technology, but using it as a
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  as an assistant or as a as an
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  aid,
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  now it feels like that equation is getting
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  turned on its head. Right? It actually feels
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  like an area that can be technology first
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  and human supported.
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  Do you do you see that too? And
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  what what are some of the implications of
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  that if you do? Yeah. I I do,
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  and it's happening rapidly. Right? You need to
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  be more in law. Right? You think about
• 11:49
  how quickly it's it's coming. But,
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  you you know, I I one of the
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  things that I I try to take away
• 11:55
  from that, because I think there's a lot
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  of anxiety amongst the team, right, about, like,
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  does this assume my job is going away?
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  And in some instances, you have to be
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  honest. Like, yes. It does. And so I
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  think what we try to focus on is,
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  well, how do we upscale the team? And,
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  you know, how do we retain those folks?
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  Like, if the answer isn't we're gonna turn
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  this on and we can get rid of
• 12:13
  everybody. That's not the answer. The answer is
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  we we we're gonna need more people. We
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  might need them in slightly different ways in
• 12:19
  different capacities. Right? And so figuring out how
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  we upscale the team and and plug them
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  in. So you maybe you're a documentation liaison
• 12:27
  or a coding liaison, and, you you know,
• 12:29
  you're sort of checking the underlying systems and
• 12:32
  making sure that what you think it's doing
• 12:33
  is what it's actually doing. So I think
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  it's it's there's no shortage of of need
• 12:38
  for skilled labor. Right? It's just making sure
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  that we have those folks. We take care
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  of them. We train them. And and sort
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  of it's a little bit of an attitude
• 12:47
  adjustment too to make sure that they're not
• 12:48
  defensive
• 12:49
  Mhmm. Or or sort of trying to to
• 12:51
  counter the implantation
• 12:53
  of the technology. And what I found in
• 12:55
  almost every instance is at first, people can
• 12:58
  be resistant, but then when they figure it
• 13:00
  out and figure that it's actually gonna help
• 13:02
  them and make their daily lives, sort of
• 13:03
  like we talked about with the physicians of
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  nurses Right. When they realize it's gonna make
• 13:06
  their lives easier and more efficient, they start
• 13:08
  to get excited about it. Yeah. And like
• 13:11
  anything in life, like, the best ideas don't
• 13:13
  always come from the CFO or the CEO.
• 13:15
  They come from the frontline folks Right. Who
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  are sitting there, you know, processing the claims
• 13:20
  or sitting there putting hands on the patient
• 13:22
  and caring for the patient. That's where the
• 13:24
  best ideas come from because that's that's the
• 13:26
  real work that we do. Yeah. So I'm
• 13:28
  I'm very excited about, you know, this transformation
• 13:30
  wave that's coming on the revenue cycle side
• 13:32
  as well. And what what,
• 13:34
  you you've alluded to some some some of
• 13:37
  the pair dynamics because you've got your own
• 13:38
  plan. But but, like, how do you think
• 13:40
  this technology might level the playing field or
• 13:43
  bring a sort of forced
• 13:45
  peace between payers and providers? Do you think
• 13:47
  it will or or not?
• 13:50
  Yeah. I mean, I'm not sure that it
• 13:52
  will. Okay. I, you know, I can be
• 13:54
  cautiously optimistic. I mean, I I I think,
• 13:57
  you know, there's a lot of manual labor
• 13:59
  that occurs on both sides. Yeah. Okay. But,
• 14:01
  you know, the the claim processing,
• 14:04
  experience. And I think the more that we
• 14:06
  can leverage technology to take out some of
• 14:08
  the noise and actually get down to the
• 14:10
  tough conversations about,
• 14:12
  you know, pre authorizations or prior auths and
• 14:15
  denials and, you you know, working through care
• 14:17
  plan design and what's, you know, in and
• 14:20
  not not in. And and those are difficult
• 14:23
  conversations that involve people, and they're often individual
• 14:26
  and specific. And I I get it, you
• 14:28
  know, sitting on the plan side. You have
• 14:30
  to have rules and you have to have
• 14:31
  guidelines, and and we do just just like
• 14:33
  others. But I think if you can leverage
• 14:36
  technology to make sure that you're focused on
• 14:38
  what you're really trying to accomplish, that that's
• 14:40
  where I think,
• 14:41
  you know, hopefully, we can get to that
• 14:42
  point. So it's it's not worth fighting and
• 14:45
  throwing claims back and forth, and and they're
• 14:47
  getting denied,
• 14:48
  you know, based on technology. It's more we
• 14:50
  can focus on some of those tough conversations.
