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Hi everyone. This is Erica Spicer Mason with

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Becker's Healthcare. Thank you so much for tuning

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into the Becker's Healthcare podcast series.

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So today we're going to talk about how

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strategic collaborations

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can strengthen ASC operations.

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Joining me for this discussion today is Armando

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Cardoso, the CEO of PayerHealth.

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Armando, welcome to the podcast. Thank you so

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much for being with us today. Thank you,

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Erica. It's great to be here.

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We're thrilled to have you. And before we

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start talking about

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ASC operations and all of the great insights

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that you have, would you mind sharing just

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a little bit more about yourself and your

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background, your work in health care, with our

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audience?

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Absolutely.

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And I appreciate folks taking the time to

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listen in. I'm Armando Cardoso, CEO of PayerHealth,

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and my journey in health care has taken

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many turns. I began in finance, actually, versus

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a health care investment banker with Morgan Stanley

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in New York, advising health care companies and

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later as a health care private equity investor

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with Summit Partners in Boston investing in health

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care companies.

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But, really, it was my shift into health

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care operations that shaped my path to pay

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your health. I had the privilege of building

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a Medicare Advantage health plan at Clover Health,

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where I was the head of growth. And

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later, I had the opportunity to lead the

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national managed care analytics team at Ascension, one

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of the largest health systems in the country.

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And from these seats, I had the opportunity

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to see the health care industry from very

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different vantage points,

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including both sides of the negotiating table.

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They also gave me the chance to develop

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a deep understanding of both fee for service

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and value based contracting,

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two areas that are more critical than ever

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for ASCs facing today's mounting pressures.

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These seats also showed me the challenges providers

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face when navigating payer relationships.

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I've seen firsthand how reimbursement challenges can limit

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the growth and sustainability of even the most

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efficient providers. So that's really what attracted me

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to payer health and the opportunity to advocate

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for providers.

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Payer health is,

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really made up of a a group of

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great folks. I mean, we've got folks who

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serve both sides of the aisle, if you

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will, you know, payer and provider. And we

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focus on strengthening payer relationships,

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protecting margins, and building financial strategies that support

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our client success.

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And then on the personal side, I live

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in Austin, Texas with my wife, our young

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sons, and three dogs.

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Oh, you've got a full house. Love knowing

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that you have three dogs. I appreciate you

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sharing with me, Taylor Armando.

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Well, it's great to have you on with

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us, and it sounds like you have so

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much experience that you're bringing to the table,

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a lot of perspective. And I can see,

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you know, you're you're already touching on a

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core concern that we know is pervasive in

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the industry and especially at ASCs right now,

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which is that concept of financial stability. So

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excited to hear some more insights from you

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there. But before we get even further, can

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you also tell us a little bit more

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about PayerHealth and, you know, what is the

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company's mission as well?

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I'd love to. You know, our our leadership

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team crafted

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what we've called the the payer health manifesto,

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and we share with our employees. And it

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it actually opens,

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with us establishing our belief that providers are

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the beating heart of the health care industry.

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They are the ones placing their hands on

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patients. They are the catalyst for change, innovation,

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and improved outcomes.

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So payer health exists to be a champion

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for providers.

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You know, our our mission is clear. We

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we focus on the protecting and improving providers'

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margins so they can focus on their mission,

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delivering exceptional patient care.

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We wanna get providers back to why they

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chose to essentially

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work in the field in the first place,

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caring for people. And that's without the being

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weighed down by the administrative burdens or constant

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fights to get paid for what they've earned.

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We do this through end to end payer

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relationship management.

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That means we fully run everything from contract

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negotiations to credentialing

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to medical billing and ongoing revenue cycle performance.

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What we found is that many ASCs are

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doing incredible work with limited teams and stretched

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resources.

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They're lean by design, but that also means

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they're often outmatched when it comes to managing

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complex payer relationships.

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Payers have entire departments,

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legal, actuarial,

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contracting, analytics,

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all designed to minimize reimbursement

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and protect the payer's margins.

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Most ASCs simply don't have the internal infrastructure

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to keep up with that level of sophistication.

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And, honestly, that imbalance is felt

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most in the, I'd say, day to day

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stuff. So outdated contracts, credentialing delays, denied claims,

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and revenue cycle inefficiencies that chip away at

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margins.

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What's fascinating is if you if you really

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just take a massive step back, ASCs are

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one of the few bright spots that are

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lowering the total cost of care in a

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fee for service model. And, yes, there's been

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strong growth in the number of ASCs,

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but growth alone doesn't guarantee sustainability.

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The reality is we've seen ASC closures, and

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financial pressure is a major contributor. Becker's actually

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has some great articles and insights that have

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been published from industry leaders on this very

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topic.

