Latest / Becker’s Healthcare Podcast / Leading Revenue Cycle Transformation at UNC Health with Stephen Rinaldi

Transcript

Leading Revenue Cycle Transformation at UNC Health with Stephen Rinaldi · Becker’s Healthcare Podcast

• 0:01
  When it comes to negotiating fair prices for
• 0:04
  health care services, guessing
• 0:06
  is no way to go. That's why there's
• 0:08
  Claritif.
• 0:08
  With over forty years of experience partnering with
• 0:11
  health care providers and the latest data driven
• 0:13
  insights built on 500,000,000,000
• 0:16
  public records, Claritif is helping revolutionize
• 0:19
  the approach to health care services pricing, helping
• 0:21
  create more predictability for providers,
• 0:24
  more affordability for payers and employers, and more
• 0:27
  quality
• 0:28
  for patients.
• 0:29
  With Claritif, health care isn't left to chance.
• 0:32
  Claritif,
• 0:33
  more clarity,
• 0:34
  less guesswork.
• 0:37
  This is Andrew Cass with the Becker's Healthcare
• 0:39
  podcast. I'm thrilled to be joined today by
• 0:42
  Steven Rinaldi, senior vice president and chief revenue
• 0:44
  officer at UNC Health. Steven, it's a pleasure
• 0:47
  to have you on the podcast.
• 0:49
  Oh, thank you so much. I appreciate the
• 0:50
  opportunity.
• 0:51
  Of course.
• 0:52
  Before we be we begin, why don't you
• 0:54
  tell us a little bit about your background?
• 0:57
  Sure. So, you know, as you mentioned, I'm
• 0:59
  the chief revenue officer for UNC Health.
• 1:02
  You know, we're a $12,000,000,000
• 1:04
  health care system
• 1:06
  spanning,
• 1:07
  North Carolina, we like to say, from the
• 1:09
  mountains to the coast,
• 1:11
  headquartered in Chapel Hill.
• 1:13
  So in my role, I'm responsible for managed
• 1:16
  care reimbursement and end to end revenue cycle
• 1:18
  for professional hospital operations.
• 1:21
  Been with UNC since 2014,
• 1:24
  joined as the CFO of one of our
• 1:26
  entities, later moved into our corporate finance,
• 1:30
  division. I'm an accountant by trade and so
• 1:32
  tend to look at things from from those
• 1:34
  lens,
• 1:36
  lenses, if you will. And
• 1:38
  been at it for for a while. Started
• 1:41
  out the earlier part of my career in
• 1:42
  banking actually with Fleet Boston and and m
• 1:45
  and a and and, and corporate finance there.
• 1:47
  So
• 1:48
  come at,
• 1:49
  health care operations from,
• 1:52
  from the perspective of those experiences.
• 1:54
  Yeah. And you have a little bit of
• 1:56
  an a CFO background as you said. And
• 1:58
  so how has that, you know, kind of
• 2:00
  influenced you as a revenue cycle leader?
• 2:02
  Yeah. Definitely. I think I bring a CFO
• 2:05
  lens to it for sure. So more concerned
• 2:08
  with
• 2:09
  communicating,
• 2:11
  from a forecast perspective where we're going and
• 2:13
  setting strategy
• 2:15
  around
• 2:16
  the headwinds that we face and and pivoting
• 2:19
  our operation, if you will,
• 2:21
  to where we need to be. I think
• 2:23
  it's a little,
• 2:25
  easier or more commonplace
• 2:27
  for a lot of revenue cycle leaders similar
• 2:30
  to,
• 2:31
  my friends that are controllers to sort of,
• 2:34
  look at things from the rearview perspective.
• 2:37
  This is how we perform. These are our
• 2:39
  core KPIs, things of that nature. And I
• 2:41
  think that those things are important
• 2:42
  because they serve foundationally
• 2:44
  to measure performance. But the real
• 2:48
  lens that I bring is really that forward
• 2:50
  looking,
• 2:51
  strategic financial plan around, how we operate from
• 2:54
  a revenue perspective.
• 2:56
  And speaking of those headwinds, what would you
• 2:58
  say is the biggest headwind you're facing right
• 3:00
  now as a revenue cycle leader? Oh, gosh.
