Latest / Becker's Healthcare Behavioral Health / Scaling Operational Excellence and the 7 Levers Powering Healthcare Performance

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Scaling Operational Excellence and the 7 Levers Powering Healthcare Performance · Becker's Healthcare Behavioral Health

0:00
Hello, everyone. This is Erica Spicer Mason with
0:02
Becker's Healthcare. Thank you so much for tuning
0:05
into the Becker's Healthcare podcast series.
0:07
So today we're going to talk about scaling
0:10
operational excellence and the seven levers that are
0:13
powering healthcare performance.
0:15
And joining me for this conversation is Sri
0:17
Vellamore, the president and chief operating officer at
0:20
NextGen Healthcare.
0:22
Sri, welcome to the podcast. I'm so happy
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to have you with us today. Thank you,
0:26
Erica. Great to be here. Well, it's great
0:28
to have you. And before we dive into
0:30
these seven efficiency levers
0:32
and what they mean for health systems, I
0:34
wondered if you could just share a little
0:35
bit more about yourself and your work at
0:37
NextGen.
0:39
Sure. Absolutely.
0:40
I'll lead with NextGen. I think NextGen, of
0:42
course, we are a leading provider of cloud
0:45
based solutions
0:46
for ambulatory practices. The company has been around
0:49
nearly five decades at this point in time
0:51
and has been evolving to really meet the,
0:54
the shaping and changing needs,
0:56
of outpatient clinics and medical groups across, you
0:59
know, 40 different clinical specialties,
1:01
over the years. So very proud of the
1:02
work that we do and the communities that
1:04
we support.
1:05
I joined NextGen Healthcare as the chief growth
1:08
and strategy officer about four years ago,
1:11
Erica. And I was named president and CEO
1:13
in January
1:14
2024
1:15
and will be, you know, shortly transitioning to
1:18
the CEO role as well.
1:20
And I bring
1:21
several decades of experience leading growth and performance
1:23
transformations across multiple industries,
1:26
you know, particularly in health care, financial services,
1:28
and technology.
1:30
My focus at NextGen has been on,
1:33
long term growth and driving innovation in our
1:35
solutions portfolio, really driving
1:38
client value and results across all the specialties
1:40
that we serve.
1:41
And prior to NextGen, I was at McKinsey
1:43
and Company for, for about ten years, and
1:46
I led, the North America health sector,
1:48
in in the digital analytics and new business
1:51
building,
1:51
practices of the firm, working with the, you
1:54
know, several leading health care organizations across care
1:57
provider life sciences.
1:58
So really excited about the opportunity,
2:01
to have a major impact here in health
2:02
care, both in my prior career and, of
2:04
course, here at NextGen.
2:06
Great to learn more about you, Sri. Thank
2:08
you so much for sharing, and
2:10
appreciate too the reminder of the tenure that
2:12
NextGen has in this space. I think that's
2:14
such an important perspective to be bringing to
2:16
this conversation as as we talk about efficiency
2:19
and how health care organizations can really drive
2:22
better performance.
2:24
And I understand in your work, you really
2:26
focus on what you call seven efficiency levers,
2:29
and that can include
2:30
anything from RCM uplift to new revenue expansion
2:34
that really represent key pathways for health systems
2:37
to improve their performance.
2:39
So can you elaborate just a little bit
2:41
more about, you know, what these levers are
2:43
all about and which ones you're seeing deliver
2:45
the greatest impact right now?
2:48
Yeah. Absolutely, Erica. It when we talk about
2:50
what's happening in the industry, there's so much
2:52
change occurring in our sector across the board.
2:55
But one thing that comes through loud and
2:57
clear,
2:57
if you cut through all the noise,
2:59
is that performance and efficiency are the key
3:03
imperatives
3:04
for ambulatory practices in this day and age,
3:07
especially for behavioral health practices.
3:09
There's so much technology friction,
3:11
significantly rising reimbursement pressures,
3:14
shortages from a workplace perspective, inflationary pressures on
3:18
practices,
3:19
and, of course, the complexity of data driven
3:21
decision making in the world of AI.
3:24
And as you look across all of these,
3:26
really, practices have no choice but to take
3:29
a step back and really take a hard
3:30
look at all the levers that are available
3:33
to them to try and drive performance. Essentially,
3:35
all of us are being asked to do
3:37
more with less.
3:38
And that's one of the reasons why we
3:40
shape the seven lever efficiency playbook for our
3:43
clients across all clinical specialties.
