Latest / Becker’s Healthcare Podcast / Jennifer Worthy, Executive Vice President of Revenue Optimization at Healthcare Outcomes Performance Company (HOPCo)

Transcript

Jennifer Worthy, Executive Vice President of Revenue Optimization at Healthcare Outcomes Performance Company (HOPCo) · Becker’s Healthcare Podcast

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  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
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  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where do they go
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  - to pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - This is Andrew Pasc with the Becker CFO
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  - and revenue cycle podcast. I'm thrilled to be
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  - joined today by Jennifer Worthy, executive vice president
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  - of revenue cycle optimization at Healthcare Outcomes Performance
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  - Company in Phoenix, Arizona. Jennifer, it's a pleasure
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  - to have you on the podcast today.
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  - Right. Thanks for having me. Yeah. And before
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  - we begin, can you take a moment to
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  - introduce yourself and share a little bit about
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  - your role and your background in healthcare?
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  - Yeah. Sure.
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  - So, obviously, Jennifer Worthy, EVP at HOPCO. I've
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  - been in revenue cycle for about,
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  - three decades now.
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  - And in my current role, what I really
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  - get excited for every day is is that
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  - HOPCO is a leader in value based care
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  - models across the country.
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  - Of course, we have the traditional practice management
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  - and clinic model, couple of ASCs as well
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  - as hospital, but,
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  - I really feel that we are on the
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  - cutting edge of bringing all of the value
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  - based care delivery models out into the community,
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  - and we do a great job at it
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  - every day.
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  - And so what are three of the top
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  - trends you're following in health care today?
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  - So the first one that I am watching
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  - right now is this widening
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  - technology gap between payers and providers.
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  - It's actually stunning yet it really, has not
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  - just come out of nowhere. Right?
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  - We've all seen payers spend years now investing
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  - in automation and predictive analytics.
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  - We know that they are now increasingly
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  - using AI driven claim management tools, and yet
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  - as provider organizations,
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  - we are all still solving denials with more
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  - people and more work queues, and our our
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  - own billing platforms themselves are having a hard
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  - time simply keeping up with the technology on
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  - the payer side. So I think it's becoming
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  - more clear just how unsustainable
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  - of a model this is. So I'm really
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  - paying attention to what is the size and
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  - the skill set of the RCM team look
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  - like as a result of this technology?
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  - How is it being operationalized
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  - to at least close that gap or start
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  - to keep somewhat of that same pace, to
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  - what payers are achieving?
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  - Because I will say, like, right now, it
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  - feels like it's a chasm. And for too
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  - many of us, we just have to catch
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  - up with the lead that the payers have
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  - had for a really long time.
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  - The the second trend that I'm looking at
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  - is or paying attention to is workforce transformation.
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  - I've been doing revenue cycle work, as I
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  - said, for about three decades.
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  - I remember when these jobs were really competitive
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  - and really prestigious, and they had a great
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  - career path. I mean, I'm proof of that.
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  - Now what we've been talking about for years
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  - is RCM staffing shortages, and I really do
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  - think that we're having
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  - the wrong conversation when we still say, how
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  - many people do we need?
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  - We need to redesign the work. Every position
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  - that is retiring right now or moving on
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  - out of revenue cycle really needs to be
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  - looked at from an angle of,
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  - can I do what this person was doing
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  - differently in a more value added way?
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  - There simply are not enough revenue cycle professionals
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  - entering the industry anymore to keep up with
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  - the increasing payer complexity
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  - that we are seeing.
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  - And I talk about this a lot in
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  - my writing on LinkedIn, and that is that
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  - the labor arbitrage
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  - model is increasingly ineffective.
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  - If you measure ROI on that model, you
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  - know the struggle.
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  - The future definitely isn't fewer people, but it
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  - is people doing higher value work while technology
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  - handles the repetitive
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  - tasks. So,
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  - the last trend I'm really paying attention to
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  - is just a fundamental
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  - mindset shift about revenue cycle and where they
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  - fit into organizations
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  - and strategic priorities.
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  - Historically, revenue cycle is built around this chase
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  - to collect model. We wait for something to
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  - go wrong. We know it's going to go
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  - wrong, and then we assign teams and people
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  - to fix it.
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  - But, the organizations
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  - that are moving towards prevention as a mindset
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  - are really on the front end of what
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  - the revenue cycle needs to look like.
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  - It's not really just like so much about
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  - how much you can,
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  - recover from chasing it as much as it
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  - is. Like, how much can you just prevent
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  - at this point?
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  - Yeah. And you said that you have three
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  - decades of experience,
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  - in revenue cycle. So I'm really curious what
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  - you think the biggest change is,
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  - you know, over that period of time.
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  - You know,
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  - it was in revenue cycle before it was
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  - even called revenue cycle.
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  - We didn't look at billing
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  - activities and patient financial
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  - experience
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  - as a
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  - from before a patient even enters
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  - your organization
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  - to
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  - what a $0 balance on their account looks
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  - like.
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  - So when, what I think, first of all,
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  - has driven the most change has been I've
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  - lived through a lot, first of all,
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  - EMR adoption,
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  - the Affordable Care Act, the explosive growth of
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  - Medicare Advantage Plans that, you know, started in
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  - the early two thousands. So that really created
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  - this patient experience
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  - model where patients really started getting smarter about
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  - the care they chose,
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  - and how they ended up paying for it.
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  - And we then built models around that. And
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  - I think that that's been the biggest shift
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  - I have seen is that it wasn't any
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  - longer, like, I'm a biller. I have this
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  - super bill, I put these codes on, I
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  - enter it, I'm sort of like one widget
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  - in, one widget out.
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  - It's now we've built our entire