• 3:03
  There are no shortage of
• 3:05
  of headwinds,
• 3:07
  right now
• 3:08
  in health care. That's for sure.
• 3:10
  I I I think that in as much
• 3:12
  as these are forces against operating performance,
• 3:15
  I think it's more productive to face sort
• 3:18
  of these challenges as opportunities. So
• 3:20
  I tend to come at it from that
• 3:22
  perspective.
• 3:23
  Some of those challenges we face include
• 3:26
  Medicare and Medicaid,
• 3:27
  reimbursement and policy program changes.
• 3:30
  Those remain,
• 3:31
  significant and certainly not unique to UNC Health,
• 3:34
  but affecting everyone in health care.
• 3:37
  Labor challenges continue to be,
• 3:39
  something that we
• 3:41
  face organizationally.
• 3:43
  Certainly competition for both remote and hybrid positions.
• 3:46
  We used to compete
• 3:48
  within our market, and against competitors. But now
• 3:51
  the marketplace,
• 3:52
  as you well know, is is national and
• 3:54
  even
• 3:55
  international
• 3:56
  since COVID, which has really changed the dynamic.
• 4:00
  We have,
• 4:01
  increased payer administrative
• 4:03
  burdens.
• 4:04
  All of
• 4:05
  the information that we see all the time,
• 4:08
  in the news, whether that's
• 4:10
  increased authorizations,
• 4:12
  peer to peer expectations for our providers, which
• 4:15
  are particularly frustrating whenever we have to take
• 4:17
  a provider away from the bedside,
• 4:20
  post visit audit audits and things of that
• 4:22
  nature. And then
• 4:24
  the pace of technological
• 4:25
  adoptions,
• 4:26
  while that's both a headwind and a tailwind,
• 4:29
  it still remains something that provides
• 4:32
  a need for us to become
• 4:35
  more educated
• 4:36
  about and to support from an implementation perspective.
• 4:40
  Mhmm.
• 4:41
  On the, labor front,
• 4:43
  how are you working to develop, the next
• 4:46
  generation of revenue cycle leaders? That's something I
• 4:48
  hear that is a challenge for a lot
• 4:49
  of, revenue cycle leaders that I speak with.
• 4:53
  Yeah. For sure. Right. All leaders in general.
• 4:55
  But, yeah, I think you have to begin
• 4:56
  with your hiring strategy,
• 4:58
  and that begins at the senior level.
• 5:01
  For us, and and my perspective is we
• 5:03
  need to really identify successful leaders whom
• 5:06
  have both succeeded and failed
• 5:09
  because I think it's important for us to
• 5:10
  recognize that we we generally learn from our
• 5:13
  failures.
• 5:14
  We also need to be
• 5:16
  nimble. By that, I mean, being able to
• 5:18
  hire talent when it's available even when we
• 5:21
  don't have a role.
• 5:23
  If we see someone and think, gosh, they're
• 5:25
  a star, and I would really love to
• 5:27
  have them on the team, but you don't
• 5:28
  have a role, I think you need to
• 5:30
  think about making one,
• 5:32
  because it's important to
• 5:35
  secure that talent for the organization when it's
• 5:37
  available.
• 5:38
  And that can be, you know, somewhat infectious,
• 5:40
  I think, in terms of both
• 5:43
  driving,
• 5:44
  execution, but also inspiring
• 5:46
  the the talent, that you have within
• 5:48
  within the division.
• 5:50
  So around that, I like to coach our
• 5:53
  leaders around asking questions that focus on execution.
• 5:56
  That's a really important differentiator for me. A
• 5:59
  lot of times, someone will say,
• 6:02
  you know, a project will come up or
• 6:03
  an implementation or something, and they'll say, well,
• 6:06
  I think I can get to that, and
• 6:08
  and we should be able to get it
• 6:09
  done in three weeks. I like to have
• 6:11
  leaders that ask key questions around that, challenge
• 6:14
  the timeline, say, you know, what is it
• 6:17
  that you also have going on that's preventing
• 6:19
  you from being able to to get to
• 6:21
  this as your highest priority
• 6:23
  so that our leaders can then reprioritize and
• 6:25
  say, well, you know, let's let's move this
• 6:27
  ahead of project a or b because it's
• 6:29
  a higher priority or it's a higher yield
• 6:32
  or or greater importance to the organization.