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Margins are tighter. The complexity of managing payer

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relationships is just growing, especially when ASCs are

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expected to go head to head with organizations

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that are structurally built to resist rate increases

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and slow reimbursement.

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The bottom line, at least as we see

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it at the payer health, is that what

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worked five years ago no longer works today.

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Trying to optimize revenue without expert support isn't

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just inefficient.

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It's honestly just risky.

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ASCs need to partner

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with folks who understand the payer landscape

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and know how to navigate it strategically. That's

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what we do at PayerHealth.

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And all that said, I do wanna be

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clear.

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You know, it's easy to vilify payers, and

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and we shouldn't. There's some amazing people doing

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work that's incredibly important within these organizations.

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And, in fact, many of our members of

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our own team came directly from the payer

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side. But this is the reality of our

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health care system in The United States today.

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It's complex. It's uneven, and it often puts

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providers at a disadvantage

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unless they plan accordingly.

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Our role at PearHealth is to help providers

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navigate that reality and thrive despite it.

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Yeah. Armando,

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I really appreciate everything that you've outlined. It's

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great to learn more about what PearHealth is

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all about. And some of these things that

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you've said are really standing out to me.

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The fact that some of these financial or

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sustainability strategies that worked five years ago aren't

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working today. You know, growth in the ASC

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space doesn't always mean sustainability.

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Really, really interesting, and it really just speaks

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to how quickly things are changing in the

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industry.

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And I also wanted to touch on too.

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You said how ASCs

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tend to lack that infrastructure that they need

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to really get around some of these challenges.

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So can you elaborate a little bit more

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on what makes PearHealth especially impactful for an

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ASC?

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Definitely. Great question. Well, unlike large health systems,

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most independent ASCs don't have entire departments dedicated

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to contracting, credentialing, or revenue cycle strategy. And

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even when portions of those functions do exist,

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they're often siloed, and that's where pay health

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fits to support. And importantly, we support with

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a deep understanding that ASCs have unique considerations.

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For example, ASC contracting isn't

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hospital or physician contracting,

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and I'm air quoting over here with a

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few tweaks.

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It's a completely different game. And that means

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it takes a completely different approach to win.

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A good example to share that's relatively recent

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is how our team helped the client, in

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this case, a physician group opening a a

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new ASC with their contracting strategy.

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The team approached the negotiation holistically.

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So, you know, we considered both the professional

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and facility dynamics to secure substantial increases in

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the physician fees and lock in favorable ASC

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rates. The team used price transparency data to

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show payers what they were already paying the

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local hospital for the same cases

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and made it clear that the higher rates

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we were proposing would still save them money.

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And, you know, as anticipated,

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a few payers still push back. And in

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this case, we pointed out what it would

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look like if we decided to go out

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of network, reminding the payers of the fact

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and the impact that this would have on

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their members,

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our clients' patients. You know? Essentially,

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this would lead to the provider having to

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tell patients something like,

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I'm so sorry, patient. If you had this

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other payer, you could get into the lower

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cost ASC right away.

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But

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because you have payer x,

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we're gonna have to send you back to

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the hospital.

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Oh, and and by the way, we're gonna

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have to push back that date. Oh, and

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and, yeah, unfortunately, it's gonna be at a

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higher cost.

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You know, those those types of conversations

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just change the dynamics, and every payer came

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to the table. And in some cases, we've

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even been able to help,

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clients earlier in the process while providers are

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still in the planning phase to build an

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ASC. We frame negotiations in those cases more

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as, you know, in terms of viability.

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So we'll essentially approach payers by saying, if

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these rates don't make sense, this ASC is

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simply not gonna get built, and you'll keep

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paying higher hospital rates. That messaging

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usually resonates and and works well.

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So, you know,

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it is important to also point out, though,

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that contracting is only one piece of the

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value we bring. What truly sets PayorHealth apart

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is how credentialing, contracting, and revenue cycle management

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work together, not in silos, but as an

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integrated platform.

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When we're managing all three functions, your entire

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reimbursement workflow lives in one place, and our

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teams have full visibility across each component.

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That integration matters

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because these areas constantly overlap.

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For example, when a new contract or provider

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goes live, our RCM team has real time

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access to credentialing approvals. That means we can

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submit claims immediately,

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avoiding denials, rework, or delays in payment.

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And if a contract is retroactive, which happens

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often, our teams work together to ensure every

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impacted claim is reprocessed at the correct rate,

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because in most cases, payers do not do

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that automatically.

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We're built to catch those opportunities.

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That kind of coordination,

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that level of, I'll call, operational rigor is

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what drives real margin impact. It really comes

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down to the reality that a great contract

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without operations to enforce it isn't worth the

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paper it's printed on.

