1 00:00:00,080 --> 00:00:02,639 Hi, everyone. This is Erica Spicer Mason with 2 00:00:02,639 --> 00:00:04,960 Becker's Healthcare. Thank you so much for tuning 3 00:00:04,960 --> 00:00:07,379 into the Becker's Healthcare podcast series. 4 00:00:07,759 --> 00:00:09,599 So today, we're going to talk about how 5 00:00:09,599 --> 00:00:12,660 AI and data driven insights are transforming reimbursement 6 00:00:12,880 --> 00:00:16,484 strategy, pair contracting, and value based care readiness. 7 00:00:17,024 --> 00:00:18,864 And joining me for this discussion are two 8 00:00:18,864 --> 00:00:21,425 leaders from the Crane Ware Group. We have 9 00:00:21,425 --> 00:00:22,804 with us Brian Werkinger, 10 00:00:23,344 --> 00:00:25,605 senior vice president of revenue intelligence, 11 00:00:26,064 --> 00:00:29,524 and Laurie Hanlon, vice president of reimbursement policy. 12 00:00:30,300 --> 00:00:32,539 Brian and Laurie, welcome to the podcast. Thank 13 00:00:32,539 --> 00:00:33,899 you so thank you both so much for 14 00:00:33,899 --> 00:00:34,799 being here today. 15 00:00:35,899 --> 00:00:38,079 Thank you for having us. Thank you. 16 00:00:38,859 --> 00:00:40,780 Yeah. Thrilled to have you both. And before 17 00:00:40,780 --> 00:00:42,159 we get into our conversation, 18 00:00:42,539 --> 00:00:44,125 would you both like to say just a 19 00:00:44,125 --> 00:00:46,125 little bit more about yourselves, your role, your 20 00:00:46,125 --> 00:00:46,625 organization? 21 00:00:47,564 --> 00:00:49,424 Brian, maybe you could get us started there. 22 00:00:50,364 --> 00:00:53,405 Happy to, Erica. So Brian working here, senior 23 00:00:53,405 --> 00:00:55,564 vice president of revenue intelligence at the Crane 24 00:00:55,564 --> 00:00:58,539 Ware Group. Group. Me, myself, I've actually been 25 00:00:58,539 --> 00:01:00,780 in the health care industry for for over 26 00:01:00,780 --> 00:01:02,640 twenty years at this point, 27 00:01:04,379 --> 00:01:06,000 coming with a a background 28 00:01:06,619 --> 00:01:09,359 in heavily in the area of pricing and 29 00:01:09,500 --> 00:01:10,400 payer analytics 30 00:01:11,144 --> 00:01:13,784 in the healthcare industry, but that is not 31 00:01:13,784 --> 00:01:14,284 all 32 00:01:14,825 --> 00:01:17,144 what the Crane Ware Group does. That's just 33 00:01:17,144 --> 00:01:17,884 me, myself. 34 00:01:18,905 --> 00:01:21,465 And the Crane Ware Group as a whole 35 00:01:21,465 --> 00:01:22,685 that we're here representing, 36 00:01:23,579 --> 00:01:25,840 they they run the gamut of the revenue 37 00:01:25,899 --> 00:01:28,299 cycle, what is historically known as the revenue 38 00:01:28,299 --> 00:01:30,239 cycle within a health care organization. 39 00:01:30,859 --> 00:01:33,200 Speaking of the provider side that is, 40 00:01:34,459 --> 00:01:36,859 meaning we we get into making sure that 41 00:01:36,859 --> 00:01:39,465 the bill is completely accurate from a coding 42 00:01:39,465 --> 00:01:39,965 standpoint 43 00:01:40,665 --> 00:01:42,584 via what we were founded on from a 44 00:01:42,584 --> 00:01:45,625 CDM management standpoint about over twenty five years 45 00:01:45,625 --> 00:01:46,125 ago, 46 00:01:46,584 --> 00:01:47,084 to 47 00:01:47,385 --> 00:01:49,965 making sure that we're modeling your payer information 48 00:01:50,025 --> 00:01:52,710 appropriately into our platform in order to help 49 00:01:52,710 --> 00:01:53,210 organizations 50 00:01:54,069 --> 00:01:54,810 make decisions, 51 00:01:55,350 --> 00:01:57,049 based on how they're being reimbursed, 52 00:01:57,990 --> 00:02:00,950 doing medical necessity, charge capture. We also have 53 00:02:00,950 --> 00:02:03,430 a whole other arm beside the the revenue 54 00:02:03,430 --> 00:02:05,829 cycle side, which is the pharmacy, business of 55 00:02:05,829 --> 00:02:06,329 pharmacy, 56 00:02:06,755 --> 00:02:09,715 getting into helping organizations with the three forty 57 00:02:09,715 --> 00:02:10,375 b side 58 00:02:10,754 --> 00:02:13,175 and making sure they're tracking those appropriately 59 00:02:13,875 --> 00:02:14,935 and optimizing 60 00:02:15,235 --> 00:02:17,495 areas in the supply chain realm. 61 00:02:18,354 --> 00:02:20,250 Wonderful. Brian, thanks so much. It's really helpful 62 00:02:20,250 --> 00:02:21,930 to know a bit more about the Crane 63 00:02:21,930 --> 00:02:24,490 Ware Group as well, some important work your 64 00:02:24,490 --> 00:02:25,710 organization is doing. 65 00:02:26,250 --> 00:02:27,449 Laurie, would you like to say a little 66 00:02:27,449 --> 00:02:28,830 bit about yourself as well? 67 00:02:29,449 --> 00:02:32,090 Sure. Thanks again for having us. My name 68 00:02:32,090 --> 00:02:34,330 is Laurie Hanlon. I'm currently the vice president 69 00:02:34,330 --> 00:02:34,830 of 70 00:02:35,145 --> 00:02:37,245 reimbursement policy at the Craneware Group. 71 00:02:37,705 --> 00:02:39,544 And as with Brian, I've been in the 72 00:02:39,544 --> 00:02:42,824 industry now for quite some time, over twenty 73 00:02:42,824 --> 00:02:46,185 years approaching well, actually, twenty five plus years 74 00:02:46,185 --> 00:02:47,084 at this point. 75 00:02:47,449 --> 00:02:48,750 And I've been in the space, 76 00:02:49,289 --> 00:02:50,590 focused around reimbursement, 77 00:02:51,049 --> 00:02:53,069 coding, billing, revenue cycle. 