Latest / Becker’s Healthcare Podcast / Michelle Joy, President and CEO of Carson Tahoe Health

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Michelle Joy, President and CEO of Carson Tahoe Health · Becker’s Healthcare Podcast

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Hello, and welcome to the Becker's Healthcare podcast.
0:35
My name is Will Riley from r one.
0:38
I'm joined today by Michelle Joy. Michelle is
0:41
president and chief executive officer at Carson Tahoe
0:44
Health in Nevada.
0:46
Welcome to the podcast, Michelle. Thank you, Will.
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I'm looking forward to talking to you today.
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To start us off, tell us a little
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bit about yourself, your background,
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and tell us about Carson Tahoe Health.
0:57
So Michelle Joy, president and CEO of Carson
1:00
Tahoe Health. I've been with the organization
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for eleven years now,
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three as the CEO and prior to that
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as the chief operating officer.
1:10
My past background prior to coming to Carson
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Tahoe was working for Banner Health in
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multiple different locations and a variety of, executive
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leadership roles. So have been on the large
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health system side and now have the opportunity
1:25
with Carson Tahoe to lead a small
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private independent,
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not for profit system. So we are comprised
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of a 200 in bed acute care hospital
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that includes behavioral health services
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as well as,
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an employed medical group with a 100 physicians
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and APPs
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with, about 20
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ambulatory care sites spread throughout Northern Nevada, really
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Carson City, the surrounding rural communities, so taking
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care of that,
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Eastern Sierra Front. Got it. And your community
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that you serve is predominantly rural, would you
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say, or what what's what's the
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demographic and population sort of mix? Yeah. So
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Carson City,
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state capital of Nevada
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is roughly 60,000
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individuals, and then there's,
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a large swath of rural Nevada
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to the east and south of us.
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So we tend to take care of that
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area as the
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only,
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acute care sole community hospital for that area.
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There are several critical access hospitals in those
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rural counties,
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but we're we're the main acute care facility.
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We're twenty minutes from Reno, but tend not
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to be in that Reno market. So our
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total service area population is about 200,000,
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mainly rural. Got it. Got it. Okay. Great.
2:46
Thank you for the background.
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And tell us a little bit what's on
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your priority list for 2026.
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What are some of the initiatives that you're
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pursuing?
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This is perfect timing because we have been
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working through our,
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strategic projects with our board,
3:02
as we finalize our budget for 2026.
3:06
So one of the areas that has been
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a key focus, the last couple of years
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is really around behavioral health. So Nevada ranks
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fifty first in the country for
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youth mental health
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services.
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Youth mental health is a crisis across the
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country,
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definitely more than a crisis in Nevada. So
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we have made huge investments over the last
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really year with support from the state of
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Nevada
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to,
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open
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adolescent inpatient beds,
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a youth crisis stabilization
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center,
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outpatient treatment space,
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and then we have what is called,
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Carson Tahoe vehicles of change. So not your
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typical
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mobile outreach
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clinic concept.
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You really have to think of these as
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ice cream trucks,
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break colors,
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lots of activities, whatever we can do
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to draw in the kids,
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break down the stigma and be able to
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connect with them through
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sound,
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food,
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play,
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art.
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So our sound
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truck actually folds into a sound stage, has
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a podcast studio built in the truck. And
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so really trying to give these kids an
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opportunity
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to create
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versus just always
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ingesting
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off their phones and
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giving them tools to build resiliency
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and,
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just, you know, kinda thinking back to probably
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when we grew up as kids, the time
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we spent outside. And so huge initiative for
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us, something that we're really excited about, has
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tons of community support. So that's number one.
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The other piece is looking at our people
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and our culture. So we've made a lot
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of investments
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in our workforce.
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We have over 2,300
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employees.
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What differentiates us from a market perspective is
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we really try to
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focus on family.
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Coming to work at Carson Tahoe, you're becoming
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part of the Carson Tahoe family.
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And so we've seen that
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play out through employee engagement surveys, recognitions that
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we've received. So this year, we're a top
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Nevada employer by Forbes.
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Becker's has recognized us as well.
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We're a top workplace in Nevada,
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top health care workplace,
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top female led workplace.
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So
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we're really
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leaning
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in to how do we continue to grow
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our own and retain
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all of our our great employees.