• 6:34
  And then to push them a little bit
• 6:36
  and say, you know, could you possibly get
• 6:38
  this done,
• 6:39
  next week or today if you have this
• 6:41
  additional resource? So I think that that's a
• 6:44
  leadership
• 6:45
  development
• 6:46
  skill that that I like to
• 6:49
  help coach our team, and our leaders around.
• 6:52
  Along those lines, I think, you know, there's
• 6:54
  some red flags to me as well. Right?
• 6:56
  If you hire a new leader into the
• 6:58
  organization, especially in a senior role, and they
• 7:00
  don't have a following,
• 7:02
  you know, if they're coming in, then they're
• 7:03
  not telling you about teammates that they'd like
• 7:05
  to bring along from the team that they
• 7:07
  led previously.
• 7:09
  I think that's a red flag and you
• 7:10
  have to ask yourself the question, you know,
• 7:12
  what's what's wrong with their leadership?
• 7:14
  Or why is it that people that have
• 7:16
  worked with them in the past don't wanna
• 7:17
  follow them to the new role? So you
• 7:19
  need to be willing to make changes if
• 7:21
  you've made the wrong decision.
• 7:22
  And, you know, some of that sometimes that
• 7:24
  can be,
• 7:25
  reallocation within the enterprise or even assistance
• 7:29
  and outplay placement, which,
• 7:31
  is never
• 7:32
  a comfortable exercise, but but always remains an
• 7:35
  important one for leaders to keep front of
• 7:36
  mind. So as we look at that next
• 7:38
  generation of revenue cycle leaders, you have to,
• 7:41
  I think, start by establishing what the expectation
• 7:43
  is and then throughout your group.
• 7:46
  And and our group is large with, you
• 7:48
  know, several thousand
• 7:49
  teammates. I think you have to then identify
• 7:52
  the folks that are not on that path
• 7:53
  and and help direct them through the right
• 7:56
  resources, whether it's education, coaching,
• 7:59
  training, shadowing, whatever it is that you can
• 8:01
  do to help identify their skill sets and
• 8:04
  then pull them along to be part of
• 8:05
  future leaders,
• 8:06
  for the organization.
• 8:08
  Mhmm. And another, thing that I hear a
• 8:10
  lot about from revenue cycle leaders that's a
• 8:12
  challenge,
• 8:14
  is the
• 8:15
  and and not just revenue cycle leaders, but
• 8:16
  I think health care as a whole is,
• 8:18
  the one big beautiful bill act. And as
• 8:20
  a revenue cycle leader, how are you prepared
• 8:23
  for the effects of that bill that are
• 8:24
  coming down the road? Yeah. The one one
• 8:27
  big beautiful bill or, OB three is is,
• 8:30
  at least I have
• 8:31
  been,
• 8:33
  told that it's, the buzzword today, definitely introduced
• 8:36
  a number of potential headwinds,
• 8:38
  beginning with the reduction of supplemental programs such
• 8:40
  as HASP
• 8:42
  and upper payment limit.
• 8:44
  Organizations are really dependent upon those supplemental
• 8:47
  programs to make up the difference between the
• 8:49
  cost footprint and the reimbursement level of Medicare
• 8:53
  and Medicaid.
• 8:54
  From a general CFO perspective, we used to
• 8:56
  talk about trying to make a Medicare,
• 8:59
  excuse me, a 3% operating margin on a
• 9:01
  Medicare book of business. But post COVID with
• 9:03
  the inflation that we've seen in labor and
• 9:05
  supplies, that's a really difficult thing to achieve.
• 9:09
  When you add on top of that the
• 9:10
  headwinds
• 9:11
  with the impact of Medicaid enrollment and the
• 9:13
  likely, you know, reduction of covered beneficiaries, it
• 9:16
  becomes even more challenging. So,
• 9:20
  for us and I think for most organizations,
• 9:22
  in order to survive this type of disruption,
• 9:25
  you really need to focus on both top
• 9:27
  line revenue integrity while working to control the
• 9:29
  cost footprint across your enterprise,
• 9:32
  to the extent possible.