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  - revenue cycle experience around the patient and even
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  - to a degree payer behaviors.
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  - Yeah. And, so now we'll go back a
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  - bit to the AI arms race so to
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  - speak.
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  - You know, AI is getting more sophisticated and
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  - deeply into the revenue cycle, you know, both
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  - the payer and provider side. How do you
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  - see that continuing to evolve over the next
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  - few years? And can,
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  - you know, providers, you know, lessen that gap?
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  - Yeah. I mean, I think that we are
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  - in the middle of the AI arms race.
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  - Most organizations
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  - just probably haven't realized it yet.
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  - Again, going back to payers, they have been
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  - increasingly
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  - sophisticated in their technology,
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  - and we're seeing that technology
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  - move upstream
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  - into managing utilization and identifying claim edits,
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  - automating reviews pre and post payment now, and
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  - they are really heavily,
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  - optimizing
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  - payment integrity programs through AI. So where providers
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  - can't respond is to just keep hiring more
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  - collectors. The economics just simply don't work.
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  - So I think that what we are gonna
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  - see over the next several years is a
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  - shift
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  - from AI as an efficiency tool in RCM
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  - to an actual strategic
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  - necessity.
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  - And I'm not alluding to the fact that,
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  - like, you need a lot of AI tools,
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  - but you do need to have the right
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  - ones that embed
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  - AI into RCM operational
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  - decision making.
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  - I am personally moving away from what dashboards
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  - are telling me in the retrospective,
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  - to using intelligence to tell me, like, what
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  - my attention needs right now. And I'll just
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  - maybe give a a good example is we've
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  - talked about clean claims rate in revenue cycle
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  - as like a performance benchmark. Right? But what
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  - clean claims is typically said without AI is
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  - where all the fields filled in correctly.
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  - I define
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  - AI now as
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  - how can that clean claim predict whether I
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  - am going to get paid or not with
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  - an emphasis on before we even submit the
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  - claim. Clean claim to me now means complete
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  - acceptance for adjudication into the system. And I
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  - think that that is where AI really has
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  - a powerful force in rev cycles. So, you
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  - know, lastly, I'll just say on this topic,
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  - payers are living and breathing in documentation and
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  - revenue cycle inputs.
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  - Health care seems to still be living in
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  - what's happening after both of those things. And
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  - we really need to shift our mindset to
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  - embrace that revenue cycle is a strategic
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  - function of our financial health and latch on
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  - to making sure that we have participated in
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  - AI,
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  - operationalizing
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  - it.
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  - Yeah. And as, you know, AI becomes more
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  - deeply embedded into workflows,
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  - what do you think the skills are that
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  - are gonna define the next generation of revenue
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  - cycle leaders?
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  - I think the next generation of rep cycle
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  - leaders are gonna look very different than the
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  - last generation.
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  - Historically,
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  - leaders,
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  - have built careers around being an expert in
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  - a function like coding or AR or collections.
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  - And some of us have made very great
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  - careers that have spanned decades around that, but
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  - those skills matter. However, they they also, I
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  - wanna say, matter in the adoption of the
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  - AI that we are looking at. And you
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  - have to be a leader that is a
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  - systems thinking leader. And if you can't extract
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  - yourself from being that sort of,
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  - siloed
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  - expert,
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  - I think that you are really going to
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  - struggle because the RCM leader, really, of the
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  - next generation is going to need to be
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  - that
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  - excellent,
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  - you know, part strategy, part operational thinker. They're
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  - going to need to influence technology outcomes rather
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  - than sitting back and letting it happen to
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  - them. So I see them really as being
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  - important
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  - internal translators
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  - of what all of the technology is, but
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  - also needing to bridge in internally
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  - departments that don't necessarily speak the same language.
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  - You know, an RCM leader has got to
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  - be able to translate outcomes to a finance
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  - team as digestible
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  - as it can be to the operations team
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  - as well.
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  - And I'll just say too that I think
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  - the teams themselves are going to evolve.
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  - I do not believe that AI is gonna
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  - replace any RCM professional, but I do think
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  - it is going to elevate all of us.
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  - And instead of spending time and manually touching
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  - accounts, we're really gonna see a team that
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  - becomes
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  - heavily skilled because they are working on things
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  - like exception,
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  - handling and root cause analysis and payer strategy.
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  - And that is really value added work.
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  - Yeah. Are there any other areas where you
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  - think that human judgment and leadership will become
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  - even more valuable?
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  - So I think that human judgment is going
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  - to it still has it still plays its
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  - part. And it plays its part when you
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  - start seeing it's, you know, we've even seen
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  - the headlines around it. Right? Like the battle
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  - of the claim bots. You're still going to
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  - need people, and and that's why I really
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  - emphasize exception handling is where the human judgment
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  - piece is going to need to come in.
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  - You're going to see accounts that reach either
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  - a certain threshold or a certain age that
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  - you're going to need to put that person
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  - in the middle of it. I think human
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  - judgment absolutely has a part still in payer
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  - contracting and the payer relationship side. It obviously
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  - is still going to very heavily influence
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  - physician education and clinical documentation improvement programs. So
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  - again, I think that if we can move
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  - our revenue cycle professionals into those roles, that
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  - is where human judgment is needed most, and
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  - it's not on pushing buttons and fixing dirty
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  - Well, thank you so much for joining us
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  - today, Jennifer. It's been a pleasure speaking with
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  - you, and I look forward to connecting with
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  - you again soon. Alright. Great. Thank you. Have
• 12:45
  - a great day.