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So that's our second initiative. And then obviously,
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with the OBBA
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facing us,
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what are what's the impact the Medicaid cuts
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are gonna have,
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along with potential three forty b changes, site
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neutrality?
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So the board has really asked us
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to look at what's our cost structure,
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what's our service line profitability,
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where can we
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expand
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into
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new partnerships,
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collaborations,
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affiliations.
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We
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are 75%
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government funded. Yeah. And so any changes
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in any of those programs
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really has a huge impact to us.
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Very good. And so you mentioned,
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efficiency,
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for example. Let's key in on that perhaps
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because I want to ask you a bit
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about
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technology and the adoption of technology at a
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facility or health system like Glass Ste.
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How are
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you thinking about,
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the adoption of AI technologies? Because it seems
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to offer promise in terms of finding efficiency
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in areas like, supporting clinicians and their care
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for patients, some of the administrative processes that
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support the back end,
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like revenue cycle, for example. How are you
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looking at?
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So we,
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one of our strategic
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pillars in our twenty twenty,
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twenty thirty strategic plan is transform and innovate,
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and so this falls right into those initiatives.
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We have brought in,
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an Ambient AI product for our medical group.
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We use that to replace,
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live remote scribes,
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which absolutely
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brought a significant cost savings to us on
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the medical group side.
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Mixed adoption,
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depending on whether you're primary care or specialist,
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but that is
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our first sort of step into,
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AI.
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We have some independent groups that come into
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the hospital or are hospital based that are
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also piloting their own AI,
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products from an ambient
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AI perspective. And so we have
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really tried to figure out what's that governance
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structure when there's outside groups bringing in different
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technology.
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And then we know that probably in the
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next area that we will expand into is
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revenue cycle. We just haven't
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had the time or the resources to really
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drill into
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into that piece of it yet. You mentioned,
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some physicians
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using it, adopting it, adopting enthusiastically, others less.
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So can you tell me more about that?
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Yeah. I think for
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our specialists, the tool that we implemented was
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really primary care based, and so it didn't
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necessarily
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capture
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the information
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in a way that was beneficial to the
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specialists. We know through the vendor that they
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continue to
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update and refine the product, that it will
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get easier for those specialists. But
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the initial feedback coming from our providers is
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they're leaving at the end of the day.
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They're not having to stay Right. Hours later
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trying to get all their notes completed. Like,
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they can walk out of the room, do
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a quick review, sign off on it, and,
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be done with that chart and then move
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on to the next one. So it really
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has,
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I think,
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improved their
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productivity, but just also their own well-being,
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by giving them a little bit more balance.
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You brought up the topic of governance,
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and and different solutions sort of popping up.
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Can you tell us more about how you're
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thinking about governance of some of these new
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projects? Yeah. So we,
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not saying that we've done it right, but
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we have really tried to,
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identify who within the organization
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from our compliance officer to
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our IT director,
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to our CMO,
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making sure that we have the right group
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of individuals reviewing everything.
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It is constantly
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evolving
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on what's the consent form, what's the communication,
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is the technology safe from a network perspective.
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And so,
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really trying to
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make sure that we're protecting the organization, protecting
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our patients with that structure. And
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this is our first for everybody,
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first try at this, and so I'm sure
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it'll continue to change as others gain more
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learning too, and we do as well. Yeah.
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I can imagine it's bringing
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new conversations into your c suite as, leadership
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meetings
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as people are looking at this from their
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different vantage points. And Yeah. And, really, also,
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a lot of credit to our board because
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they have asked for more information,
11:02
more education
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around AI, really Okay. Not just the technology
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part, but what are the future workforce implications,
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and
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how are we
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going to adjust
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as potentially
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positions change,
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positions are no longer there? What are those
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positions that might be
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replaced by AI? Those are all questions that
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our board is asking. And so in early
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twenty twenty six, we will be doing a
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deep dive with the board into
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implications of AI. It feels like you mean,
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you've touched on it on revenue cycle being
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an area where it's traditionally been very labor
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driven with technology playing a support role. Mhmm.
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But it feels like that equation can be
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flipped with this techno with this advancement. Right?
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That it can be technology driven with labor,
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humans playing a playing a support role now.
12:02
Yeah. Absolutely. And especially when we look at,
12:05
the payer relations
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that we
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have and
12:09
the amount of AI that we see the
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payer starting to use, and how do we
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how do we compete?