• 9:34
  Most organizations
• 9:36
  cannot reduce cost quickly enough to offset a
• 9:38
  loss of revenue. This creates what is commonly
• 9:41
  known as a financial structural weakness. So you
• 9:43
  really have to be excellent at converting clinical
• 9:45
  services into net revenue.
• 9:47
  From a revenue cycle perspective, that means strong
• 9:50
  front end processes and financial clearance,
• 9:52
  really connecting,
• 9:54
  the scheduling process
• 9:56
  to making sure that the scheduled service will
• 9:58
  be covered from a reimbursement perspective and then
• 10:01
  also that the patient won't have any surprises
• 10:03
  from a liability perspective.
• 10:06
  Despite all those efforts, if you don't,
• 10:09
  in addition, have a strong denial management program
• 10:11
  and a focused strategy of holding
• 10:13
  payers accountable for what you've agreed to in
• 10:15
  your contracts,
• 10:16
  I I think you'll still fail or will
• 10:18
  still have revenue leakage.
• 10:21
  There is
• 10:22
  no shortage of new rules and policies and
• 10:24
  challenges that are that are popping up
• 10:27
  that, you know, really are not even necessarily
• 10:29
  part of o b three, but become exploited
• 10:32
  as much larger
• 10:34
  issues because they are aware you can lean
• 10:37
  your efforts to reduce any impact of OB3.
• 10:40
  And, and it takes us there in the
• 10:42
  conversation.
• 10:44
  Even in revenue cycle, though, there's opportunities on
• 10:46
  the expense side.
• 10:47
  We used to look to cost to collect
• 10:49
  as being the key metric,
• 10:51
  but cost to collect is commonly calculated by
• 10:53
  taking the expense of your revenue operation and
• 10:56
  dividing it by net revenue.
• 10:58
  And most of the CFOs and revenue cycle
• 11:00
  leaders out there will tell you that while
• 11:02
  that might be the industry standard, it's really
• 11:04
  transactional volume that that defines the demand for
• 11:08
  revenue cycle. You could have net revenue stay
• 11:10
  completely flat, but one policy change or one
• 11:13
  payer change increase the number of authorizations. And
• 11:16
  all of a sudden, you need more people
• 11:17
  or more technology, but your net revenue hasn't
• 11:19
  increased.
• 11:20
  So on the expense side, look at productivity,
• 11:23
  evaluating service lines that need revision, whether they're
• 11:26
  contracting or you're trying to exit that business,
• 11:29
  and then really try to leverage technology,
• 11:32
  where possible and appropriate in into the organization
• 11:35
  is is really where we're focused.
• 11:38
  And as we're recording this, we are getting
• 11:40
  pretty close to the 2025
• 11:42
  here. So I wanted to ask what your
• 11:45
  biggest accomplishment or when that you've had this
• 11:48
  year.
• 11:49
  Yeah. Thanks, so much for asking me that.
• 11:52
  It's nice to be able to to celebrate
• 11:54
  some of these things. I would say by
• 11:56
  far the strength of team and our transition,
• 11:59
  for revenue cycle operations from a PBHB or
• 12:03
  professional hospital background using sort of the the
• 12:05
  EPIC platform that we're on as as the
• 12:07
  buzzword there,
• 12:09
  to a front, middle, back,
• 12:11
  model has been our greatest win. And by
• 12:14
  that, I mean, we've been fortunate in recruiting
• 12:15
  excellent leaders with a depth of experience,
• 12:19
  humility, and a sense of teamwork to drive
• 12:21
  success.
• 12:22
  These folks are really content experts with a
• 12:25
  track record of leading and innovating.
• 12:27
  Super critical with the headwinds we're facing.
• 12:31
  It's also
• 12:32
  an exciting time to be part of a
• 12:34
  university health care system where we have academics
• 12:37
  and research at our core. That really helps
• 12:39
  foster a model of continuous learning,
• 12:42
  which is important culturally and to drive our
• 12:45
  growth.