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And the inverse,

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great operations

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without a fair contract, well, that's that's, I'd

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say the equivalent of holding a candle to

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the sun. We focus on being a true

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extension for our clients and their teams, focusing

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on making every dollar count.

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Yeah. Thanks so much, Armando. It's helpful to

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know all of this, and it it does

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sound like very holistic support, you know, between

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the contracting, credentialing, the RCM work, and then

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all of the coordination that's going on behind

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the scenes.

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Really interesting.

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You know, do you find that there are

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any misconceptions

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about these services, you know, whether it's these

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services that you do as payor health or

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similar companies? And what would what would you

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like to clear up for anyone listening?

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Definitely. I appreciate that. Well, I'd say the

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most common misconception here is that we're just

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a contracting service, just a credentialing team, or

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just a billing company. We do offer those

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services for sure, and we definitely offer them

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modularly. So we can tailor solutions to our

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clients' needs. But what sets us apart is

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that we've built expertise across the full reimbursement

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life cycle. And that means that we can

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plug in exactly where we're needed while still

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keeping an eye on the broader system. That

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makes us a more

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agile, more strategic partner.

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Even in those more focused or limited engagements,

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we end up being a better partner.

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You know, our clients are often also surprised

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by how much money is left on the

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table and sometimes how quickly that changes once

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we're involved.

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A good example of this, I'd say, is,

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that's also relatively recent is we're onboarding a

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new client and found a lesser of issue.

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So, you know, in this case, they were

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being paid below their contracted rate because their

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charge master was set too low. We helped

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them correct it, and without even contacting a

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payer, they saw a half a million dollar

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improvement in revenue.

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That kind of catch doesn't happen when functions

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are operating in silos, and that's critical because

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payer reimbursement structures

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are complex and inconsistent,

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and they use everything from

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APCs,

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APGs, and EAPGs

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to carve outs, case rates, and multi procedure

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logic.

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And what's even more crazy is that payers

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can change these unilaterally

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without notifying the provider.

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So unless you're looking across contract data, charge

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data, and claims data together, you're almost guaranteed

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to miss revenue opportunities

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or let underpayments go uncorrected for months or

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even years. That's why our integrated model matters.

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Yeah. Thanks, Armando.

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And, you know, looking ahead, what are some

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of the things PayerHealth is focusing on or

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anticipating in the next three to five years,

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especially as as we've talked touched on earlier,

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the health care and reimbursement model continues to

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involve. Would love to know what's ahead for

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you.

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For sure. And and some of these are

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are familiar themes, but it's so critical. You

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know, first, I'd say the long running drumbeat

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around value based care. It's been part of

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the industry conversation for years,

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but we see it as a key force.

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ASCs need to be ready for more bundled

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payments, outcomes based contracts, and alternative payment models.

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We're helping clients get ahead of that, not

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because it's suddenly everywhere, but because it's a

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shift that's likely to keep building, and we

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want our clients to be ready.

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Second is consolidation and growth in the ASC

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market.

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More centers are expanding their service lines, adding

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locations, or joining platforms, and that kind of

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growth only works if it's backed by smart,

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scalable payer strategies.

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You can't expand clinical capacity without ensuring contracts

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and revenue cycle operations or keeping pace. That's

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a big focus area for us. How do

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we help our clients scale without losing leverage

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or visibility?

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But one of the kind of items taking

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center stage now, I'd say, and the biggest

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disruptor is AI. AI is rapidly changing the

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ways that payers review, flag, and deny claims.

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We're seeing AI used to run clinical reviews,

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identifying documentation gaps or patterns that trigger denial

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recommendations.

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And while payers often say that a physician

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still signs off, in practice, those physicians have

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often become rubber stamps for the algorithm.

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That's why our RCM team matters. We're not

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just working denials. We're identifying patterns across payers,

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spotting inconsistencies,

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and challenging decisions with real insight.

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Importantly,

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we're also bringing AI into our processes,

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not to replace people, but honestly to make

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them more effective

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because the days of relying solely on headcount

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to review denials, code claims, or chase status

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updates are well behind us. From the bots

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that automate claim status checks to AI assisted

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coding and charge entry tools, we're investing heavily

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in technology that streamlines the repetitive work so

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our team can focus on the claims that

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really require strategy, nuance, and escalation.

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There is no doubt, at least in my

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mind, that payers will continue using AI to

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reduce reimbursement.

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So our job as Fair Health is to

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ensure providers have a partner who can match

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that pace

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and fight smart with the right data, the

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right tools, and the right people.

404
00:15:20,549 --> 00:15:23,370
Yeah. Sounds like a really smart approach, Armando.