• 14:53
  And, you know, the the reality is as
• 14:54
  you look at the increasing costs, you know,
• 14:57
  GLP ones are a good example or, you
• 14:59
  know, lots of different novel therapy, gene therapy,
• 15:02
  etcetera. These are exceptionally expensive, and you you
• 15:04
  know, you have to sort of figure out
• 15:06
  how you manage that. And I get it
• 15:07
  from both sides of sort of the payer
• 15:10
  side and the provider side. And, hopefully, we
• 15:12
  can use technology to help make those conversations,
• 15:15
  you know, go a little bit more smoothly
• 15:17
  between us. Yeah. Okay.
• 15:19
  Nick, maybe just to to bring us home,
• 15:22
  how how are some of these innovations and
• 15:24
  changes making life better for patients?
• 15:27
  We've talked about providers. We talked about administrators,
• 15:29
  but but how what's the knock on effect
• 15:31
  for them? Yeah. And I'll I'll I'll pick
• 15:32
  on,
• 15:34
  the ambient documentation, ambient listening. I think that's
• 15:37
  a great one. You know, obviously, the physicians
• 15:40
  and nurses, you know, I think there's application
• 15:42
  there as well to to be able to
• 15:43
  limit some of the the complicated documentation
• 15:46
  that they have to do and time spent
• 15:48
  sort of after hours or anything pajama time
• 15:50
  people talk about.
• 15:52
  The other benefit that though is they can
• 15:53
  actually sit there and look the patient in
• 15:55
  the eye, kinda like we're looking each other
• 15:56
  in the eye having a conversation. That's meaningful.
• 15:56
  Mhmm. Right? And and we've all been patients.
• 15:58
  A conversation, that's meaningful. Mhmm. Right? And and
• 16:00
  we've all been patients,
• 16:02
  at at one point or another in our
• 16:03
  life. And to have, you know, physicians sort
• 16:05
  of facing sideways typing and not even looking
• 16:08
  at you, that's not a good experience. No.
• 16:10
  And that could be the best physician in
• 16:11
  the world, and I'm not picking on those
• 16:13
  physicians. That's the sort of dynamic we put
• 16:15
  them in as administrators.
• 16:17
  You know?
• 16:18
  But to to sort of give that back
• 16:20
  to them so they can sit there and
• 16:21
  have real bedside manner and have, you know,
• 16:24
  meaningful
• 16:25
  human interactions with the patients again. I think
• 16:27
  that's the most beneficial thing for our patients
• 16:29
  when I think about the advent of technology.
• 16:31
  And, yes, it's also convenience. It's, you know,
• 16:35
  AI looking at the schedule and figuring out
• 16:36
  when there's open slots and being able to
• 16:38
  geotag and look at where you live and,
• 16:40
  you know, what practice might be closest to
• 16:42
  you or what location might be closest to
• 16:44
  you and help you get in faster and
• 16:46
  easier and help with quick registrations. And so
• 16:49
  I think there's there's lots of exciting benefits
• 16:52
  coming for our patients, and and some of
• 16:54
  them are here already, which is which is,
• 16:56
  you know, for me, it's it's wonderful to
• 16:57
  see that and hear the positives. It's not
• 16:59
  all perfect,
• 17:00
  but it does make you feel good when
• 17:02
  you hear some of those success stories. Cool.
• 17:04
  Nick, thank you so much. It's been really
• 17:06
  great talking to you and hearing about what
• 17:08
  you're doing. Super, really appreciate it. Thank you,
• 17:11
  Will. Thank you. Alright. Thank you. Thanks.