1 00:00:00,135 --> 00:00:01,405 - Hello everybody and thank you 2 00:00:01,405 --> 00:00:03,925 for tuning into the Becker's Healthcare podcast series. 3 00:00:04,385 --> 00:00:06,045 I'm Gracelyn Keller for Becker's Healthcare 4 00:00:06,265 --> 00:00:10,285 and I'm pleased to be joined by Chris Sven, who is the CEO 5 00:00:10,305 --> 00:00:11,525 of Turquoise Health. 6 00:00:11,895 --> 00:00:13,605 Chris, thanks so much for joining me. 7 00:00:14,475 --> 00:00:17,495 - Thanks for having me. - And to get us started, uh, 8 00:00:17,495 --> 00:00:18,615 could you please introduce yourself 9 00:00:18,615 --> 00:00:20,415 and share a little bit more about your 10 00:00:20,415 --> 00:00:21,615 role in Turquoise Health? 11 00:00:21,995 --> 00:00:24,255 - My name's Chris. I'm the CEO of Turquoise 12 00:00:24,255 --> 00:00:25,975 and we're in the price transparency business. 13 00:00:26,605 --> 00:00:28,495 That means something very different from 14 00:00:28,685 --> 00:00:32,055 what price transparency meant before January 1st, 2021. 15 00:00:32,115 --> 00:00:33,255 So we've been around for three 16 00:00:33,255 --> 00:00:34,335 years and we've been pretty busy. 17 00:00:35,445 --> 00:00:37,775 - Wonderful. Well, first question here, 18 00:00:38,505 --> 00:00:40,375 price transparency is top of mind 19 00:00:40,435 --> 00:00:42,295 for leaders across healthcare systems 20 00:00:42,835 --> 00:00:46,015 and at the same time, contract negotiations between payers 21 00:00:46,035 --> 00:00:48,095 and providers are contentious this year, 22 00:00:48,915 --> 00:00:50,655 in some cases pretty publicly. 23 00:00:51,145 --> 00:00:54,255 Could you describe how price transparency is affecting 24 00:00:55,135 --> 00:00:56,535 contracting and negotiations 25 00:00:56,755 --> 00:00:58,375 and what are the biggest challenges 26 00:00:58,375 --> 00:00:59,455 you're seeing for both parties? 27 00:01:00,205 --> 00:01:03,255 - Well, we have a whole new variable in provider payer 28 00:01:03,255 --> 00:01:05,895 negotiations that we didn't have before 2021. 29 00:01:06,365 --> 00:01:09,855 This is the real negotiated rate of you 30 00:01:09,875 --> 00:01:14,055 and your competitors down to the service and code and NPI. 31 00:01:14,725 --> 00:01:16,935 This makes negotiations more transparent. 32 00:01:17,475 --> 00:01:18,935 Uh, it makes 'em more contentious 33 00:01:18,935 --> 00:01:20,695 because prior to this, 34 00:01:21,175 --> 00:01:24,375 a hospital CFO never saw their competitors negotiated rates 35 00:01:24,395 --> 00:01:26,415 during, during a negotiation. 36 00:01:27,815 --> 00:01:29,875 - And healthcare organizations are striving 37 00:01:29,935 --> 00:01:33,355 for efficiency amid current staff and resource shortages. 38 00:01:33,735 --> 00:01:36,235 So aside from negotiations, what other areas 39 00:01:36,415 --> 00:01:39,675 of contracting are ripe for innovation or streamlining 40 00:01:39,855 --> 00:01:43,275 and where does technology such as AI fit in here? 41 00:01:43,775 --> 00:01:46,635 - So turquoise, as we think of helping, uh, 42 00:01:46,965 --> 00:01:49,555 folks in negotiations with a full stack, what 43 00:01:49,555 --> 00:01:51,595 that means is helping both on the data front. 44 00:01:51,775 --> 00:01:55,315 So what is the appropriate market rate 45 00:01:55,895 --> 00:01:57,395 for this particular contract, 46 00:01:57,415 --> 00:01:58,595 but also on the language front. 47 00:01:58,975 --> 00:02:01,155 So what clauses are actually in your 48 00:02:01,395 --> 00:02:02,675 contracts for a health system. 49 00:02:02,775 --> 00:02:05,875 You might be trying to standardize your reimbursement 50 00:02:05,905 --> 00:02:08,035 clauses with your large payers so 51 00:02:08,035 --> 00:02:10,835 that your revenue cycle team isn't facing denials 52 00:02:10,855 --> 00:02:13,155 and tons of payer shenanigans. 53 00:02:13,155 --> 00:02:16,795 And so folks are using the transparency data to tell them 54 00:02:16,795 --> 00:02:19,435 what rates should be, but they need help from AI 55 00:02:19,455 --> 00:02:22,675 to know what's actually in your contracts, what language 56 00:02:23,325 --> 00:02:26,115 would you find for a given clause across all your payer 57 00:02:26,435 --> 00:02:29,835 contracts, and what language would you suggest going into a 58 00:02:29,995 --> 00:02:32,595 negotiation that is more favorable for you 59 00:02:32,595 --> 00:02:34,555 and your team so that you face fewer denials? 