3:46
And these levers, specifically,
3:48
they touch on some critical areas that can
3:51
drive
3:52
three to 5% in revenue improvement for practices
3:55
and anywhere from 12 to 15%
3:57
in EBITDA gains if they're executed effectively.
4:00
And I'll quickly step through the list of
4:02
these levers. You know, the first among these
4:04
is clinical efficiency.
4:06
We we hear frequently how long it takes
4:09
physicians to
4:10
complete document,
4:12
documentation,
4:13
to capture codes, to capture charges, to submit
4:16
claims.
4:17
And what we are focusing on is how
4:19
do we shorten that encounter to cash posting
4:23
time frame for the typical practice by making
4:25
clinicians more efficient. And this is through ambient
4:27
AI
4:28
documentation tools.
4:30
A second area, we're focused on
4:32
on is related to access and volume. So
4:35
no shows continue to be a major problem
4:37
for practices.
4:39
A typical no show one no show a
4:41
day for a physician practice can translate into
4:43
nearly $15,000
4:45
of lost
4:46
revenue on an annualized basis. So
4:48
going after solving that is materially important for
4:51
practices.
4:53
The optimization
4:54
of patient and payer mix, how they negotiate
4:56
their contracts with the insurance companies and
4:59
ensuring at a minimum that they're paid what
5:01
they what they are contracting for and looking
5:04
at opportunities to actually improve their performance relative
5:06
to their peers in any geography.
5:08
That's critically important as number three.
5:11
We look at the, the patient mix itself.
5:14
So how are they attracting patients? How are
5:16
they retaining patients and ensuring that in a
5:18
highly competitive local market that patients choose to
5:21
walk into your clinic and not somewhere else?
5:23
That that becomes critically important,
5:26
is number four.
5:27
Revenue expansion opportunities are emerging very rapidly for
5:31
practices beyond traditional clinical care.
5:34
Practices are looking to try and
5:36
participate in clinical research, do data syndication,
5:40
expand and adjacencies, and look at those kind
5:43
of opportunities to add more revenue, above and
5:45
beyond the conventional conventional means.
5:49
Site optimization
5:50
is really important as lever six. We have
5:53
clinics that are spread out across geographies and
5:55
in a in a world
5:57
where you don't have enough staff,
5:59
available to sit at all your sites, having
6:01
the ability to use analytics to say, where
6:04
should my staff be on any particular day
6:06
and time that's lined up against the cyclicality
6:09
of demand that the clinics are seeing can
6:12
make a significant
6:13
difference,
6:14
in managing capital costs and infrastructure.
6:17
And then, of course, you know, purchasing efficiencies.
6:20
Practices are have historically not been as sophisticated
6:24
about working with financial institutions to look at
6:26
how they might use banking and payments products
6:29
to maximize their ability
6:30
to, to do procurement, to, to manage their
6:33
payment cycle, and there are there are significant
6:35
efficiencies to be gained by doing that as
6:37
well. So I know I stepped through those
6:39
pretty quickly, but those are sort of seven
6:41
major areas that are very directly lined up
6:43
against the challenges that we hear practices talk
6:46
about.
6:47
Yeah. Yeah. Sri, I appreciate you outlining all
6:49
seven and giving us some quick examples of
6:52
what that looks like in some of these
6:54
domains. You gave a great example with the
6:56
concern around clinical efficiency.
6:58
You know, we're seeing a rise in documentation
6:59
tools, Ambient AI in particular.
7:02
So, again, appreciate some of those examples that
7:05
you shared along the way. And I know
7:07
that around your introductory remarks, you had also
7:10
mentioned
7:11
kind of how NextGen has this special line
7:13
of sight into what's going on at behavioral
7:15
health organizations.
7:17
And I know behavioral health care is certainly
7:19
facing a lot of unique
7:21
operational and financial challenges. You had noted some
7:24
reimbursement issues.
7:26
So can you share some more strategies that
7:28
you're seeing improve both care quality and sustainability
7:31
at those organizations in particular, and any examples
7:33
of what's really working?
7:35
Yeah. Absolutely. So behavioral health organizations are in
7:39
a bit of a, you know, unique position
7:41
relative to other practices because unlike most other
7:43
practices,
7:45
there is significantly greater fragmentation
7:47
in the provider base
7:49
nationally. So there's a lot more pressure,
7:51
on on behavioral health organizations to drive consistency
7:55
across multiple distributed sites, for instance.
7:57
They are also
7:59
one of the practices that has a greater
8:01
reliance on public and private funding models.