78 00:02:53,449 --> 00:02:55,689 I've been in the academic world as an 79 00:02:55,689 --> 00:02:56,189 adjunct 80 00:02:56,650 --> 00:02:57,150 instructor, 81 00:02:57,930 --> 00:03:00,909 for a a large university in Central Ohio. 82 00:03:02,074 --> 00:03:03,754 But, you know, it's near and dear to 83 00:03:03,754 --> 00:03:05,215 my heart as I continue 84 00:03:05,674 --> 00:03:08,074 to go down this path of understanding how 85 00:03:08,074 --> 00:03:08,574 hospitals, 86 00:03:09,034 --> 00:03:10,334 providers are paid 87 00:03:10,715 --> 00:03:12,894 and what can we do to support them. 88 00:03:13,689 --> 00:03:15,370 Laurie, thank you so much for rounding us 89 00:03:15,370 --> 00:03:17,209 out with the intros, and great to know 90 00:03:17,209 --> 00:03:18,650 a bit more about your background and your 91 00:03:18,650 --> 00:03:20,269 work in the academic space too. 92 00:03:20,969 --> 00:03:22,489 And I know the the basis of our 93 00:03:22,489 --> 00:03:24,729 conversation today, you know, we're we're talking a 94 00:03:24,729 --> 00:03:25,305 lot about 95 00:03:25,864 --> 00:03:26,844 payment processes 96 00:03:27,224 --> 00:03:28,444 and and payer contracting, 97 00:03:28,745 --> 00:03:29,965 reimbursement strategy. 98 00:03:30,584 --> 00:03:32,844 And a lot of those areas, we're seeing 99 00:03:32,984 --> 00:03:35,324 greater and greater use of technology 100 00:03:35,704 --> 00:03:36,924 by health care organizations 101 00:03:37,224 --> 00:03:40,284 to really better facilitate those processes and hopefully 102 00:03:40,344 --> 00:03:40,800 see, 103 00:03:41,520 --> 00:03:42,819 more robust reimbursements. 104 00:03:43,680 --> 00:03:45,599 So my first question to you both is 105 00:03:45,599 --> 00:03:48,819 how can AI and predictive modeling help providers 106 00:03:48,879 --> 00:03:52,659 better understand the impact of current utilization patterns 107 00:03:52,719 --> 00:03:55,460 within the context of those payer contract terms? 108 00:03:56,514 --> 00:04:00,034 Yes. Yeah. So we're actually seeing AI and 109 00:04:00,034 --> 00:04:02,854 predictive modeling becoming increasingly central 110 00:04:03,555 --> 00:04:06,534 to how health systems evaluate their payer contracts, 111 00:04:06,594 --> 00:04:07,094 especially 112 00:04:07,875 --> 00:04:11,180 as utilization patterns shift in this post pandemic 113 00:04:11,240 --> 00:04:14,379 world and care really continues to, migrate, 114 00:04:14,840 --> 00:04:17,160 as we've seen it over the years, migrate 115 00:04:17,160 --> 00:04:19,639 to the outpatient settings, and it's increasingly doing 116 00:04:19,639 --> 00:04:20,139 so. 117 00:04:20,839 --> 00:04:21,053 Traditionally, analyzing contract performance required that manual review 118 00:04:21,053 --> 00:04:21,579 and retrospective 119 00:04:22,680 --> 00:04:23,180 claims 120 00:04:35,355 --> 00:04:35,855 reimbursement. 121 00:04:36,620 --> 00:04:39,339 And that's changing. It's exciting, but it it 122 00:04:39,339 --> 00:04:42,779 is changing. And today, organizations are starting to 123 00:04:42,779 --> 00:04:43,279 use 124 00:04:43,740 --> 00:04:46,800 artificial intelligence, as we all know, to interpret 125 00:04:47,020 --> 00:04:49,420 the terms that are embedded in those payer 126 00:04:49,420 --> 00:04:49,920 contracts. 127 00:04:50,300 --> 00:04:52,514 So things like reimbursement logic, 128 00:04:53,155 --> 00:04:56,055 carve outs, or even those tiered payment structures, 129 00:04:56,835 --> 00:04:59,395 and and you pair that with real time 130 00:04:59,395 --> 00:05:01,254 or recently utilization data. 131 00:05:02,194 --> 00:05:05,634 This shows providers it allows providers to model 132 00:05:05,634 --> 00:05:06,935 those what if scenarios. 133 00:05:07,649 --> 00:05:08,550 For example, 134 00:05:09,169 --> 00:05:12,229 what happens if orthopedic cases shift to ambulatory 135 00:05:12,370 --> 00:05:15,889 settings? Or what if emergency department volumes spike 136 00:05:15,889 --> 00:05:16,389 unexpectedly? 137 00:05:17,569 --> 00:05:20,149 The models can forecast the financial implications 138 00:05:20,689 --> 00:05:21,990 across multiple payers, 139 00:05:22,785 --> 00:05:24,725 which obviously will give leaders 140 00:05:25,105 --> 00:05:27,264 much more information and a clearer view of 141 00:05:27,264 --> 00:05:28,725 where their exposure lies. 142 00:05:29,105 --> 00:05:29,845 And importantly, 143 00:05:30,944 --> 00:05:34,564 AI also supports being more, efficient with benchmarking. 144 00:05:35,529 --> 00:05:38,509 It streamlines that process of comparing an organization's 145 00:05:38,649 --> 00:05:40,750 performance to internal targets, 146 00:05:41,290 --> 00:05:42,350 historical baseline, 147 00:05:43,129 --> 00:05:44,810 or even if you went as far as 148 00:05:44,810 --> 00:05:46,589 looking at external peer groups. 149 00:05:47,209 --> 00:05:50,269 This is critical not just for identifying variances, 150 00:05:50,410 --> 00:05:53,685 but also for guiding conversations around strategy, 151 00:05:54,384 --> 00:05:55,685 air delivery optimization, 152 00:05:56,305 --> 00:05:56,805 and 153 00:05:57,105 --> 00:05:59,045 really looking at that contract refinement. 154 00:05:59,985 --> 00:06:02,545 Another really important use as I think we're 155 00:06:02,545 --> 00:06:04,564 all starting to hear more about is 156 00:06:04,979 --> 00:06:05,959 detecting patterns. 157 00:06:06,579 --> 00:06:08,899 So using AI to to do that pattern 158 00:06:08,899 --> 00:06:09,399 detection. 159 00:06:09,939 --> 00:06:10,919 And by analyzing 160 00:06:11,220 --> 00:06:14,579 utilization alongside those contract terms, that we're talking 161 00:06:14,579 --> 00:06:16,759 about, organizations can identify 162 00:06:17,060 --> 00:06:17,560 underperforming 163 00:06:17,939 --> 00:06:18,439 services 164 00:06:19,194 --> 00:06:22,154 or utilization trends that aren't aligning with how 165 00:06:22,154 --> 00:06:23,455 the contracts are structured. 166 00:06:24,394 --> 00:06:26,955 And, really, this is especially relevant as more 167 00:06:26,955 --> 00:06:28,894 payment models introduce complexity, 168 00:06:29,194 --> 00:06:31,435 if you think of, like, those bundled payments 169 00:06:31,435 --> 00:06:33,935 or tiered rates or even site neutral payments. 170 00:06:34,819 --> 00:06:36,979 So as industry moves towards value based care, 171 00:06:36,979 --> 00:06:38,519 which I know we're gonna get into, 172 00:06:39,220 --> 00:06:41,720 as as we believe it's essential for providers 173 00:06:41,779 --> 00:06:44,819 to build those internal capabilities around contract modelings. 174 00:06:44,819 --> 00:06:47,079 And it's really not just for finance teams, 175 00:06:47,459 --> 00:06:49,779 but for those clinical and operational leaders as 176 00:06:49,779 --> 00:06:50,279 well. 177 00:06:50,714 --> 00:06:53,214 And the goal is to shift from reactive 178 00:06:53,915 --> 00:06:54,654 to proactive. 179 00:06:55,754 --> 00:06:56,975 Using that data 180 00:06:57,514 --> 00:06:58,735 to inform service, 181 00:06:59,115 --> 00:06:59,935 line strategy, 182 00:07:00,794 --> 00:07:02,735 maybe understanding risk better, 183 00:07:03,479 --> 00:07:05,500 and preparing for those negotiations, 184 00:07:06,279 --> 00:07:08,220 with much more informed position. 185 00:07:08,759 --> 00:07:10,839 So ultimately, the health care system is heading 186 00:07:10,839 --> 00:07:13,099 towards a more dynamic reimbursement structure. 187 00:07:13,479 --> 00:07:14,699 Providers can combine 188 00:07:15,000 --> 00:07:17,419 that AI driven contract intelligence 189 00:07:18,175 --> 00:07:20,735 with real time utilization insight, and they're gonna 190 00:07:20,735 --> 00:07:22,355 be better positioned to respond 191 00:07:22,975 --> 00:07:26,194 to those market challenges and policy shifts before 192 00:07:26,655 --> 00:07:28,275 they impact that bottom line. 193 00:07:29,134 --> 00:07:31,375 Yeah. Laurie, thank you so much. Really interesting 194 00:07:31,375 --> 00:07:34,040 to hear how technology is really driving this 195 00:07:34,040 --> 00:07:35,180 proactive approach 196 00:07:35,800 --> 00:07:36,540 to contracting, 197 00:07:37,000 --> 00:07:37,500 negotiations, 198 00:07:37,800 --> 00:07:38,300 reimbursement. 199 00:07:38,920 --> 00:07:41,399 So really helpful overview. I I appreciate that 200 00:07:41,399 --> 00:07:42,060 so much. 201 00:07:42,360 --> 00:07:43,899 And you mentioned in your response, 202 00:07:44,600 --> 00:07:47,524 well, you referenced complexity a few times. And 203 00:07:47,524 --> 00:07:48,665 I know that we're seeing 204 00:07:49,125 --> 00:07:53,064 payer and provider contracts becoming increasingly complex. So 205 00:07:53,285 --> 00:07:56,084 can either you or Brian just elaborate a 206 00:07:56,084 --> 00:07:58,104 bit more on how AI can help standardize 207 00:07:58,245 --> 00:08:01,569 information to support better analysis of current payment 208 00:08:01,569 --> 00:08:04,629 terms and also prepare for future contract structures? 209 00:08:05,730 --> 00:08:06,629 Oh, absolutely. 210 00:08:07,730 --> 00:08:11,009 Oh my gosh. And payer contracts today, I 211 00:08:11,009 --> 00:08:12,949 think everybody could agree, 212 00:08:13,410 --> 00:08:14,069 are anything 213 00:08:14,834 --> 00:08:17,095 but uniform, anything but standardized. 214 00:08:17,875 --> 00:08:20,115 As many out there know, even within the 215 00:08:20,115 --> 00:08:21,095 same organization, 216 00:08:21,875 --> 00:08:22,615 same provider, 217 00:08:23,555 --> 00:08:25,975 terms and contract structures can 218 00:08:26,355 --> 00:08:28,375 vary widely across their payers. 219 00:08:28,769 --> 00:08:29,990 You have different methodologies, 220 00:08:30,849 --> 00:08:33,730 different carve outs, different definitions of how you 221 00:08:33,730 --> 00:08:34,950 find those carve outs, 222 00:08:35,330 --> 00:08:36,389 and much more. 223 00:08:36,929 --> 00:08:39,809 And that variability makes it so difficult for 224 00:08:39,809 --> 00:08:42,370 providers to truly understand how they're gonna be 225 00:08:42,370 --> 00:08:44,149 reimbursed and even harder 226 00:08:44,825 --> 00:08:46,044 to compare performance 227 00:08:46,424 --> 00:08:49,004 across payers or negotiate with confidence. 228 00:08:50,264 --> 00:08:52,745 AI is really starting to play a a 229 00:08:52,745 --> 00:08:55,804 really critical role, honestly, in addressing that complexity 230 00:08:56,024 --> 00:08:58,284 by helping to standardize the contract 231 00:08:58,825 --> 00:08:59,325 terms 232 00:08:59,990 --> 00:09:01,669 in a way that they're the way that 233 00:09:01,669 --> 00:09:02,409 they're, like, 234 00:09:02,870 --> 00:09:03,769 essentially interpreted 235 00:09:04,149 --> 00:09:06,569 and then, of course, how we analyze them. 236 00:09:07,029 --> 00:09:10,009 So instead of reviewing each contract manually 237 00:09:11,029 --> 00:09:12,970 and and trying to track down 238 00:09:13,705 --> 00:09:15,004 dozens of reimbursement 239 00:09:15,384 --> 00:09:18,105 logistics and and look at different spreadsheets and 240 00:09:18,105 --> 00:09:18,605 documents, 241 00:09:19,464 --> 00:09:21,325 AI can take that information 242 00:09:21,784 --> 00:09:24,904 and extract it and normalize those contract terms 243 00:09:24,904 --> 00:09:26,365 into a consistent structure. 244 00:09:27,670 --> 00:09:30,170 This enables providers to be able to see 245 00:09:30,230 --> 00:09:31,210 side by side 246 00:09:31,910 --> 00:09:34,710 how similar their services are and how similar 247 00:09:34,710 --> 00:09:37,769 their those services are reimbursed across different agreements 248 00:09:37,910 --> 00:09:40,410 and identify where terms might be misaligned, 249 00:09:41,504 --> 00:09:44,705 with their clinical or operational realities, so what 250 00:09:44,705 --> 00:09:46,085 they're actually doing. 251 00:09:46,545 --> 00:09:48,705 And this is just as important as how 252 00:09:48,705 --> 00:09:51,445 a standardized sets the stage for future planning. 253 00:09:52,065 --> 00:09:53,764 So as payment models evolve, 254 00:09:54,429 --> 00:09:56,129 as we see fee for service 255 00:09:56,509 --> 00:09:59,550 move to more value based, bundled, or perhaps 256 00:09:59,550 --> 00:10:01,730 even in some cases some hybrid models, 257 00:10:02,429 --> 00:10:04,050 providers really need to understand 258 00:10:04,429 --> 00:10:06,529 not only how they're being paid today, 259 00:10:07,394 --> 00:10:09,394 but how those terms could shift in the 260 00:10:09,394 --> 00:10:09,894 future. 261 00:10:10,595 --> 00:10:12,915 AI can help simulate that. It can tell 262 00:10:12,915 --> 00:10:15,175 us what the impact is going to be 263 00:10:15,555 --> 00:10:17,095 of different contract structures, 264 00:10:17,955 --> 00:10:20,915 based on the provider's unique patient population and 265 00:10:20,915 --> 00:10:21,815 service mix. 266 00:10:22,589 --> 00:10:24,269 So at the end, it's you know, really 267 00:10:24,269 --> 00:10:26,529 by building a a standardized view 268 00:10:27,470 --> 00:10:29,949 of existing payment terms and modeling how future 269 00:10:29,949 --> 00:10:31,409 contracts could perform, 270 00:10:32,110 --> 00:10:34,449 providers gain a much clearer path forward. 271 00:10:34,835 --> 00:10:37,095 It supports stronger financial forecasting, 272 00:10:37,875 --> 00:10:39,174 more informed negotiations, 273 00:10:40,434 --> 00:10:43,475 and ultimately ensures that payment structures align again 274 00:10:43,475 --> 00:10:46,595 with both that clinical priority as well as 275 00:10:46,595 --> 00:10:47,654 long term sustainability. 276 00:10:49,120 --> 00:10:51,220 And, Erica, if I can, I mean, 277 00:10:51,600 --> 00:10:54,419 appreciate everything Lori's saying and and 278 00:10:54,879 --> 00:10:57,299 so true, but I'm just gonna comment on 279 00:10:57,759 --> 00:11:00,259 AI as a whole briefly here 280 00:11:00,605 --> 00:11:02,924 on this? So, yes, AI can do all 281 00:11:02,924 --> 00:11:04,764 this, and it's interesting when we talk to 282 00:11:04,764 --> 00:11:05,264 providers 283 00:11:06,365 --> 00:11:09,084 and we say, you know, all of this 284 00:11:09,084 --> 00:11:12,125 is possible with AI. Everybody's extremely hesitant right 285 00:11:12,125 --> 00:11:14,444 now. We heard it at the conference as 286 00:11:14,444 --> 00:11:16,839 well with people saying that they're starting to 287 00:11:16,839 --> 00:11:19,740 introduce AI, and it's how accurate is it. 288 00:11:20,120 --> 00:11:21,799 And it is accurate, and I think it's 289 00:11:21,799 --> 00:11:23,959 just important that it's gonna be a period 290 00:11:23,959 --> 00:11:27,179 of time and a phased approach to organizations 291 00:11:27,639 --> 00:11:28,139 accepting, 292 00:11:29,915 --> 00:11:32,554 this incorporation of AI. It very much so 293 00:11:32,554 --> 00:11:33,754 can do it. Laurie and I see it 294 00:11:33,754 --> 00:11:35,434 with our own hands at the Crane Ware 295 00:11:35,434 --> 00:11:37,294 Group, what it's capable of doing, 296 00:11:37,915 --> 00:11:39,754 but it's getting comfortable because it's not a 297 00:11:39,754 --> 00:11:40,254 human 298 00:11:41,139 --> 00:11:41,639 completely 299 00:11:42,100 --> 00:11:44,339 sort of there. At least that's what people 300 00:11:44,339 --> 00:11:46,360 perceive it to be. But in actuality, 301 00:11:46,820 --> 00:11:48,679 it very much incorporates 302 00:11:49,059 --> 00:11:51,240 human that's driving the AI 303 00:11:51,620 --> 00:11:53,459 and training it to do the things that 304 00:11:53,459 --> 00:11:55,975 Lori has been referencing here. So it's absolutely 305 00:11:56,035 --> 00:11:58,274 fascinating from my standpoint what it's capable of 306 00:11:58,274 --> 00:12:00,355 doing as long as you have the right 307 00:12:00,355 --> 00:12:03,154 people behind it building it to do the 308 00:12:03,154 --> 00:12:04,215 items referenced 309 00:12:04,675 --> 00:12:05,415 by Laurie. 310 00:12:07,329 --> 00:12:09,169 It's such a such an important add on, 311 00:12:09,169 --> 00:12:11,990 Brian. I completely understand where you're coming from 312 00:12:12,370 --> 00:12:15,730 saying how at Becker's annual meeting just a 313 00:12:15,730 --> 00:12:17,809 couple weeks ago, we we certainly hear a 314 00:12:17,809 --> 00:12:20,289 lot of excitement around AI in in the 315 00:12:20,289 --> 00:12:20,789 reimbursement 316 00:12:21,169 --> 00:12:23,855 and payment space, but also, of course, hesitation 317 00:12:24,075 --> 00:12:25,774 concern at the same time. So 318 00:12:26,154 --> 00:12:28,174 I appreciate that clarification there. 319 00:12:28,875 --> 00:12:31,375 And I wanna shift just a bit here 320 00:12:31,595 --> 00:12:33,695 to talk a little bit about Medicare Advantage, 321 00:12:33,834 --> 00:12:35,934 another topic that at the conference, 322 00:12:36,315 --> 00:12:37,615 certainly, no 323 00:12:37,929 --> 00:12:40,029 no shortage of topics and conversations 324 00:12:40,410 --> 00:12:41,950 around MA. But 325 00:12:42,330 --> 00:12:45,290 as we see shifts or potential pullbacks in 326 00:12:45,290 --> 00:12:46,190 Medicare Advantage 327 00:12:46,809 --> 00:12:49,470 in certain markets, especially, what are the implications 328 00:12:49,769 --> 00:12:53,254 for hospitals and patients, especially communities that are 329 00:12:53,254 --> 00:12:54,875 relying on managed care 330 00:12:56,054 --> 00:12:58,154 models? Oh my goodness. This is 331 00:12:58,455 --> 00:13:01,754 certainly an emerging and very important issue. 332 00:13:02,215 --> 00:13:04,134 As as you said, we heard it at 333 00:13:04,134 --> 00:13:04,794 the conference, 334 00:13:05,335 --> 00:13:06,634 in several sessions. 335 00:13:07,095 --> 00:13:07,595 But 336 00:13:08,220 --> 00:13:11,259 as we look across our our makeup, our 337 00:13:11,259 --> 00:13:13,279 our footprint of of our providers, 338 00:13:13,740 --> 00:13:16,620 and in several markets, especially in those rural 339 00:13:16,620 --> 00:13:18,639 areas or even the underserved 340 00:13:19,179 --> 00:13:20,079 urban regions, 341 00:13:20,784 --> 00:13:22,945 Medicare Advantage has filled a a very critical 342 00:13:22,945 --> 00:13:26,065 gap, by providing managed care structures that help 343 00:13:26,065 --> 00:13:27,605 patients navigate the system, 344 00:13:27,985 --> 00:13:29,365 you know, coordinate care, 345 00:13:30,144 --> 00:13:34,245 and really access services beyond what the traditional 346 00:13:34,384 --> 00:13:34,884 Medicare 347 00:13:35,345 --> 00:13:36,085 might offer. 348 00:13:36,750 --> 00:13:38,990 And when we talk about Medicare Advantage going 349 00:13:38,990 --> 00:13:40,769 away or plans 350 00:13:41,149 --> 00:13:44,509 exiting specific geographies, we're not just talking about 351 00:13:44,509 --> 00:13:45,970 a shift in payor mix. 352 00:13:46,429 --> 00:13:49,090 We're really talking about the potential of unraveling 353 00:13:49,230 --> 00:13:50,495 of local care, 354 00:13:50,955 --> 00:13:52,575 the the management infrastructure. 355 00:13:53,595 --> 00:13:55,215 So from a hospital perspective, 356 00:13:55,995 --> 00:13:58,975 the change or disappearance even to an extent 357 00:13:59,035 --> 00:14:01,295 of Medicare Advantage Plans can certainly 358 00:14:02,039 --> 00:14:04,299 disrupt the long established patterns, 359 00:14:04,759 --> 00:14:06,779 care coordination programs, and even 360 00:14:07,159 --> 00:14:10,299 preventative service models. And many hospitals, 361 00:14:11,080 --> 00:14:14,459 particularly those smaller or safety net facilities, 362 00:14:15,065 --> 00:14:18,184 have invested care teams and outpatient supports that 363 00:14:18,184 --> 00:14:20,904 are tied directly to how those Medicare Advantage 364 00:14:20,904 --> 00:14:21,804 plans operate. 365 00:14:23,225 --> 00:14:25,964 So, you know, if those plans exit, 366 00:14:26,664 --> 00:14:27,000 hospitals 367 00:14:27,960 --> 00:14:30,779 find themselves managing a more fragmented patient population 368 00:14:30,919 --> 00:14:32,299 often with fewer resources 369 00:14:32,759 --> 00:14:33,980 and less predictable 370 00:14:34,360 --> 00:14:35,259 care pathways. 371 00:14:35,720 --> 00:14:37,500 For patients, especially 372 00:14:38,200 --> 00:14:39,340 those with chronic conditions, 373 00:14:40,195 --> 00:14:42,514 the loss of managed care can mean losing 374 00:14:42,514 --> 00:14:43,014 access 375 00:14:43,875 --> 00:14:45,575 to disease management programs, 376 00:14:46,034 --> 00:14:48,454 perhaps some transportation services, or even 377 00:14:48,754 --> 00:14:50,134 simple appointment reminders. 378 00:14:50,995 --> 00:14:51,654 The downstream 379 00:14:52,115 --> 00:14:54,294 effect is often a return to the emergency 380 00:14:54,355 --> 00:14:54,855 room 381 00:14:55,409 --> 00:14:58,309 for those unmanaged or preventable issues. 382 00:14:58,929 --> 00:15:00,470 And that's a real concern 383 00:15:01,089 --> 00:15:03,089 in the markets that have already seen a 384 00:15:03,089 --> 00:15:05,110 strain on acute care settings. 385 00:15:06,370 --> 00:15:08,370 What we believe the industry needs to be 386 00:15:08,370 --> 00:15:10,789 doing right now is scenario planning. 387 00:15:11,625 --> 00:15:14,125 Understand where Medicare Advantage participation 388 00:15:14,585 --> 00:15:15,485 may be unstable, 389 00:15:17,144 --> 00:15:21,245 assessing how that affects those local provider networks, 390 00:15:21,865 --> 00:15:24,745 and identify what safety nets or even policy 391 00:15:24,745 --> 00:15:26,605 levers can be put in place. 392 00:15:27,500 --> 00:15:29,840 And, Eric, I'm gonna chime in here again 393 00:15:30,220 --> 00:15:31,980 and take it from a different sort of 394 00:15:32,139 --> 00:15:34,460 not a different completely, but just piggybacking on 395 00:15:34,460 --> 00:15:36,059 some of the things that Laurie was saying 396 00:15:36,059 --> 00:15:37,419 here, but adding to it a little bit 397 00:15:37,419 --> 00:15:39,519 and referencing some of the things that, 398 00:15:40,095 --> 00:15:42,095 we both heard, Laurie and myself and maybe 399 00:15:42,095 --> 00:15:44,975 yourself, Erica, at the conference, the the recent 400 00:15:44,975 --> 00:15:45,794 payer conference. 401 00:15:47,294 --> 00:15:50,095 Beyond just Medicare Advantage, the payer as a 402 00:15:50,095 --> 00:15:50,595 whole 403 00:15:51,615 --> 00:15:54,434 is also looking to potentially shift 404 00:15:55,269 --> 00:15:58,089 maybe the types of plan offerings that they 405 00:15:58,709 --> 00:16:00,549 provide and put on the table in front 406 00:16:00,549 --> 00:16:03,589 of the their consumer, which is technically the 407 00:16:03,589 --> 00:16:05,589 patient that's signing up for the coverage just 408 00:16:05,589 --> 00:16:06,730 like Medicare Advantage. 409 00:16:07,634 --> 00:16:10,455 So either one, either of those avenues, 410 00:16:11,235 --> 00:16:13,554 when you go backwards a little bit in 411 00:16:13,554 --> 00:16:14,455 terms of sort 412 00:16:14,915 --> 00:16:16,675 of, not so much, I mean, well, Craneware 413 00:16:16,675 --> 00:16:17,415 Group does 414 00:16:17,955 --> 00:16:19,095 help providers 415 00:16:19,554 --> 00:16:21,475 and moving away from the payer side, what 416 00:16:21,475 --> 00:16:23,095 this means with this shift 417 00:16:24,779 --> 00:16:26,000 is these patients 418 00:16:26,300 --> 00:16:27,759 that Laurie was referencing 419 00:16:28,220 --> 00:16:30,080 that maybe don't have the coverage, 420 00:16:31,420 --> 00:16:32,720 where do they end up? 421 00:16:33,820 --> 00:16:36,139 They end up going to the emergency department 422 00:16:36,139 --> 00:16:38,024 within the providers. So they don't they don't 423 00:16:38,105 --> 00:16:40,504 have the insurance that they need that puts 424 00:16:40,504 --> 00:16:43,384 them on those necessary plans, which ultimately raises 425 00:16:43,384 --> 00:16:45,305 and increases the cost to the provider to 426 00:16:45,305 --> 00:16:46,904 provide that care because you're coming in as 427 00:16:46,904 --> 00:16:48,125 maybe as a self pay. 428 00:16:48,425 --> 00:16:49,884 Maybe you're a sicker patient. 429 00:16:50,264 --> 00:16:51,004 So then 430 00:16:51,379 --> 00:16:52,899 the care that you need at that point 431 00:16:52,899 --> 00:16:55,080 in time, because you haven't been going along 432 00:16:55,220 --> 00:16:57,379 the path with coverage and getting the care 433 00:16:57,379 --> 00:16:59,459 along the way, you're sicker, you go in 434 00:16:59,459 --> 00:17:01,220 and the cost to provide that care is 435 00:17:01,220 --> 00:17:01,879 much higher, 436 00:17:02,259 --> 00:17:04,440 then that burden is shifted to 437 00:17:04,894 --> 00:17:07,934 the provider to take care of that. How 438 00:17:07,934 --> 00:17:09,855 do they make sure that they are remaining 439 00:17:09,855 --> 00:17:10,355 profitable 440 00:17:10,734 --> 00:17:13,534 from a provider standpoint? Remember, yes, all these 441 00:17:13,534 --> 00:17:15,934 organizations are not considered not for profit, but 442 00:17:15,934 --> 00:17:17,394 at the end of the day, organizations 443 00:17:17,694 --> 00:17:20,220 still need to make money to continue to 444 00:17:20,220 --> 00:17:21,920 provide the care that is necessary 445 00:17:22,539 --> 00:17:24,779 for the market that they serve. So if 446 00:17:24,779 --> 00:17:26,700 these shifts happen that we're talking about, about 447 00:17:26,700 --> 00:17:29,180 the Medicare Advantage maybe shifting and maybe pulling 448 00:17:29,180 --> 00:17:31,259 back a little bit, that's gonna shift to 449 00:17:31,259 --> 00:17:33,664 provide more cost in the organization and sicker 450 00:17:33,664 --> 00:17:36,224 patients that they're taking care of that ultimately 451 00:17:36,224 --> 00:17:36,724 can 452 00:17:37,025 --> 00:17:39,825 lead to an impact on the provider's bottom 453 00:17:39,825 --> 00:17:40,325 line. 454 00:17:40,865 --> 00:17:41,365 Mhmm. 455 00:17:41,744 --> 00:17:44,785 I really appreciate how you both outlined that 456 00:17:44,785 --> 00:17:45,605 so clearly. 457 00:17:45,984 --> 00:17:48,900 What a significant domino effect that is, 458 00:17:49,519 --> 00:17:51,519 both to your points about, you know, how 459 00:17:51,519 --> 00:17:54,799 this ultimately impacts a provider organization, but more 460 00:17:54,799 --> 00:17:56,500 immediately patients as well. 461 00:17:57,200 --> 00:17:59,680 So so really appreciate you both outlining kind 462 00:17:59,680 --> 00:18:01,894 of the the potential consequences of some of 463 00:18:01,894 --> 00:18:03,914 these shifts we're seeing in Medicare Advantage. 464 00:18:04,454 --> 00:18:06,214 And I wanna stick with just for one 465 00:18:06,214 --> 00:18:07,815 more question, I wanna stick on the payer 466 00:18:07,815 --> 00:18:09,654 side for just a moment. You know, we're 467 00:18:09,654 --> 00:18:13,835 seeing growing availability of payer transparency data. So 468 00:18:14,259 --> 00:18:15,720 how do you recommend providers 469 00:18:16,099 --> 00:18:19,079 think about using that information to really generate 470 00:18:19,220 --> 00:18:22,179 meaningful insights and also to support decision making 471 00:18:22,179 --> 00:18:23,079 with their services? 472 00:18:24,740 --> 00:18:26,900 Oh, boy. Erica, there's been a lot of 473 00:18:26,900 --> 00:18:30,184 data put pushed out there at the fingertips 474 00:18:31,125 --> 00:18:33,384 for for everyone, not only the consumer, 475 00:18:33,924 --> 00:18:35,144 but also the, 476 00:18:36,565 --> 00:18:37,464 I guess, vendors, 477 00:18:38,005 --> 00:18:38,664 the government. 478 00:18:38,964 --> 00:18:41,365 There's access to both the payer side, the 479 00:18:41,365 --> 00:18:44,099 hospital side's pushing data out there. But with 480 00:18:44,099 --> 00:18:46,500 the release of this TIC data, what is 481 00:18:46,500 --> 00:18:47,000 transparency 482 00:18:47,940 --> 00:18:50,759 in coverage, what is what people call TIC, 483 00:18:50,900 --> 00:18:52,359 that's on the payer side, 484 00:18:52,980 --> 00:18:55,460 where they had to put out all the 485 00:18:55,460 --> 00:18:56,200 the reimbursement 486 00:18:56,500 --> 00:18:58,815 information in terms of what how they pay 487 00:18:58,815 --> 00:19:00,434 the providers across the country. 488 00:19:01,694 --> 00:19:04,035 It really put it at a whole different 489 00:19:04,095 --> 00:19:06,515 sort of level from a standpoint of visibility 490 00:19:06,575 --> 00:19:07,075 into 491 00:19:07,454 --> 00:19:08,974 what those rates have 492 00:19:09,295 --> 00:19:10,194 what they've negotiated, 493 00:19:11,134 --> 00:19:12,515 across the health systems. 494 00:19:13,829 --> 00:19:16,230 So now, as I was saying, so many 495 00:19:16,230 --> 00:19:18,329 people have access to an overwhelming 496 00:19:18,950 --> 00:19:20,169 volume of raw 497 00:19:20,869 --> 00:19:22,329 rate files from payers 498 00:19:22,630 --> 00:19:25,049 published to comply with federal transparency 499 00:19:25,349 --> 00:19:25,849 regulations. 500 00:19:27,375 --> 00:19:30,095 Although that's a major step forward in our 501 00:19:30,095 --> 00:19:31,394 industry that we're in, 502 00:19:32,255 --> 00:19:35,134 the real opportunity lies in what providers do 503 00:19:35,134 --> 00:19:36,035 with that information. 504 00:19:37,295 --> 00:19:39,455 And how can it be used to support 505 00:19:39,455 --> 00:19:40,195 more constructive, 506 00:19:40,950 --> 00:19:43,369 data informed conversations with payers? 507 00:19:43,909 --> 00:19:45,990 So I will say, yes, it's out there. 508 00:19:45,990 --> 00:19:47,750 But one of the things that that is 509 00:19:47,750 --> 00:19:48,490 so important 510 00:19:49,029 --> 00:19:51,109 to know is how that data is laid 511 00:19:51,109 --> 00:19:53,335 out. And when I say laid out, how 512 00:19:53,335 --> 00:19:55,434 it's been pushed out in files, 513 00:19:55,975 --> 00:19:57,115 it doesn't necessarily 514 00:19:57,414 --> 00:20:00,295 completely align with how maybe a payer contract 515 00:20:00,295 --> 00:20:01,035 is structured. 516 00:20:01,494 --> 00:20:03,035 So it does require, 517 00:20:03,975 --> 00:20:04,795 some, I guess, 518 00:20:05,255 --> 00:20:06,795 additional scrubbing to 519 00:20:07,330 --> 00:20:09,170 almost normalize it and make it so that 520 00:20:09,170 --> 00:20:10,070 it's usable, 521 00:20:11,009 --> 00:20:13,490 for individuals to go back and then try 522 00:20:13,490 --> 00:20:15,650 to figure out what is this saying, what 523 00:20:15,650 --> 00:20:16,549 does this mean. 524 00:20:16,850 --> 00:20:18,630 But what it does drive 525 00:20:19,934 --> 00:20:22,734 is, in my mind, and is a better 526 00:20:22,734 --> 00:20:25,054 partnership, and we and we heard that, I 527 00:20:25,054 --> 00:20:27,154 think, at the payer conference as well. 528 00:20:28,015 --> 00:20:30,015 It's no longer should be looked as an 529 00:20:30,015 --> 00:20:32,255 enemy. You know, I'm either on the payer 530 00:20:32,255 --> 00:20:34,034 side or I'm on the provider side. 531 00:20:34,549 --> 00:20:36,730 This publishing of data is requiring 532 00:20:37,029 --> 00:20:39,029 or leading us in the direction that they 533 00:20:39,029 --> 00:20:40,809 actually truly work together 534 00:20:41,269 --> 00:20:41,769 because 535 00:20:42,150 --> 00:20:44,789 one can't survive without the other. So they 536 00:20:44,789 --> 00:20:45,289 can't 537 00:20:46,230 --> 00:20:49,355 be one-sided and and kinda going against each 538 00:20:49,355 --> 00:20:50,894 other, which is in a way 539 00:20:51,195 --> 00:20:52,735 how the industry has, 540 00:20:53,275 --> 00:20:54,174 I guess, gone 541 00:20:54,634 --> 00:20:55,295 to date. 542 00:20:55,914 --> 00:20:58,394 And and both myself and Lori have been 543 00:20:58,394 --> 00:21:00,235 in the industry for many years and we've 544 00:21:00,235 --> 00:21:01,535 kinda seen it evolve, 545 00:21:02,390 --> 00:21:04,970 in that way to a certain extent. So 546 00:21:05,269 --> 00:21:07,269 that that's what I would say around this. 547 00:21:07,269 --> 00:21:08,970 It's it really ties to 548 00:21:09,429 --> 00:21:11,289 what are we gonna do with that data? 549 00:21:11,750 --> 00:21:13,529 It's out there. So how 550 00:21:13,909 --> 00:21:15,750 how do you you actually use it and 551 00:21:15,750 --> 00:21:16,730 put it to good? 552 00:21:17,545 --> 00:21:18,904 So I don't know, Laurie, if you wanted 553 00:21:18,904 --> 00:21:20,365 to add anything to that. 554 00:21:21,384 --> 00:21:24,025 Yeah. I I think that when we think 555 00:21:24,025 --> 00:21:26,605 about this massive amount of data that's available 556 00:21:26,744 --> 00:21:28,664 at our fingertips and to Brian's point, you 557 00:21:28,664 --> 00:21:31,400 know, however it's used, it's gonna be used 558 00:21:31,400 --> 00:21:33,480 in in different formats and different things and 559 00:21:33,480 --> 00:21:35,640 interpreting it. But at the end of the 560 00:21:35,640 --> 00:21:38,299 day, it's about looking at what's been 561 00:21:38,759 --> 00:21:40,840 published or what's what's out there for for 562 00:21:40,840 --> 00:21:43,900 folks to to absorb and ingest or whatnot. 563 00:21:44,484 --> 00:21:46,565 And it really needs to be looked at 564 00:21:46,565 --> 00:21:48,325 in the sense of it's not just to 565 00:21:48,325 --> 00:21:50,884 compare rates. Right? We're not looking at just 566 00:21:50,884 --> 00:21:53,204 to, say, well, this one pays more than 567 00:21:53,204 --> 00:21:53,944 this one. 568 00:21:54,325 --> 00:21:57,044 It's really there to help both the payer 569 00:21:57,044 --> 00:21:58,664 and the provider understand 570 00:21:59,650 --> 00:22:01,829 and and get the why behind the numbers 571 00:22:02,049 --> 00:22:05,410 so providers can really approach payers with more 572 00:22:05,410 --> 00:22:09,089 clear evidence based questions. So coming to them 573 00:22:09,089 --> 00:22:09,750 and saying, 574 00:22:10,049 --> 00:22:11,650 well, you know, where are the rates not 575 00:22:11,650 --> 00:22:14,505 aligned with the market or service intensity or 576 00:22:14,505 --> 00:22:16,825 maybe even looking into how can we ensure 577 00:22:16,825 --> 00:22:19,325 reimbursement models reflect clinical realities 578 00:22:20,025 --> 00:22:21,325 and operational investments. 579 00:22:21,784 --> 00:22:23,565 So when really when this information 580 00:22:23,865 --> 00:22:25,005 is used thoughtfully, 581 00:22:25,700 --> 00:22:28,099 the data becomes a tool for collaboration, like 582 00:22:28,099 --> 00:22:31,059 Brian mentioned, and and helping to identify those 583 00:22:31,059 --> 00:22:31,880 shared goals 584 00:22:32,500 --> 00:22:33,559 across access, 585 00:22:34,339 --> 00:22:35,559 quality, and 586 00:22:35,859 --> 00:22:36,920 even sustainability. 587 00:22:37,700 --> 00:22:40,375 Mhmm. So as health care systems benefit, when 588 00:22:40,375 --> 00:22:41,815 we're looking at both the provider and the 589 00:22:41,815 --> 00:22:44,134 payer, when they're working from that common set 590 00:22:44,134 --> 00:22:47,494 of facts, if you will, you've got more 591 00:22:47,494 --> 00:22:48,714 information about 592 00:22:49,414 --> 00:22:51,335 what do we have available to us and 593 00:22:51,335 --> 00:22:53,595 how can we work together to strengthen 594 00:22:53,894 --> 00:22:55,194 those relationships. 595 00:22:56,029 --> 00:22:59,649 Shifting the conversation from reactive disputes to more 596 00:22:59,869 --> 00:23:00,849 proactive alignment. 597 00:23:01,710 --> 00:23:02,210 Mhmm. 598 00:23:02,509 --> 00:23:05,809 Yeah. Laurie, Brian, I really appreciate these insights, 599 00:23:05,869 --> 00:23:08,769 and it sounds like the data is there. 600 00:23:09,205 --> 00:23:11,445 It's just perhaps not in a perfect format 601 00:23:11,445 --> 00:23:13,285 yet, but it's going in a direction of 602 00:23:13,285 --> 00:23:16,025 supporting this more collaborative relationship between 603 00:23:16,484 --> 00:23:17,625 providers and payers. 604 00:23:18,325 --> 00:23:19,845 And and I think that we're seeing that 605 00:23:19,845 --> 00:23:21,785 in other areas too, especially 606 00:23:22,390 --> 00:23:24,869 value based care payment models. You know, there's, 607 00:23:24,869 --> 00:23:27,769 of course, payers and providers alike are interested 608 00:23:27,829 --> 00:23:29,750 in the in the outcomes and the benefits 609 00:23:29,750 --> 00:23:30,650 of those models. 610 00:23:31,269 --> 00:23:33,529 And so my final question for our conversation 611 00:23:33,589 --> 00:23:35,429 today, you know, as we're thinking about value 612 00:23:35,429 --> 00:23:37,349 based care and how it continues to grow 613 00:23:37,349 --> 00:23:38,009 and evolve, 614 00:23:38,414 --> 00:23:40,335 how should providers be foe what should they 615 00:23:40,335 --> 00:23:42,975 be focusing on to succeed in those models? 616 00:23:42,975 --> 00:23:45,315 And how can better analysis and partnership 617 00:23:45,695 --> 00:23:47,055 to both of your points play a role 618 00:23:47,055 --> 00:23:47,955 in that success? 619 00:23:49,455 --> 00:23:50,275 Yeah. So 620 00:23:51,695 --> 00:23:52,914 value based payment, 621 00:23:54,009 --> 00:23:56,009 This has been talked about even back when 622 00:23:56,009 --> 00:23:56,750 I entered, 623 00:23:57,369 --> 00:23:59,289 different forms of it back when I entered 624 00:23:59,289 --> 00:24:00,029 the industry. 625 00:24:01,450 --> 00:24:03,450 Still have a ton of fee for service 626 00:24:03,450 --> 00:24:05,450 that's out there, although it's shrinking. But when 627 00:24:05,450 --> 00:24:07,230 you look at value based payment, 628 00:24:08,434 --> 00:24:10,115 it it really isn't new because, again, it's 629 00:24:10,115 --> 00:24:11,954 been talked about for many years, but what 630 00:24:11,954 --> 00:24:14,375 we're really seeing is a broadening and deepening 631 00:24:14,914 --> 00:24:15,815 of these models 632 00:24:17,154 --> 00:24:20,515 extending beyond primary care. So it's no longer 633 00:24:20,515 --> 00:24:23,380 just about hitting a few quality metrics or 634 00:24:23,380 --> 00:24:24,440 reducing readmissions. 635 00:24:24,819 --> 00:24:25,559 For providers, 636 00:24:26,099 --> 00:24:27,799 that means a shift in focus. 637 00:24:29,059 --> 00:24:32,519 As value based care expands across more services 638 00:24:32,579 --> 00:24:33,799 and patient populations, 639 00:24:34,660 --> 00:24:35,960 providers are under 640 00:24:37,195 --> 00:24:38,255 increasing pressure 641 00:24:38,715 --> 00:24:39,535 to balance, 642 00:24:40,875 --> 00:24:42,335 let's say clinical outcomes 643 00:24:42,715 --> 00:24:43,615 with financial 644 00:24:43,994 --> 00:24:44,494 sustainability. 645 00:24:45,275 --> 00:24:47,674 It's no longer enough to manage a revenue 646 00:24:47,674 --> 00:24:48,494 cycle efficiently. 647 00:24:49,840 --> 00:24:52,880 Health systems now need to understand the true 648 00:24:52,880 --> 00:24:55,059 cost of care to maintain competitive, 649 00:24:55,440 --> 00:24:57,299 to remain accountable under these models. 650 00:24:57,759 --> 00:24:59,279 And and that's a key piece. So one 651 00:24:59,279 --> 00:25:01,519 of the things that they heavily talk about 652 00:25:01,519 --> 00:25:03,860 with value based payment is the payment 653 00:25:04,304 --> 00:25:06,565 and making sure you're hitting the quality metrics, 654 00:25:06,944 --> 00:25:09,105 making you sure you're hitting all the different 655 00:25:09,105 --> 00:25:09,605 levers 656 00:25:10,065 --> 00:25:12,625 to actually receive the payment. But in all 657 00:25:12,625 --> 00:25:13,125 actuality, 658 00:25:14,384 --> 00:25:15,684 there's there's a fundamental 659 00:25:15,984 --> 00:25:17,365 piece that's being missed. 660 00:25:18,009 --> 00:25:20,089 That's great that you, as a provider, you're 661 00:25:20,089 --> 00:25:22,349 getting the payment and you have this model. 662 00:25:22,569 --> 00:25:24,910 But if you're not managing the overall 663 00:25:26,009 --> 00:25:26,990 margin management, 664 00:25:27,450 --> 00:25:29,609 which you're looking at the revenue piece with 665 00:25:29,609 --> 00:25:31,835 the payment, but if you're you are not 666 00:25:31,835 --> 00:25:34,394 factoring in the true cost of care that's 667 00:25:34,394 --> 00:25:35,375 in that model, 668 00:25:35,914 --> 00:25:37,754 that that's great that we've gone to value 669 00:25:37,754 --> 00:25:38,494 based payment. 670 00:25:39,434 --> 00:25:42,234 Hospitals are gonna sink because they're not managing 671 00:25:42,234 --> 00:25:43,914 their margin and making sure that they're also 672 00:25:43,914 --> 00:25:46,019 paying attention to the cost to provide that 673 00:25:46,019 --> 00:25:48,339 care there. And it no longer can we 674 00:25:48,339 --> 00:25:51,940 rely on the standard RCC model, the ratio 675 00:25:51,940 --> 00:25:53,940 of cost to charge model, which is a 676 00:25:53,940 --> 00:25:55,779 true is more of an estimate of what 677 00:25:55,779 --> 00:25:57,480 it costs to provide the care. 678 00:25:57,940 --> 00:25:59,779 You need to get down to a true 679 00:25:59,779 --> 00:26:01,335 cost of care or what would also 680 00:26:13,174 --> 00:26:15,680 cause it's not because it's not like a 681 00:26:15,680 --> 00:26:16,180 manufacturing 682 00:26:17,200 --> 00:26:18,420 industry, healthcare. 683 00:26:18,880 --> 00:26:21,059 We've lived in a whole different realm 684 00:26:21,759 --> 00:26:22,259 today 685 00:26:23,359 --> 00:26:25,440 and still do for the most part. There's 686 00:26:25,440 --> 00:26:26,500 very few organizations 687 00:26:26,799 --> 00:26:28,960 that you could go to and say, I 688 00:26:28,960 --> 00:26:30,375 understand my true cost. 689 00:26:31,174 --> 00:26:32,855 It's an estimate off of a ratio of 690 00:26:32,855 --> 00:26:35,755 cost to charge. So it is absolutely fantastic 691 00:26:35,974 --> 00:26:38,075 that the industry is moving towards 692 00:26:38,375 --> 00:26:40,295 value based payment. And I'm not sure what 693 00:26:40,295 --> 00:26:42,875 the numbers are in terms of lives covered 694 00:26:43,509 --> 00:26:46,169 under a value based payment model. I know 695 00:26:46,470 --> 00:26:48,470 it's growing to your point, