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Hi, everyone. This is Lucas Voss with the

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Becker's Healthcare Podcast. Thanks so much for joining

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us today. We have a very exciting topic

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and, more importantly,

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a very exciting

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guest. I'm very thrilled to be joined by

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John Espens, VP Strategy at Cerus,

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who will talk to us about trade offs

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of outsourcing versus internalizing payment integrity solutions. It's

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almost like a philosophical

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discussion, I feel like, John. Thanks for being

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here today.

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Thank you for having me.

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Absolutely. If you could give us just a

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brief introduction to yourself and sort of your

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overview of your work in in health care

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for the audience.

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Sure. Happy to. Well, as you said, my

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name is Jona Spence, vice president of strategy

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here at Cirrus Health. Maybe a little bit

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on Cirrus First. So Cirrus offers a number

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of payment integrity solutions to our health care

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payer partners,

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ensuring, obviously, that claims are paid accurately and

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saving them money.

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As far as my background,

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I would say, like most people in the

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industry, I didn't plan to go into health

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care Mhmm. But rather it kinda found me.

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I started out,

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actually right out of college performing

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collections on behalf of hospitals,

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but it gave me an interesting perspective of

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hospital billing. And then I quickly moved over

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to the insurance side of the industry,

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where I've held a number of different roles,

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hospital negotiations

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to client management,

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to today in my current role of, vice

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president strategy where I act as member of

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the executive leadership team, ensuring our strategy closely

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aligns with that of, the needs of our

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clients, and then, of course, addressing any market

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changes.

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And you mentioned the most important part, saving

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people money. Right?

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Yes. Always. Yeah. That's the the key piece.

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Well, for us to dive into this, I

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think we have to set the stage a

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little bit for where we are today and

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and what everything looks like from your perspective.

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So I I wanted to start with that.

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For for payers,

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what are some of the benefits and and

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drawbacks

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to insourcing right? And then also, what are

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the main factors

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that really tend to influence health plan leaders'

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decisions to insource to go that route or

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not if they choose to?

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Thanks. Yeah. I might start with a few

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benefits

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to in sourcing first. Yeah. Absolutely.

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Yeah. So maybe starting off with probably the

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most obvious benefit being the ability to have

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just complete control of the program operations.

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So as a payer, you know, the vendor

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partner really should be an extension of their

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internal program,

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but the reality is they're giving up some

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level of control when they in source or

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outsource rather.

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We see it from time to time where

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a policy changes or even a a payer's

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philosophy

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around PI changes,

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and they just need to make a change

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very quickly,

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you know, in how they're doing things. So

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for example, a payer may need to go

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from being less provider centric to very provider

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centric,

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maybe to help with a star rating or,

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you know, contracting efforts.

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But in a fully in sourced program allows

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them to make those changes

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very quickly

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so that they can satisfy their own company,

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strategy.

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Another benefit to insourcing, I would say, is

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consistency.

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We've seen some payers in the industry split

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up their payment integrity services,

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between multiple

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vendor partners,

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and it ends up causing differences

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in their work product.

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And, eventually, it causes confusion among their provider

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community.

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Mhmm. So an in source program,

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the payer knows what's going out their door.

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It's consistent,

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and then in turn, it cuts down on

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the provider noise. And that's that's the goal

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of any good PI program is gonna make

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sure that our provider community is happy.

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Now, of course, on the other hand, I

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would argue the drawbacks

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of a program that's a 100% insourced considerably

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outweigh those of the the benefits.

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Mhmm. Maybe a little biased.

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One draw drawback probably being the cost of

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the program.

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The reality is vendors can, you know, offer

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these services much cheaper than payers,

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you know, when they do, you know, try

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to perform these themselves internally.

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It's just been proven time and time again,

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vendors drive a much higher ROI

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than building that internally.

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Mhmm. So if you think about building out

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a full PI program, you need to really

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have knowledge and expertise,

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and those people don't come cheap.

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But even then, the cost of staffing a

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PI program is more than just, you know,

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a person's salary or even the one and

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a half times the person's salary as we

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kinda calculate

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the cost of employing someone.

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Now there are tools and resources

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that those employees will need for that program.

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And a vendor partner already has those in

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place. They have the experienced staff and or

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tools in place that you'll need,

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to stand up a program.

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And that's that's a big benefit too, I

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think, being able to have Yeah. In house.

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Yeah.

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Yeah. Well and then real the reality is

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what they're doing is they're spreading the cost

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of that knowledge across multiple payers. Mhmm. So

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you you're able to spread the cost with

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essentially your competition.

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And then I would say I'll touch on

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just one other, you know, drawback,

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probably the largest drawback, and that is,

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you know, definitely worth mentioning, and that is

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the loss of knowledge. You

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know,

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you lose, I'll say, the entrepreneurship,

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when you in source a program.

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So I've personally seen partners who completely in

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sourced their PI programs

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that just a few short years later have

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come back to the market looking to reengage

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with vendors again.

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And it it's not because they aren't finding

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savings. Right? But because they recognize that they

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aren't finding anything new.

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So things change rapidly in our industry. We

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all know that,

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and ventures are eager to innovate. Right? They

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have to go out and find the next

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big thing to remain competitive. Yeah. You have

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to provide that innovation to be able to

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say, hey. We we need that next step.

