- Hello everybody and thank you
for tuning into the Becker's Healthcare podcast series.
I'm Gracelyn Keller for Becker's Healthcare
and I'm pleased to be joined by Chris Sven, who is the CEO
of Turquoise Health.
Chris, thanks so much for joining me.
- Thanks for having me. - And to get us started, uh,
could you please introduce yourself
and share a little bit more about your
role in Turquoise Health?
- My name's Chris. I'm the CEO of Turquoise
and we're in the price transparency business.
That means something very different from
what price transparency meant before January 1st, 2021.
So we've been around for three
years and we've been pretty busy.
- Wonderful. Well, first question here,
price transparency is top of mind
for leaders across healthcare systems
and at the same time, contract negotiations between payers
and providers are contentious this year,
in some cases pretty publicly.
Could you describe how price transparency is affecting
contracting and negotiations
and what are the biggest challenges
you're seeing for both parties?
- Well, we have a whole new variable in provider payer
negotiations that we didn't have before 2021.
This is the real negotiated rate of you
and your competitors down to the service and code and NPI.
This makes negotiations more transparent.
Uh, it makes 'em more contentious
because prior to this,
a hospital CFO never saw their competitors negotiated rates
during, during a negotiation.
- And healthcare organizations are striving
for efficiency amid current staff and resource shortages.
So aside from negotiations, what other areas
of contracting are ripe for innovation or streamlining
and where does technology such as AI fit in here?
- So turquoise, as we think of helping, uh,
folks in negotiations with a full stack, what
that means is helping both on the data front.
So what is the appropriate market rate
for this particular contract,
but also on the language front.
So what clauses are actually in your
contracts for a health system.
You might be trying to standardize your reimbursement
clauses with your large payers so
that your revenue cycle team isn't facing denials
and tons of payer shenanigans.
And so folks are using the transparency data to tell them
what rates should be, but they need help from AI
to know what's actually in your contracts, what language
would you find for a given clause across all your payer
contracts, and what language would you suggest going into a
negotiation that is more favorable for you
and your team so that you face fewer denials?
- Absolutely. And can you share some examples of practical
and effective applications of AI in contracting as well
as notable outcomes
or case studies that highlight
the benefits and impact of this?
- Yeah, so one of our health system customers might take
and upload all of their PDF contracts across an entire
region, uh, stuff from the filing cabinet,
poorly scan blurry, they might say right away, you know,
use AI to tell us
what is our timely filing clause for appeals?
What is our lesser of language, really take stock of
that sort of language across all of their payer contracts,
what's their claims filing submission
deadline, et cetera, et cetera.
And then you'll go into a negotiation more prepared, say,
Hey, we want to standardize these clauses
so our revenue cycle team's not dealing
with all these different types of denials
and hey, payer, we're gonna push
for having this language in this contract so
that we all deal with few with less administrative hassle.
And that's, that's kind of the standard thing we're seeing
with with AI today.
- And then for payers
and health systems looking to level up their negotiating
and contracting process,
what best practices would you recommend?
And then what's a good first step to kind of get into those?
- You know, the biggest realization is
that we're in a totally different game
now compared to two years ago.
The transparency data has really shifted negotiations
and this sudden, sudden increase in the ability
of an AI model to assist in negotiations.
I mean, this is less than a year old.
And so if you're not using either of those
to assist in negotiations, these are really low risk, safe,
secure, immediate ways to augment your workforce,
to make your negotiations more efficient, more precise,
and there's not a huge implementation burden
or hassle, and it's a quick win.
- Absolutely. Well, that wraps up our conversation today.
So Chris, thanks so much for your time
and for the great discussion.
- Thank you. - And I'd also like to thank Turquoise Health
as well for sponsoring today's episode.
You can tune into more podcasts from the Becker's Healthcare
Series by visiting our podcast
page at becker's hospital review.com.
Thanks so much.