• 12:46
  Across our revenue cycle, the leaders that we
• 12:49
  have have helped put together excellent teams at
• 12:52
  all levels within our organization that are really
• 12:55
  focused on the patient financial experience and teamwork.
• 12:57
  So
• 12:58
  culturally and from a,
• 13:01
  motivational
• 13:01
  alignment perspective, I feel we're really in a
• 13:04
  in a great place. And, the people are
• 13:06
  the most important part of that operation, and
• 13:08
  and that's why I really feel like it's
• 13:10
  the biggest win we've had this year.
• 13:12
  Great. And, what are you what is your
• 13:14
  top priority,
• 13:15
  heading into 2026?
• 13:18
  So, you know, as we look at 2026,
• 13:21
  really remains supporting and continues for our clinical
• 13:23
  operation
• 13:24
  and executing strategies.
• 13:27
  You know, our mission at UNC is to
• 13:29
  improve the health and well-being of North Carolinians.
• 13:32
  In order to do that,
• 13:34
  we really need to have operating performance and
• 13:36
  margin.
• 13:37
  Hate to be cliche, but the no margin,
• 13:39
  no mission remains really important into your ability
• 13:42
  to to reinvest.
• 13:44
  So our team is really at the elbow,
• 13:46
  with our care delivery model, both supporting and
• 13:49
  collaborating.
• 13:50
  I think that means,
• 13:52
  as a top priority, we have to be
• 13:53
  really deliberate in understanding those service lines and
• 13:56
  providing the right resources to support them. Sometimes
• 13:59
  that means, at the elbow resources, which we,
• 14:03
  commonly
• 14:04
  receive requests for from our, surgical teams,
• 14:07
  means being at the bedside and utilization management
• 14:10
  and clinical documentation
• 14:12
  improvement and and being part of of planning
• 14:14
  where we're expanding and and and changing,
• 14:17
  what we're doing from an operational perspective.
• 14:20
  Yeah. In addition to that, going back to
• 14:22
  one of your previous questions, the continued development
• 14:24
  of the strength of the team remain a
• 14:26
  top priority
• 14:27
  as we're implementing, you know, different AI technologies,
• 14:31
  including those with, like, you know, augmented technology
• 14:34
  with human in the loop,
• 14:35
  where they make sense. I think that that
• 14:37
  creates anxiety for the teammates. Am I going
• 14:39
  to be replaced by technology?
• 14:41
  So a lot of that is around
• 14:43
  setting a priority of,
• 14:45
  continuing to elevate our team to operate at
• 14:47
  the top of their training, at the top
• 14:49
  of their license, if you will,
• 14:51
  and leveraging technology to make their life easier
• 14:54
  where we can pick up efficiency. So
• 14:57
  the buzzword I like to use is sort
• 14:59
  of delivered revenue integrity,
• 15:01
  sort of to to monitor and manage that
• 15:04
  conversion of clinical care into revenue, you know,
• 15:06
  focusing
• 15:07
  to the extent we can on being, on
• 15:09
  being precise.
• 15:11
  That's
• 15:12
  easier said than done since, you know, our
• 15:15
  our payers are working to delay, dilute, or
• 15:18
  or otherwise reduce our ability to receive payment.
• 15:21
  But we all know that long term, that's
• 15:23
  really unsustainable.
• 15:24
  And so
• 15:25
  unless we
• 15:26
  pivot and, make sure that we are, you
• 15:29
  know, sort of firing on all cylinders to
• 15:31
  the extent that we have control over that
• 15:34
  aspect of our business, we need to we
• 15:36
  need to take advantage of it to the
• 15:37
  best of our ability. So I think as
• 15:39
  we look into not just 2026,
• 15:41
  but really beyond, that will need to be
• 15:44
  a continued important focus of of us from
• 15:46
  a revenue perspective.
• 15:48
  And the last question I wanted to ask
• 15:50
  you, and I think we touched a little
• 15:51
  bit on this earlier, but what is the
• 15:53
  key to being an effective revenue cycle leader?
• 15:57
  It's a great,
• 15:58
  another great question.