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What's next here?

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Exactly. And how do we do that? We

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do that through collaboration.

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But you're not gonna go collaborate with

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your your competition. Right? You're not gonna call

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it Exactly.

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Yeah. Aetna's not gonna call United, we'll say,

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and say, hey. What are you doing? So

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vendors are able to provide that collaboration across

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the industry

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with you know, and doing it delicately without

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kinda sharing any trade secrets.

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So Yeah. And, again, maybe a little,

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biased in this regard, but in sourcing just

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unintentionally

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creates a lack of innovation.

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Yeah. It's very interesting. I didn't think about

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that, and that's certainly something that's that's a

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sort of an added an added factor that

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people should be thinking about as well. And

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one of the things I think that that's

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very interesting that you've you've mentioned a a

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couple of times here

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in our intro question was the fact that

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that control is control of operations is such

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a big piece of this conversation.

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Being able to control the process, being able

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to control the insourcing approach, how does this

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added control provide more flexibility

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in responding to market changes, and how does

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it ultimately impact cost, which is the most

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important piece?

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Yeah. No. You nailed it on the head.

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Right? The importance of control comes down to

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costs.

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You know, let's say a concept you've you

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know, a payer has implemented is wrong or

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it receives a lot of pushback from provider

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community.

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You know, correcting that mistake can be very

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costly if you don't act quickly.

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So and, obviously, there's a an administrative cost

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associated with overturning a concept.

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You know? Ideally, you have a vendor partner

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who you could trust, you know, to do

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it right the first time, but you don't

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wanna be touching a claim more than once.

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And so if something like that happens,

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when you have complete control,

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you can act quickly

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and fix it to cut down on cost

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as much as possible. And that's just, you

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know, one example.

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Yeah. You're able to to react quickly,

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react to change, being able to do that

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and and have that added control. I think

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that that's really key,

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to be able to to create that that

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flexibility

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too, for for an organization.

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And along those lines and I know we've

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we've touched on this a little bit too.

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This space is constantly evolving. There is constant

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innovation like you've said. Right? We need to

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be able to do that to be able

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to move forward,

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regulatory,

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technology,

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the market. Right? The market changes. Those things

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are are key components.

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What are some of the things that you're

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watching today that are important to you,

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and what are what's your advice for health

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plan leaders that really want to maximize this

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process of of insourcing

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in the environment that we're in today?

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Yeah. No. It can be difficult to keep

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up with all of the changes in the

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industry.

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You know, if insourcing is something that a

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payer is passionate about, I think staying in

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front of conferences

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is always a good way to do that.

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Again, I think this is where a a

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vendor partner can be a big help.

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Sirus, we partner with different law firms and

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entities that help us kinda stay

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abreast of what's happening and changing.

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Of course, the biggest trend we're probably all

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of us are watching right now is the

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transition

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of government oversight in health care Yeah. After

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the election.

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You know, it's safe to say we all

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expect to see a change in priorities of

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CMS, especially,

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and potentially some new legislation because of it.

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You know, we can make assumptions on where

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we think those priorities will lie in the

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future,

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but,

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I'll maybe save those for another day. But,

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you know, as a payer community,

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yeah, we just we need to be intentional.

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And, again, I think collaboration is key,

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just to ensure that we are consistent in

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our application

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in the industry as a whole

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and as

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a payer community.

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And then another one I'd say, which is

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still worth calling out, you know, we've seen

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a few things come out of the last

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big security hack in our industry,

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but I do expect there will be a

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a lot more regulatory changes to come out

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of that unfortunate situation.

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So we continue to watch that one closely

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as well,

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to just kinda see what the impact will

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be as we expect some more security

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requirements and things come out of that.

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I think, personally, I think we already have

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our next episode, Janna. I think that that

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that should be it. That should be the

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next episode. I think that's a great topic

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to discuss in terms of what what's next

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for for this space.

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Yeah. So much so much to discuss.

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So many things that that we've mentioned here

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have implications for for a ton of organizations.

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John, I wanna just leave you and give

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you some time if there's anything else that

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you wanna mention that we didn't touch on

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that that might be important for folks that

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are listening today,

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for for their own, operations or in general,

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their own interest. Is there anything else that

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you'd you'd like to mention?

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No. Not really. I'd just say, you know,

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one, thank you for having me. And then,

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of course, I'm always happy to make myself

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available.

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Collaboration and consulting is what Cirrus is known

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for, but it's something I'm also personally passionate

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about. So if anyone in the industry,

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feels the need to reach out, please do.

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I always welcome any dialogue and open to

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just talking about what makes sense in the

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industry.

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And we talked about partnerships. It's important to

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engage vendors for innovation.

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It's important to talk about talk about, talk

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about innovation, talk about, talk about these things

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with partners that that you can trust. I

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think that's really key to drive innovation. Janna,

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thanks so much for your time today and

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and for the great discussion. This was awesome.

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Thank you.

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And I'd also like to thank Sarah's for

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sponsoring this episode today. You can tune in

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to more podcasts from Becker's Healthcare by visiting

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our podcast page at beckershospitalreview.com.