60 00:02:35,615 --> 00:02:38,415 - Absolutely. And can you share some examples of practical 61 00:02:38,415 --> 00:02:42,375 and effective applications of AI in contracting as well 62 00:02:42,375 --> 00:02:43,375 as notable outcomes 63 00:02:43,555 --> 00:02:44,855 or case studies that highlight 64 00:02:44,855 --> 00:02:46,175 the benefits and impact of this? 65 00:02:46,645 --> 00:02:49,495 - Yeah, so one of our health system customers might take 66 00:02:49,835 --> 00:02:52,935 and upload all of their PDF contracts across an entire 67 00:02:52,935 --> 00:02:55,415 region, uh, stuff from the filing cabinet, 68 00:02:55,555 --> 00:02:59,565 poorly scan blurry, they might say right away, you know, 69 00:02:59,705 --> 00:03:00,765 use AI to tell us 70 00:03:00,765 --> 00:03:03,085 what is our timely filing clause for appeals? 71 00:03:03,555 --> 00:03:06,325 What is our lesser of language, really take stock of 72 00:03:06,325 --> 00:03:08,685 that sort of language across all of their payer contracts, 73 00:03:08,985 --> 00:03:10,965 what's their claims filing submission 74 00:03:11,245 --> 00:03:12,445 deadline, et cetera, et cetera. 75 00:03:12,785 --> 00:03:16,205 And then you'll go into a negotiation more prepared, say, 76 00:03:16,205 --> 00:03:18,285 Hey, we want to standardize these clauses 77 00:03:18,305 --> 00:03:20,325 so our revenue cycle team's not dealing 78 00:03:20,355 --> 00:03:22,125 with all these different types of denials 79 00:03:22,625 --> 00:03:25,325 and hey, payer, we're gonna push 80 00:03:25,345 --> 00:03:27,205 for having this language in this contract so 81 00:03:27,205 --> 00:03:30,685 that we all deal with few with less administrative hassle. 82 00:03:31,065 --> 00:03:32,845 And that's, that's kind of the standard thing we're seeing 83 00:03:32,845 --> 00:03:34,285 with with AI today. 84 00:03:35,545 --> 00:03:36,925 - And then for payers 85 00:03:36,925 --> 00:03:39,805 and health systems looking to level up their negotiating 86 00:03:39,985 --> 00:03:41,165 and contracting process, 87 00:03:41,395 --> 00:03:43,445 what best practices would you recommend? 88 00:03:43,585 --> 00:03:46,045 And then what's a good first step to kind of get into those? 89 00:03:46,745 --> 00:03:48,925 - You know, the biggest realization is 90 00:03:48,925 --> 00:03:50,485 that we're in a totally different game 91 00:03:50,625 --> 00:03:52,085 now compared to two years ago. 92 00:03:52,665 --> 00:03:56,085 The transparency data has really shifted negotiations 93 00:03:56,585 --> 00:04:00,245 and this sudden, sudden increase in the ability 94 00:04:00,245 --> 00:04:02,885 of an AI model to assist in negotiations. 95 00:04:02,965 --> 00:04:04,325 I mean, this is less than a year old. 96 00:04:04,545 --> 00:04:06,365 And so if you're not using either of those 97 00:04:06,465 --> 00:04:10,645 to assist in negotiations, these are really low risk, safe, 98 00:04:11,065 --> 00:04:14,165 secure, immediate ways to augment your workforce, 99 00:04:14,705 --> 00:04:17,285 to make your negotiations more efficient, more precise, 100 00:04:17,905 --> 00:04:20,205 and there's not a huge implementation burden 101 00:04:20,265 --> 00:04:21,645 or hassle, and it's a quick win. 102 00:04:23,195 --> 00:04:25,595 - Absolutely. Well, that wraps up our conversation today. 103 00:04:25,615 --> 00:04:27,475 So Chris, thanks so much for your time 104 00:04:27,495 --> 00:04:28,675 and for the great discussion. 105 00:04:29,245 --> 00:04:32,315 - Thank you. - And I'd also like to thank Turquoise Health 106 00:04:32,375 --> 00:04:34,315 as well for sponsoring today's episode. 107 00:04:34,615 --> 00:04:36,955 You can tune into more podcasts from the Becker's Healthcare 108 00:04:37,295 --> 00:04:38,835 Series by visiting our podcast 109 00:04:39,465 --> 00:04:42,075 page at becker's hospital review.com. 110 00:04:42,075 --> 00:04:42,755 Thanks so much.