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Hi, everyone. This is Erica Spicer Mason with

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the Becker's Healthcare podcast series. Thank you so

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much for tuning in today. I'm thrilled to

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be joined by Steve Sutherland, the senior vice

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president of information systems at Saris,

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who will talk to us about AI and

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machine learning in the payment integrity space.

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Steve, welcome to the podcast. Thank you so

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much for joining us today.

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Hello, Erica. Thank you very much for having

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me. I appreciate the opportunity.

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We're thrilled to have you here to talk

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about this topic today. And before we really

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get into it, I wanted to see if

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you'd like to share just a little bit

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more about yourself,

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your role, your organization,

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whatever feels top of mind for you.

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Sure. Sure. Well, I'm a native Texan. I

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was born and raised here in in the

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Dallas Fort Worth area, and I have been

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with,

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the Saris Organization now for going on 30

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years, actually. I think I'm I think I'll

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celebrate my 29th anniversary

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in the fall or early

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early next year. And I've had I've served

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in

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a various different roles within the IT spectrum

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here with the company, but I really just

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have seen the company,

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grow exponentially and and really grown along with

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it from a very small

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organization into, you know, what it is today,

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which, you know, we've got almost a 1000

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folks within the within the Cirrus

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part of the company,

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and and we're, you know, a part of

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a bigger company, CorVel Corporation. So

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Wonderful. Thanks so much, Steve. Appreciate you sharing

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a little bit more about your background. It's

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incredible. You've been with Cerus for about 30

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years.

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So I'm sure you've seen so much change

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in in those decades.

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So I'm really looking forward to the perspective

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that you'll have here with

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technology and payment integrity. So

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I think we can kind of get into

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it from there.

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So I'm wondering if you can share with

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our audience what you see as the role

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of artificial intelligence

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and machine learning in addressing payment integrity pain

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points.

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And in your experience working with payers, are

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there specific benefits that partners have realized in

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applying those tools to claims processes?

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Would love to know any success stories or

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case studies that might come to mind.

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Sure. No. That's a it's a great question

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and really a relative and and hot topic

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today in today's industry.

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And and those technologies are really

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helping improve

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accuracy and consistency and efficiencies and in payment

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processing in general. I mean, they're applicable all

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across all sorts of other industries, obviously, as

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well. But in payment processing,

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you know, payers have a very specific time

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frame

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within

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which they have to make payments to providers

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based on contractual

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and regulatory

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requirements. So they not only have a short

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window

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to do claim adjudication, but also,

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validate and apply various types of

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reviews and business logic and and all sorts

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of things that happen within the process while,

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you know, adhering to those very strict time

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time frame. So efficiency really is key. They've

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there's a lot to be done in a

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short amount of time frame, and it needs

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to be done accurately. So

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artificial intelligence and machine learning

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specifically can really help improve these processes by,

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you know, automation. So automating certain

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very manual and sometimes inefficient steps.

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Claim identification.

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So helping

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identify and tag or flag problematic

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claims or trends that they might see that

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it can be taken off of the

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conveyor belt, if you will, or out of

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the process and looked at by a by

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an expert or some some other type of

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of audit reviewer. So,

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those are just a few of those of,

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you know, examples of how it can be

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used.

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Very general, but we we have several specific

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use cases within our workflow

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where we've taken very manual processes

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like like data capture, you know, keying data

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from an image or something and improving that

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dramatically by applying this type of technology.

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Yeah. I appreciate the example, Steve, and I

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think everything you outlined really speaks to what

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an impact

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efficiency in this process

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can play when it comes to compliance, timely

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payments, adhering to contractual agreements.

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There's a lot kind of on the line

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in that in that window of time as

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you mentioned.

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And I know you also mentioned how payment

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integrity plays kind of this key role in

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health care where it ensures that claims adjudication

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is accurate and that health care organizations are

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appropriately reimbursed for the care that they provide.

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So as health care billing processes become more

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complex,

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what key challenges are there when it comes

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to the widespread adoption of AI in the

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PI space?

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And aside from complexity, are there other factors

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that are kind of driving those issues?

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Sure. Yeah.

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There's always challenges, you know, with everything, especially

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anything new and and new technologies. So, you

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know, applying this

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complex technology

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to complex billing processes in general and then

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also health care data in itself can be

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a challenge.

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It's

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not always

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consistent. It's not always standardized based on your

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billing practices and those sorts of things. So

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the data working with the data in itself

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can be

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very complicated

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and challenging.

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So there are certain

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pitfall

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or many pitfalls you want to try to

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avoid. A very important one is to exercise

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caution and and be diligent when it comes

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to data privacy and security,

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as well as transparency and defensibility.

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So those all kind of, you know, go

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along together,

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regulatory

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challenges in some cases.

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So really relying on your compliance and security

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teams to provide

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a sound governance and policy,

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when you go into these

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deploying these types of solutions. Really, you need

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to need to look at that upfront and

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really have that established.

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There can also be a steep learning curve

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with staff and finding,

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expertise

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and resources

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to be able to to build these types

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of solutions and have the knowledge and and

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expertise. So really just have patience and be

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persistent as you try to recruit talent and

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expertise and and also train current staff on

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learning these technologies.

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There can also be some gaps

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with,

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the output of some of these solutions and

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tools.

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So as you deploy these things,

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you know, what the analysis showed or what

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the research

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showed might not necessarily

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come to fruition

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when you put it in in an operational

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setting and the actual results might be off.

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So really just having,

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a continuous improvement and validation process so that

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you're always making sure that, you know, the

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output is what it should be and that

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it's valid and continually improving

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whether it's a a machine learning model or,

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know, an

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AI, solution

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in itself.