• 16:00
  You know, I think being
• 16:03
  effective
• 16:04
  as a revenue cycle leader is
• 16:07
  similar and and if not identical to the
• 16:10
  leadership traits that you need in general in
• 16:12
  any role.
• 16:14
  So the the way I look at this
• 16:15
  is self awareness, integrity,
• 16:17
  humility,
• 16:19
  really foundational characteristics of inspiring leaders. And I
• 16:23
  think it's important to,
• 16:25
  to create that internal discipline for execution through
• 16:28
  inspiration.
• 16:29
  In order to do that, we need to
• 16:31
  have a strong self awareness and own our
• 16:34
  successes and failures.
• 16:36
  One of my favorite books is Extreme Ownership
• 16:38
  by Jocko Wilnick.
• 16:40
  He talks a lot about leaders needing to
• 16:42
  take responsibility for everything in the world. And,
• 16:44
  you know, one of the quotes that he
• 16:46
  has in the book, both him and and
• 16:48
  Leif Babin, his coauthor is there are no
• 16:50
  bad teams. There's only bad leaders.
• 16:53
  And,
• 16:54
  I think that that's a really important lesson.
• 16:57
  They also talk about this thing called cover
• 16:59
  and move, which, of course, is a tactical
• 17:01
  skill used in hostile environments to to to
• 17:04
  move safely under fire. But in the business
• 17:06
  sense, it really means that teams must support
• 17:08
  each other independently
• 17:10
  through, you know, interconnected efforts versus isolation. So
• 17:14
  get rid of silos,
• 17:16
  encourage matrix cost divisional partnerships and collaboration and
• 17:19
  things of that nature.
• 17:21
  I think that that's the critical
• 17:23
  piece that can make you effective as a
• 17:25
  leader, whether in revenue cycle or in other
• 17:27
  areas.
• 17:28
  But I think because revenue cycle touches all
• 17:31
  aspects of the business,
• 17:32
  it's really important for us to
• 17:35
  to exercise those sorts of leadership qualities.
• 17:39
  You're not working with one department. You have
• 17:41
  to work across all of the departments.
• 17:43
  And in order to do that, you have
• 17:45
  to be,
• 17:46
  humble and and eager to learn and and
• 17:49
  receptive and a good communicator.
• 17:51
  Again, just really grateful for the team that
• 17:54
  we have that they are so adept at
• 17:55
  doing this. But,
• 17:57
  overall, I think if you focus on those
• 17:59
  things as a leader, you'll you'll be successful.
• 18:02
  Lots of books and lots of material out
• 18:04
  there on that, and, I'm sure there's different
• 18:07
  perspectives and views on what makes a a
• 18:09
  a great leader.
• 18:11
  But to me,
• 18:12
  a lot of times, we we can
• 18:15
  see them and know who they are, and,
• 18:18
  and and they often have the characteristics and
• 18:21
  qualities,
• 18:22
  that I've that I've mentioned.
• 18:25
  Whether or not they had them at the
• 18:27
  beginning, I think that, you know, some leaders
• 18:29
  are are born that way, but I think
• 18:31
  many people learn to lead, and and you
• 18:33
  do that by making mistakes and and learning
• 18:35
  from them. So
• 18:37
  Right. Okay. Thank you so much for joining
• 18:39
  us today, Steven. It's been a pleasure speaking
• 18:41
  with you, and I, look forward to talking
• 18:43
  with you again soon. Yeah. Thank you so
• 18:45
  much. I always appreciate the opportunity and, I'm
• 18:48
  grateful for the, invitation.
• 18:52
  For health care services, predicting and negotiating prices
• 18:55
  can feel like a guessing game. But with
• 18:57
  Claritif,
• 18:58
  complexity
• 18:59
  becomes clarity.
• 19:01
  With Claritif's technology data and insights, payers are
• 19:03
  equipped with the information needed to help reduce
• 19:06
  claims payment errors.
• 19:07
  Providers can get more insight into payments and
• 19:10
  fair pricing, and employers have the analytics to
• 19:13
  make more informed decisions on benefits design. With
• 19:16
  Claridif, health care decisions can be made with
• 19:19
  confidence.
• 19:20
  Claridif,
• 19:21
  more clarity,
• 19:22
  less guesswork.