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I I shouldn't say compete, but how do
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we protect ourselves
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within that space and making sure that we
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have all the coding and the documentation
12:27
that is needed so that it doesn't get
12:29
kicked out by the payer's AI.
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And then we spend all that administrative burden
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trying
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to resubmit and justify what we're doing. And
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so,
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it's it's definitely a huge huge opportunity and
12:43
and could be a game changer in that
12:45
space. What are some of the, years you
12:47
think about that and imagine that future? What
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are some of the hurdles that you might
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have to get through between
12:52
with your own workforce
12:54
and with your payer relationships as you sort
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of try and do this? I think from
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a workforce piece is
13:02
finding ways
13:04
to make sure that
13:06
folks know we want to keep them within
13:08
the organization
13:09
wherever we can
13:11
and
13:12
that we are not looking at just eliminating
13:15
those bodies, but let's
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retrain and use them where we can.
13:21
But change is always hard,
13:23
especially when you have we have a lot
13:25
of folks that have worked for the organization
13:28
fifteen, twenty years, and now you're gonna ask
13:30
them to learn something totally different.
13:34
And so especially
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for us,
13:37
oftentimes when you're in a large system, a
13:40
lot of that rev cycle team is concentrated
13:43
and consolidated
13:45
at the corporate office system level.
13:47
But all of these folks are
13:50
living in our community.
13:51
We see them every day, and so
13:55
making sure that we're
13:57
taking care of our staff
13:59
through this change.
14:00
And then I think with the payer piece
14:06
is, payer relations,
14:07
ebb and flow.
14:09
Right. Like,
14:11
we, we have one payer that we have
14:13
been you know, I don't wanna probably the
14:16
right word is battling for, three years now.
14:20
And so,
14:21
you know, we know their,
14:24
editor tools are kicking our claims out, everything
14:28
else. And so
14:29
I do think that
14:31
it is an opportunity with some of our
14:34
payers
14:35
to make adjustments to our contracts
14:38
and Yeah. Try and figure out how do
14:41
we,
14:42
leverage
14:43
some
14:45
improvement on our side
14:47
to show to the payers that, yeah, we
14:49
are trying we are trying to code correctly.
14:51
We we just want to get paid for
14:53
the care that we're providing
14:56
and,
14:57
continue to
14:58
we have to work with them all. So
15:00
figuring that out. You do have to, don't
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you? Because,
15:03
you're you're you're somewhat on the back foot,
15:06
right, as a smaller Yeah. Provider.
15:09
So you got to look for advantages where
15:12
you where you can.
15:13
Yeah. And it's you know, in our last,
15:18
payer issue that we had,
15:20
we were
15:22
negotiating,
15:23
trying to settle around
15:25
$4,000,000
15:26
in unpaid claims.
15:28
The payer views that as
15:31
this is
15:32
not
15:33
substantial A material. Impact. Yeah. But for us,
15:37
that's a huge impact Yeah. To our organization
15:41
because of our size. And so
15:43
we ran into a lot of discrepancy on
15:46
that piece of it. And so we just
15:49
we're we're that little organization that just keeps
15:53
nipping and,
15:55
fighting back wherever we can because every every
15:58
dollar makes a difference for us.
16:01
What are your to conclude,
16:03
Michelle, what are your hopes for from a
16:05
patient perspective? Next year, you talked about your
16:07
behavioral health initiative. Yeah.
16:10
What else? I you know, for us,
16:13
Person Tahoe has been serving,
16:16
that
16:17
rural Northern Nevada community
16:20
for seventy five years now. And so it
16:23
is making sure that we
16:25
continue
16:26
to
16:27
serve that community,
16:29
meet their needs as we have the last
16:31
seventy five years,
16:33
bring continue to build trust and confidence
16:37
within
16:38
hospitals and health care because there have been
16:42
a lot of challenges over the last several
16:44
years post COVID on that level of trust.
16:47
And so
16:48
just making sure that we are doing the
16:51
absolute very best that we can
16:54
for our community and that they know that
16:57
and trust us with their with their care.
17:00
Michelle, thank you so much. It's super. I
17:03
really appreciate talking to you. Thank you, Will.
17:05
Thank you. Thank you.