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Mhmm. And probably the last thing I'd mention

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is just is just to avoid becoming too

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reliant on technology,

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on this specific technology or any really in

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general

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over, you know, human knowledge and expertise. So

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finding that good balance between, you know, how

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the technology can be used and what parts

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of processes

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we can make more efficient and take and

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take the human element out of it. But

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then, you know, finding that balance of there's

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always going to

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be some of that that that really does

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need a human touch.

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Yeah. That balanced approach sounds essential, and I

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appreciate what you said at the beginning of

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your response, Steve, that applying complex technology to

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already complex billing processes

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bound to have some challenges and barriers.

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So I appreciate you outlining some of those

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kind of pitfalls that organizations can avoid and

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acknowledging there will be a steep learning curve.

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The continuous improvement and validation is key.

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So, yeah, thank you again for for outlining

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all of that. And I think that leads

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me into the next question that I had

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for you, which

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is, you know, just kind of acknowledging this

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idea of change management and demonstrating value anytime

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leaders are

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kind of encouraging their teams embrace new technology.

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We hear from leaders all the time that

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change management is one of the the most

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challenging aspects of introducing new tech.

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So wondering if you have best practices or

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resources that you'd recommend to leaders who are

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planning to or have even newly adopted AI

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and machine learning for payment integrity.

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And maybe you can say a few words

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on how they can prepare for future advancements,

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and other changes ahead.

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Definitely. I can share some thoughts and and

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and some of my experiences in in that

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space. So

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I I always say

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and and have found based on our experience,

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identifying the right use cases upfront.

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These technologies can be used to do

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a plethora of things. There's a there's a

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1,000,000 use cases. Right? But really identifying what

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is the right use case to start with.

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So if you're just getting into this, how

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do I how do I get my foot

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in the door? What can I do? What

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you don't want to do is

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bite off the most complex

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project that that's out there that's on your

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radar.

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Keep it simple.

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Find a very

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simple,

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easy use case to start with. Don't try

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to tackle that most complex solution first, but

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keep it simple. And then that way, you

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can get, you know, get your foot in

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the door, get your feet wet. You can

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you can get some experience and have some

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some quick wins without, you know, having to

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put in all of the time and effort

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before you're able to see sort of the

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fruits of your labor. Right?

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So the and then building proof of concepts,

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it's kind of the same it's kind of

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the same thought process. Right? So let's build

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a proof of concept

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on this use case, prove it out,

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get your feet wet, you know, make sure

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that it that it proves out what your

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goal was to begin with and that and

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then you can lower your risks and and

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increase your success by having those proof of

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concepts because you're gonna have some failures. Right?

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So if you build a proof of concept

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and it doesn't quite work the way you

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thought it would,

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then, you know, you sort of back up,

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make some adjustments, and and start again. So

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we we always like to do proof of

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concepts

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on especially

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complex projects like this or or with the

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potential to be really complex.

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One of the other things is to get

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early buy in from key stakeholders. I mean,

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this may sound like a a no brainer,

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but you really gotta make sure that you've

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got your business strategy and your and your

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technology initiatives aligned so that everybody is on

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the same page as far as, you know,

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what the goals are and what the expectations

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are.

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Like a lot of

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current technologies out there, data really is the

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key.

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So having good sound data government management

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around that data and then the architecture.

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The old saying,

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garbage in and garbage out definitely applies in

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this scenario. You've gotta have good data, and

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you've gotta have a good strategy and management

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around that data.

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And I guess the last thing I would

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say is just to educate,

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your staff and and your business units about

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these technologies, about data science,

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explaining these use cases and proof of concepts

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and, you know, getting folks to buy in

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and and get excited about these things.

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Training always helps with the learning curve. But,

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I mean, having some positive outcomes and realizing

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value really will increase your excitement and building

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trust in these these new tools and technologies

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and the processes.

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Thanks so much, Steve. I think this is

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really great advice, and I especially appreciate that

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point that you said about keeping it simple,

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especially

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in the beginning of deploying this technology, perhaps

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an organization is doing it for the first

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time and,

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keeping it simple can help help them get

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those quick wins, which I imagine would go

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a long way in demonstrating value upfront and

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kind of justifying the investment. So,

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again, great advice for our listeners. And

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before we end our time together today, is

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there anything else you wanted to share that

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maybe we didn't cover already or any final

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takeaways that you'd like our audience to know?

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No. Maybe maybe just reiterate, you know, kinda

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what you just said, you know, making sure

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that your strategy and technology

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initiatives are aligned, getting that early buy in,

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and building bonds with your key stakeholders.

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Keep it simple. Keep it flexible.

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You know, the right use cases,

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proof of concepts, those quick wins, build some

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momentum gradually.

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The quicker you can demonstrate

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value, the quicker you're gonna get not only

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management,

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buy in, and confidence, but also your end

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users, the folks who are actually going to

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be using these solutions,

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and show that value within the organization.

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And just just to kinda wrap it up,

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I mean, you know, Saris I've been, you

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know, in the business for, like I said,

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for 30 years with Saris. I mean, we

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we are a technology leader in the PI

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space, and we've been doing this for a

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long time. So I would just, you know,

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extend the offer to reach out if if

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there are any questions or anything that, you

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know, I could assist with, and,

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my door is always open.

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Fantastic.

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Thank you so much, Steve. Really appreciate the

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time and all of the insights today. It's

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been a great discussion.

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Thank you very much, Eric. I've I've enjoyed

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it, and, it's a it's been a pleasure.

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Well, thank you again, Steve. And we'd also

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like to thank Saris for sponsoring today's episode.

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You can tune into our podcast from Becker's

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Healthcare by visiting our podcast page at beckershospitalreview.com.