8:04
Because even in even in instances where they're
8:07
seeing a single patient, it's possible that there
8:09
might be multiple payers
8:11
that BH organizations
8:12
need to reach out to for reimbursements, and
8:14
they need public and private funding partnerships to
8:16
succeed.
8:18
And then, of course, you know, we're looking
8:20
at regionalization
8:21
as well. It is hard for behavioral health
8:23
clinics to be profitable in many cases unless
8:26
they have the ability to refer into facility
8:29
based
8:30
complex services.
8:32
E and M codes aren't enough for them
8:33
to sustain their their practices in many instances.
8:36
So they need to be able to work
8:38
with a broader ecosystem,
8:40
in
8:41
in their localities to really drive the kind
8:43
of impact and results. So with those particular
8:46
concerns in mind,
8:48
with, with the h organizations, a couple of
8:50
the levers that tend to become
8:53
more important,
8:54
the staffing and site optimization
8:56
becomes really important for behavioral health practices.
9:00
Can we use analytical tools, AI solutions to
9:02
essentially look at patient schedules and help these
9:05
clinics determine
9:06
how best to distribute their resources
9:09
across their different locations?
9:11
In many cases, what we've seen
9:13
is that that has the potential to reduce
9:15
their payroll cost by nearly eight to 14%.
9:18
Either in terms of not needing to hire
9:21
additional staff or getting more capacity
9:23
and productivity out of the folks that they
9:25
already have. It also takes them nearly 50%
9:28
less time to manage schedules across their distributed
9:31
entities. So that's one example.
9:34
A second area that's really, really important is
9:37
related to referrals as we just talked about.
9:40
It is typical for many practices to have
9:43
as much as 20 to 10 to 20%
9:46
of their revenue lost because of leakage or
9:49
because of not being able to manage the
9:52
referral patterns between their clinics
9:54
and in many cases, complex care facilities and
9:57
and inpatient facilities,
9:59
to provide these complex services that their patients
10:01
need.
10:02
So,
10:03
we are rolling out solutions
10:05
with our practice management capability
10:07
to help practices really navigate that referral pattern
10:10
and make sure that that leakage doesn't occur.
10:13
And more importantly, that the patients get seen
10:16
by the providers that they need to
10:18
in a in a timely way so that
10:20
they can get to the best possible outcomes.
10:22
A third area that's really important for behavioral
10:24
health, of course, is there's a significant shortage
10:28
of clinicians.
10:29
And behavioral health is one area
10:31
where
10:32
you have more than just
10:34
the clinicians themselves participating
10:37
in,
10:38
in providing care. You have therapists. You have
10:41
care navigators. You have, you know, a larger
10:44
or broader variety
10:46
of folks that are involved in
10:49
in providing care. And and it's more helpful
10:51
to think about the care providers as as
10:54
prescribers and social workers and,
10:57
peer and family members and not just the
10:59
physicians. So
11:00
providing the ambient solutions, whether it's, you know,
11:04
providing patient summarization through AI or diagnostic and
11:07
ordering suggestions and using
11:09
mobile and AI capabilities to allow that care
11:12
provider, regardless of whether they're an MD or
11:14
not,
11:15
see patients and capture those notes and turn
11:17
those into charges becomes incredibly important in behavioral
11:20
health settings.
11:21
And,
11:22
you know, what we've seen is that nearly
11:24
95%
11:25
of the critical documentation
11:27
that is required in order to complete an
11:29
encounter can be done by these automated solutions
11:32
working in tandem with with these care providers.
11:35
So that becomes critically important in behavioral setting
11:37
as well.
11:38
And then, of course, you know, last but
11:40
not the least,
11:41
you know, behavioral health organizations are increasingly relying
11:45
on telehealth services.
11:46
So having
11:48
having the ability to see patients virtually,
11:50
even a concept that we call street medicine,
11:53
where you're able to go see patients where
11:55
they are instead of expecting them to be
11:57
able to show up to your facilities and
11:59
then having the ability to asynchronously
12:01
treat the patients, capture those notes, and still
12:04
have all of that documentation be taken tied
12:07
so reimbursement is not impacted becomes critically important
12:09
for these organizations as well. So those are
12:12
some interesting nuances
12:13
on the b eight side that are more
12:15
important than your typical practice.
12:18
Yeah. Sri,
12:19
really appreciate the
12:21
overview. So it sounds like,
12:23
three key levers you've mentioned are staffing and
12:25
site optimization
12:26
and referrals,
12:27
the clinician shortage.
