Latest / Becker’s Healthcare Podcast / Peter D. Banko, President & CEO of Baystate Health

Transcript

Peter D. Banko, President & CEO of Baystate Health · Becker’s Healthcare Podcast

• 0:02
  R one is the leader in health care
• 0:03
  revenue management, helping providers achieve new levels of
• 0:06
  performance through smart orchestration.
• 0:09
  With more than twenty years of experience, r
• 0:11
  one partners with 1,000 providers,
• 0:13
  including 95 of the top 100 US health
• 0:16
  systems and handles over 270,000,000
• 0:19
  payer transactions annually. If you want to learn
• 0:21
  more about how you can transform your revenue
• 0:23
  cycle operations, visit us at wwwr1rcm.com.
• 0:31
  Hello, and welcome to the Becker's Healthcare podcast.
• 0:34
  My name is Will Riley from r one.
• 0:37
  I'm joined on the podcast today by Peter
• 0:39
  Banco. Peter is president and CEO of Baystate
• 0:43
  Health.
• 0:43
  Hello, Peter. Welcome to the podcast. Hi, Will.
• 0:46
  Thanks for having me. You bet. Peter, do
• 0:48
  you wanna start by telling us a bit
• 0:50
  about you and tell us about Baystate Health?
• 0:52
  Yeah. I've been with Baystate Health since June
• 0:54
  2024 as president and CEO.
• 0:57
  Baystate's,
• 0:58
  an academic
• 0:59
  affiliate system affiliate with UMass Chan School of
• 1:02
  Medicine.
• 1:03
  We're also the safety net health system for
• 1:05
  Western Massachusetts.
• 1:07
  If we don't do it, no one else
• 1:08
  does. And, we're an in a true integrated
• 1:11
  system. So
• 1:12
  five hospitals,
• 1:14
  1,300,
• 1:15
  physician provider group integrated, employed, and then our
• 1:19
  own health plan, Health New England.
• 1:21
  Fantastic. Tell me, Peter, about some of the
• 1:23
  big priorities facing you as you go into
• 1:26
  next year. What's on your list? Yeah. Well,
• 1:28
  our year started October 1, our fiscal year.
• 1:30
  So There we are then. Okay. We got
• 1:31
  four priorities. First is access. So physician access,
• 1:34
  hospital throughput access.
• 1:37
  The second one is,
• 1:39
  accelerating
• 1:39
  our high reliability
• 1:41
  organization,
• 1:42
  journey, HRO journey around quality safety experience. The
• 1:45
  third is,
• 1:47
  better integrating our health plan and our providers
• 1:49
  together, huge opportunity there. And our last one
• 1:53
  is,
• 1:54
  cost transformation. So continuing our cost transformation,
• 1:58
  journey. Got it. Okay. I will probably explore
• 2:01
  some of those a little bit as we
• 2:02
  as we go here.
• 2:04
  And maybe maybe the last one,
• 2:06
  first, because I want to ask you about
• 2:09
  innovation, and I wanna ask you about technology.
• 2:11
  Okay.
• 2:12
  Healthcare providers have traditionally moved fairly
• 2:15
  slowly and cautiously when it comes to technology
• 2:17
  investments. Right? It's been fairly conservative.
• 2:20
  But I wonder if you feel that with
• 2:21
  the advent of a lot of AI tools
• 2:23
  and technologies, that's changing. Is health care becoming
• 2:26
  a bit more assertive about using technology? Yeah.
• 2:29
  I would say
• 2:30
  we've been slow. I think the one big
• 2:32
  beautiful bill is gonna bring it to a
• 2:34
  stall,
• 2:35
  though, this next year. The boards and leadership
• 2:37
  are gonna be distracted.
• 2:39
  But we're starting to use AI more on
• 2:43
  behind the behind the scenes back office services
• 2:47
  where we think I mean, our clinicians are
• 2:49
  adopting it in a variety of areas, but
• 2:51
  we think there's some big cost transformation
• 2:53
  opportunities with AI
• 2:55
  in revenue cycle,
• 2:57
  IT, human resources, marketing.
• 3:00
  Yeah. Okay.
• 3:01
  And how are you how are you going
• 3:03
  about it? I mean, are you,
• 3:05
  how are you thinking about partnerships in that
• 3:07
  space? And are you working with the traditional
• 3:10
  players that you've always worked with or that
• 3:11
  always provide the infrastructure for you? Are you
• 3:14
  working with new disruptors and insurgents? Disruptors. Yeah.
• 3:18
  Is that is that right? Okay. I don't
• 3:19
  think the traditional
• 3:21
  paths are as innovative. So we're out there
• 3:24
  finding
• 3:26
  partners, like, on revenue cycle, for instance, on
• 3:28
  front end, back end, making a better consumer
• 3:31
  experience.
• 3:32
  Mhmm. We've we found that those tools are
• 3:34
  better on the outside as bolt ons to
• 3:36
  your established systems rather than going with established
• 3:39
  tools. Yeah. Okay. Okay.
• 3:42
  And how do you then partner with them?
• 3:44
  I mean, obviously, you bring some significant advantages
• 3:46
  in terms of scale and data and so
• 3:48
  on. How do you form those partnerships
• 3:52
  and make them productive? Yeah. Well, we we
• 3:54
  look for organizations that have a common mission,
• 3:55
  vision, values,
• 3:56
  and, quite honestly, people that we like working
• 3:59
  with. Yeah. That boils down to it. There's
• 4:01
  a lot of you know, we're at Becker's.
• 4:03
  There's a lot of people selling stuff here,
• 4:04
  but it's really, can you work with them,
• 4:06
  and can you work
• 4:07
  with them in the long term? So those
• 4:09
  are the things we're really looking for. And
• 4:11
  then
• 4:12
  is what you're they're offering real? Mhmm. Because
• 4:15
  there's a lot of vaporware out there in
• 4:16
  the AI space. So can it deliver results?
• 4:19
  We're not gonna be an alpha or beta,
• 4:21
  but we're gonna make sure it's been tested
• 4:23
  before.
• 4:24
  You mentioned you have an imperative around cost
• 4:27
  management, rightsizing cost. I can't remember exactly how
• 4:30
  you phrased it, but that and then you've
• 4:32
  talked a bit about,
• 4:33
  finding fertile ground in financial processes and revenue
• 4:36
  cycle. Can you tell us a bit more
• 4:39
  about that? Because revenue cycle's been an area
• 4:41
  that has always been very labor intensive. Yeah.
• 4:44
  Right? Labor first, technology second,
• 4:46
  tools supporting people, but very much people centric.
• 4:50
  It feels like it does feel like a
• 4:52
  prime candidate for widespread automation. Yeah. We've got
• 4:55
  a lot of disparate systems still in at
• 4:57
  base state, which a lot of systems do.
• 4:59
  So we we're
• 5:00
  we're buying
• 5:02
  and partnering with organizations, put systems on top
• 5:05
  of that to make it easier for our
• 5:07
  labor to do their work Uh-huh. Monitor their
• 5:09
  performance.
• 5:10
  And then on the digital side, we're adding,
• 5:14
  front facing tools for consumers on the front
• 5:16
  end
• 5:17
  and back end.
• 5:19
  That's in the process
• 5:21
  right right now. And then, starting
• 5:24
  to this next year, use AI agents. So
• 5:26
  so many of the calls around your bill
• 5:29
  can be handled by AI now.
• 5:32
  Having that
• 5:33
  at our fingertips and for for our patients
• 5:35
  will be beneficial.
• 5:37
  And perhaps with with payers as well? I
• 5:40
  mean, you you have probably have to make
• 5:41
  quite a few calls to them too then.
• 5:42
  Oh, we have our own health plan. So
• 5:44
  we're we're doing a lot of that in
• 5:46
  our own ecosystem. Right? So making,
• 5:48
  creating less friction between our providers and our
• 5:51
  health plan Yeah. Around prior auths and Yeah.
• 5:55
  Some gold carding and all those things. So
• 5:57
  we're we're showing preference to our own health
• 5:59
  plan, because we think that that's a we're
• 6:01
  the biggest opportunities.
• 6:03
  Yeah. Okay. Okay. Presumably in things like clean
• 6:06
  claims submission and things like that as well.
• 6:08
  I had a message. If a doctor,
• 6:10
  99%
• 6:11
  of the time is following
• 6:14
  process and protocol, there's no reason to to
• 6:16
  do a prior auth. Right? So Right. Making
• 6:20
  the our doctors complain most about our health
• 6:22
  plan and the friction that it causes and
• 6:24
  the amount of time that they're spending and
• 6:26
  their staff are spending. So just trying to
• 6:28
  reduce the friction between people providing the care
• 6:31
  and payment of claims. Yeah. And what about
• 6:34
  on the clinical side? How are you using
• 6:36
  some new technologies
• 6:38
  to help physicians and make their lives better?
• 6:40
  Yeah. I would say we're we're early in
• 6:42
  that process. We're going through an EMR
• 6:45
  review right now with the system we're on
• 6:47
  versus where we need to be in the
• 6:48
  future. So our platform's a little bit weak
• 6:51
  there, but we are using
• 6:52
  some tools in cardiology,
• 6:54
  oncology.
• 6:56
  I was at I did my physical last
• 6:57
  week, ambient listening Yeah. Tools,
• 7:00
  trying to find the right one for our
• 7:02
  clinicians, helping them or letting them guide that
• 7:04
  process?
• 7:06
  This is an area where a lot of
• 7:07
  people are using new technologies in their daily
• 7:10
  lives,
• 7:11
  not just consumers, but, like, physicians, all of
• 7:14
  us. Right?
• 7:15
  And they're finding
• 7:16
  remarkable results from it and really good utilization
• 7:19
  from it. Are you seeing a lot of
• 7:20
  demand and pull from within your organizations to
• 7:23
  use these I'd say it's just beginning. Would
• 7:25
  you? You know, we had a we had
• 7:26
  a board retreat in May, and
• 7:29
  our chief chief of cardiology,
• 7:31
  he's a cardiac surgeon,
• 7:34
  and our head of cancer are really using
• 7:36
  it a lot. You know, they said that
• 7:38
  the things that they're using used to take
• 7:40
  a month are now taking a couple hours
• 7:42
  for them to do, but it was it
• 7:44
  was surprising. It AI is still in its
• 7:47
  infancy and adoption on the even on the
• 7:49
  clinical space. Yeah. Okay. Okay.
• 7:52
  Are you setting up new governance frameworks or
• 7:54
  management frameworks to to think about how to
• 7:57
  implement it and use it? Oh, that was
• 7:59
  a big discussion at our board,
• 8:02
  advance in May was we're just now starting
• 8:05
  to set up governance structures,
• 8:08
  policies, procedures.
• 8:11
  You know, our board's
• 8:13
  talking about adding AI expertise to our governance.
• 8:16
  So really, I think Yeah. We're we're probably
• 8:18
  more in the infancy around educating board, educating
• 8:21
  leadership, educating clinicians. Yeah. Okay. Okay. It's interesting.
• 8:24
  Do you think you might need new roles?
• 8:26
  Because
• 8:27
  or Absolutely. Yeah. Yeah. Absolutely. I think for
• 8:30
  at a governance level, having that expertise, and
• 8:32
  then on the leadership team
• 8:34
  to, having that expertise. Right. Right. Right. Right.
• 8:37
  And, hopefully, in the clinical space, finding finding
• 8:39
  a physician or another clinician that could help
• 8:42
  guide the clinical piece too. Yeah. Yeah. Okay.
• 8:45
  Okay.
• 8:47
  How do you think that that will play
• 8:49
  out for you in the long run? Because,
• 8:51
  like, we again, going back to say revenue
• 8:53
  cycle, it's been very labor centric.
• 8:55
  You're you've talked about some clinical use cases
• 8:58
  that are emerging. It will change the nature
• 9:00
  of the labor force that's employed by a
• 9:03
  big health care provider like you. Yeah. How
• 9:05
  are you thinking about that? Oh, well, you
• 9:06
  know, with kids in that age, 20 age
• 9:09
  range, graduating graduate school and other things,
• 9:12
  I think jobs are disappearing. Right? So those
• 9:14
  entry level
• 9:15
  management jobs are disappearing. So then the question
• 9:19
  is, how do the people get the experience
• 9:21
  to take the second and third level?
• 9:24
  I think retooling
• 9:25
  our workforce
• 9:27
  for other areas where we need them is
• 9:29
  important. You know, we've got workforce challenges like
• 9:31
  everybody else. So Uh-huh. AI will replace
• 9:34
  some contact center or frontline stuff, but re
• 9:37
  retooling those folks to be able to take
• 9:39
  other needed positions that we have in the
• 9:41
  in the workforce. Yeah. Yeah. Yeah. Yeah. But
• 9:44
  it's gonna be a significant transformation.
• 9:47
  Huge. Yeah. Especially well, I mean, for health
• 9:49
  care, it's gotta be on the back office
• 9:51
  side. Right? We've gotta we've gotta get overhead
• 9:54
  cost down below 8% given our headwinds in
• 9:57
  the industry. So we've gotta embrace AI and
• 10:01
  take advantage.
• 10:02
  Not like we've done that before with scale
• 10:04
  and other things, but take advantage of the
• 10:05
  cost efficiencies. Yeah. Right. Right. Right. You mentioned
• 10:08
  headwinds. Can you talk a little bit about
• 10:10
  some of those that are facing you?
• 10:12
  Yeah. I mean, in our market, we're
• 10:14
  we don't have a growing population in Western
• 10:16
  Mass.
• 10:17
  We're
• 10:18
  69%
• 10:19
  Medicare, Medicaid, which is not a great recipe.
• 10:22
  Right? Right. And, that's why access is a
• 10:24
  big issue. We have a lot of people
• 10:25
  that have commercial insurance leaving the market for
• 10:28
  Boston or Hartford.
• 10:29
  So we've gotta retain,
• 10:31
  those patients. But
• 10:33
  the heavy Medicare, Medicaid, I think one big
• 10:35
  beautiful bill at a minimum is a 100,000,000
• 10:38
  right off the top,
• 10:40
  probably more like a 150,000,000,
• 10:42
  and then as the state cuts trickle down.
• 10:44
  So and Massachusetts has really embraced
• 10:47
  trying to get everybody covered, and that that's
• 10:49
  gonna reverse itself. So, yeah, we have some
• 10:51
  headwinds coming next October. And what can you
• 10:54
  I mean, you gotta you gotta move quickly.
• 10:56
  Right? We've gotta speed up our cost transformation
• 10:59
  work. So we're doing a lot of heavy
• 11:01
  work this year, probably more than we really
• 11:03
  need to to to meet our
• 11:06
  expectations
• 11:07
  so that next year is not as heavy
• 11:09
  a heavy a lift going forward. But we're
• 11:11
  starting to talk about with the state and
• 11:14
  and DC about
• 11:15
  alternative payment models, so total cost of care.
• 11:18
  So we're you know, the state budgets are
• 11:20
  impacted by all this, our budgets impacted. So
• 11:23
  can we align around
• 11:24
  some creative waiver models
• 11:27
  to be encouraged to keep people out of
• 11:29
  the hospital rather than this fee for service?
• 11:32
  Yeah. Right. Right. Right. Because in the end,
• 11:34
  the reimbursement is less, but the
• 11:36
  consequences in terms of uncompensated
• 11:38
  care and so on, emergency room visits are
• 11:40
  pretty pretty damaging as well. Yeah. Just getting
• 11:42
  people out of the ER, getting the right
• 11:44
  care, right place, right time, right right caregiver.
• 11:47
  So there's some I think there's we're gonna
• 11:49
  have to flip the script and find new
• 11:51
  payment models. And in the context of all
• 11:53
  of that change then, you've talked about the
• 11:56
  patient a little bit. But how do you
• 11:58
  then also keep focused on the patient experience?
• 12:00
  Right? Because you're you're trying to manage costs
• 12:02
  and deal with this change, but and yet
• 12:04
  you're you've gotta keep your eye on Yeah.
• 12:06
  Patient who you're serving. Quality and our level
• 12:08
  of our clinician and our table stakes Yeah.
• 12:10
  Patient experience. And I I I would say
• 12:12
  access, like delivering Uh-huh. Care in a consumer
• 12:15
  driven way when the patient wants it, where
• 12:17
  they want it. Because how my 30 year
• 12:19
  old wants care versus how
• 12:22
  I want care are completely different. So we're
• 12:24
  doing some of that work now
• 12:27
  around we've got an oath model orchestrated access
• 12:30
  to, to health care
• 12:32
  and
• 12:35
  just doing a lot of work right now
• 12:37
  around process because we're never gonna find enough
• 12:39
  providers. Mhmm. So we've gotta figure out ways
• 12:44
  to grease the skids for patients, make it
• 12:46
  easier to access. So we're we're just starting
• 12:48
  that work right now. So
• 12:50
  when we talk in April, we'll be able
• 12:52
  to talk more about the things that we're
• 12:53
  we're uncovering. Okay. Okay.
• 12:56
  Super. Alright. Thank you so much for giving
• 12:58
  us an overview of what's going on. Yes.
• 13:00
  Is there anything else that you want to
• 13:01
  add before we before we close, Lisa? Great
• 13:03
  interview. Thanks, Will. Okay. Alright. Thank you very
• 13:05
  much. Yeah. Appreciate it.
• 13:17
  Yeah.