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So thank you so much for giving us

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your take on on what's ahead and how

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Pear Health is is going to support organizations

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in that landscape.

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So, also, before I let you go, I

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also did wanna learn more about I understand

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there's a partnership that you have with J

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and J MedTech. So would love to just

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share a little bit more about that with

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our listeners and why you're excited about working

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with J and J.

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Definitely. Definitely.

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This strategic alliance with Johnson and Johnson MedTech

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is exciting because it's it's rooted in a

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clear shared commitment to helping ASC succeed,

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not just clinically, but economically and operationally as

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well.

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J and J MedTech has built what what

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I consider to be a very powerful framework

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focused on clinical excellence, economic value, and operational

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support. And Pear Health is very proud to

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be part of the resources that they bring

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to the table.

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While J and J delivers the world class

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tools, the technology, and education to elevate care,

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00:16:18,789 --> 00:16:21,370
we help ensure that the ASC's reimbursement strategy,

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payer relationships, and revenue cycle performance are just

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as strong as what's happening in the OR.

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And when reimbursement is aligned and systems are

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efficient,

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00:16:30,355 --> 00:16:32,674
ASCs gain the headspace to focus on what

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00:16:32,674 --> 00:16:35,495
matters most, delivering excellent care.

437
00:16:36,115 --> 00:16:38,375
That's how this work ultimately altogether

438
00:16:39,154 --> 00:16:42,514
comes to the end output that's very important,

439
00:16:42,514 --> 00:16:44,250
and that's supporting clinical excellence

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00:16:45,049 --> 00:16:46,889
too. So that's what makes this alliance so

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00:16:46,889 --> 00:16:49,309
powerful. By working together, we can bring ASCs

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00:16:49,370 --> 00:16:51,149
a more complete support system

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00:16:51,529 --> 00:16:54,429
from the operating room to the negotiating table.

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It's all about helping them do more with

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less

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00:16:57,455 --> 00:16:59,455
and get paid fairly for the value that

447
00:16:59,455 --> 00:17:00,915
they bring to the health care system.

448
00:17:02,014 --> 00:17:04,654
Sounds like a a very aligned partnership. So,

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00:17:04,654 --> 00:17:06,654
Armando, thank you so much for sharing a

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00:17:06,654 --> 00:17:08,894
bit a bit more about that. And before

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00:17:08,894 --> 00:17:10,919
we wrap up our time together, is there

452
00:17:10,919 --> 00:17:12,679
anything else that maybe we didn't touch on,

453
00:17:12,679 --> 00:17:15,079
that we missed, that you wanted to add

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00:17:15,079 --> 00:17:16,619
as final thoughts for our listeners?

455
00:17:17,480 --> 00:17:19,740
No. Erica, I think you you really appreciated

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00:17:19,799 --> 00:17:21,640
you taking the time, and, I think this

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is a great conversation.

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00:17:23,404 --> 00:17:26,044
I would say just this. PearHealth, we're a

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00:17:26,044 --> 00:17:28,065
team of experts who genuinely care.

460
00:17:28,444 --> 00:17:31,265
We're not here to offer cookie cutter solutions.

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00:17:31,404 --> 00:17:33,984
We want to listen, assess, and build strategies

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00:17:34,204 --> 00:17:36,704
that are tailored to each ASC's unique situation.

463
00:17:37,079 --> 00:17:38,759
So if you're interested in learning more about

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how PayerHealth can support your team, you can

465
00:17:41,079 --> 00:17:42,919
reach out directly through your local J and

466
00:17:42,919 --> 00:17:44,539
J MedTech ASC representative

467
00:17:44,839 --> 00:17:46,859
by clicking the link below the podcast.

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00:17:47,240 --> 00:17:50,025
And you could also visit us at payerhealth.com.

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00:17:50,025 --> 00:17:54,105
That's payrhealth.com

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00:17:54,105 --> 00:17:56,265
to explore more about what we do. Really

471
00:17:56,265 --> 00:17:58,025
appreciated the opportunity to be here today and

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00:17:58,025 --> 00:17:59,005
enjoyed the conversation.

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00:18:00,105 --> 00:18:02,744
Likewise, Armando. Thank you so much for making

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00:18:02,744 --> 00:18:03,644
time for Becker's.

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00:18:03,970 --> 00:18:05,570
And, of course, we also wanna thank our

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podcast sponsor for today, Johnson and Johnson MedTech.

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00:18:09,170 --> 00:18:11,170
Listeners, be sure to tune into more podcasts

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00:18:11,170 --> 00:18:13,890
from Becker's Healthcare by visiting our podcast page

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00:18:13,890 --> 00:18:16,390
at beckers hospital review dot com.