12:29
And it's fascinating what you said about how
12:32
I believe I'm hopefully, I'm quoting you correctly
12:34
that about 95%
12:35
of processes within those levers can be automated.
12:38
Did I hear you
12:40
right on that? Yeah. We we yeah. I
12:42
was referring to the documentation need that nearly
12:45
95%
12:46
of what is needed or considered to be
12:48
complete documentation post encounter can be supported or
12:51
enabled through these AI and ambient scribing tools.
12:54
Got it. Well, thank you for clarifying. And
12:57
it's really interesting to hear how technology can
12:59
factor into that and all of the opportunities
13:01
there.
13:02
So thank you again for the overview for
13:03
behavioral health. So important.
13:05
And, you know, zooming out a little bit,
13:08
as health care organizations
13:09
are looking to scale innovation. So whether this
13:12
is a behavioral health practice or other ambulatory
13:15
organization.
13:16
In your view, what shifts are most important
13:19
for enabling success across multiple levers, especially
13:23
when leaders are balancing those short term wins
13:25
and goals with longer term visions?
13:29
Yeah. It's, you know, innovation is a word
13:31
that gets thrown around a lot in our
13:33
in our industry, and it's helpful to kinda
13:36
take a step back and say, what do
13:37
we really mean when we talk about it
13:38
in in these terms?
13:40
So
13:41
when we refer to innovation in the context
13:43
of the clients that we serve,
13:45
what we are really doing is taking a
13:47
step back and saying, how could we reimagine
13:49
care and payment models
13:51
with a very kind of pragmatic lens and
13:53
say, how do we reimagine these processes on
13:55
how care is delivered, how payments occur,
13:58
how the practices actually operate on a day
14:00
to day basis so that we can drive
14:03
outsized performance and outcomes.
14:05
And if you take that lens to what
14:06
innovation means in this in this context,
14:09
you have the ability to both,
14:12
be as aggressive as you want to be
14:13
with that reimagination or be as pragmatic as
14:16
you need to be,
14:17
in terms of what it is that you're
14:19
attacking.
14:20
But the common thread, regardless of which approach
14:22
you take and how bold you want to
14:24
be,
14:25
there are really three things
14:26
that really matter. You know, first and foremost
14:28
is do you have,
14:31
the data
14:32
that you need to make sound decisions
14:34
about what will truly drive change and results
14:36
for your organization. So that's number one.
14:39
It's critically important for all these entities to
14:42
have created usable data environments
14:45
with robust governance around it to baseline where
14:48
they are today and be able to demonstrate
14:50
that they're actually making meaningful progress
14:53
against those entities going forward. So that's number
14:55
one. Number two
14:58
is really, understanding what the what the goal
15:01
is that they're trying to get to. We
15:02
talked about seven levers
15:04
earlier in our conversation just now. The reality
15:07
is not all of them are needed for
15:09
every entity.
15:10
Some organizations can get by with solving one
15:12
or two of those, and some really need
15:15
maybe four or five of those. And that's
15:17
really driven by the organization's urgency and readiness
15:20
to attack those problems.
15:22
So, specifically, what that means is taking a
15:24
portfolio approach
15:26
and not just trying to solve these with
15:28
point solutions, which tend to create a lot
15:30
of friction.
15:31
It's really taking a more programmatic approach and
15:34
saying, what is my end goal and what
15:36
is the best combination of these answers that
15:38
gets me to where I'm trying to get
15:39
to? So having that
15:41
programmatic thinking, the structure to actually execute this
15:44
and that in that lens becomes critically important.
15:47
The third thing that we've learned that's really,
15:49
really important is even when the answers are
15:51
obvious
15:52
and they're staring you in the face, it
15:54
is very, very hard to change habits,
15:57
particularly
15:58
with with care providers and clinicians that are
16:01
used to treating patients a certain way.
16:03
And
16:04
that change management aspect is incredibly important,
16:08
particularly
16:09
providing elbow level support to the frontline,
16:12
enabling them and coaching them through the use
16:14
of all of these technology tools and new
16:16
processes,
16:18
being transparent in showing them the results
16:21
of all the new solutions that you're deploying
16:23
on their behalf. And that creates the right
16:25
level of engagement and ownership
16:27
on the part of the front line to
16:29
sustain these results. Otherwise, you end up getting
16:31
a lot of pilots,
16:32
with short term results and the innovation doesn't
16:34
actually stick in the long run. So just
16:37
to reiterate those three things again,
16:40
data driven decision making, having programmatic
16:43
leadership,
16:45
and a portfolio approach to solving the problems,
16:47
and then that frontline change management.
16:50
Yeah. Shree, these are great pointers here, and
16:53
I love what you said about change management
16:55
when you were underscoring the importance of it.
16:58
You also mentioned getting I think you had
17:00
mentioned something like elbow level support. So it's
17:03
more than just perhaps a a high level
17:05
communication campaign to your staff. It's it's more
17:07
about that hands on support. So, definitely aligns
17:10
with some of the the challenges and needs
17:12
that we've heard leaders talk about here at
17:14
Becker's.
17:15
This has been a really great conversation. I've
17:17
learned a lot about the behavioral health space
17:19
from you and and how these efficiency levers
17:21
are really driving change. Is there anything that
17:24
we perhaps glossed over too quickly or didn't
17:26
touch on that you wanted to just share
17:28
as final words for our listeners?
17:31
I don't not nothing that we miss per
17:32
se, but another area that I think is
17:34
really important is to, you know, pay attention
17:37
to two other things.
17:38
A lot of the dialogue as it relates
17:40
to all of these issues tends to be
17:42
very provider centric and practice centric. And it's
17:44
just as we've been discussing today. It's all
17:46
about how to make the practices more efficient
17:48
and help them drive sustainability.
17:51
The other lens that's really important with which
17:53
to approach all of this is, of course,
17:54
the patient lens at the end of the
17:56
day.
17:57
And while we talk a lot about patient
17:58
centricity,
18:00
one of the things to pay attention to
18:01
is not as much energy goes towards actually
18:05
looking at the technologies that the patients are
18:07
using, making sure that they are aware and
18:09
informed and educated on how best to use
18:11
it. I'll give you a tangible example.
18:14
We could invest, a ton in providing
18:17
in solving the no show and the referral
18:19
problem.
18:20
But the patient self scheduling and the intake
18:23
side of that equation, which is when they're
18:25
sitting on their couch, on their mobile phone,
18:27
or their computer, making the appointments,
18:29
wanting to look at wait lists, or wanting
18:32
to be notified about, you know, being overdue
18:34
for their physical.
18:35
That entire engagement and communication
18:38
model,
18:39
and looking at that patient journey from an
18:41
end to end perspective and closing the loop
18:43
on that is just as important as solving
18:45
the issues from the practice perspective.
18:48
So they go hand in hand. So while
18:50
practice is looking at efficiency,
18:51
they should also make sure that they've got
18:53
the right engagement platform,
18:55
that connects everything from the searching, the scheduling,
18:58
the education, the awareness building,
19:01
the visit management, the post visit communications and
19:04
follow-up, the care management tools, the payments tools,
19:07
and ensure that patients are able to do
19:09
all of that seamlessly and frictionlessly in a
19:11
single platform,
19:12
to really make some of this stick. So
19:13
that's one part of it. The second part
19:15
of it is we have,
19:18
our friends in Washington DC
19:20
that are also,
19:21
very engaged and involved in shaping,
19:24
the future of health care in our country
19:26
and keeping an eye on all the regulatory
19:29
changes that are happening, the compliance expectations,
19:31
the certifications,
19:32
the pledges,
19:34
as they relate to TEFCA and taking the
19:36
clipboard out of their hospital room. There are
19:38
all of those actions and movements that are
19:40
happening from a regulatory perspective as well,
19:43
that we need to pay attention to. So
19:46
eye on the prize.
19:47
Efficiency, obviously, very important, but doing it in
19:49
the context of, you know, what's right for
19:51
patients and and ensuring that you're doing all
19:54
of this in line and in step with
19:55
what's happening, with regulatory bodies is, is the
19:58
other part of the puzzle to not miss.
20:01
So well said, Sri. I I wanna thank
20:03
you again for spending time with Becker's today
20:06
and giving us all of your insights and
20:08
experience
20:09
with these efficiency levers and and all of
20:12
the the various areas that really factor into
20:14
them. I love what you said about keeping
20:16
eye on the prize with the patient lens
20:18
and also the regulatory changes compliance.
20:21
It's been a great discussion. So thank you
20:22
again for making time for it today.
20:25
My pleasure, Erica. Thank you so much for
20:26
having us.
20:27
We're happy to have you. And, of course,
20:29
we also wanna thank our podcast sponsor, NextGen
20:32
Healthcare.
20:33
Listeners, be sure to tune in to more
20:35
podcasts from Becker's Healthcare by visiting our podcast
20:37
page at beckershospitalreview.com.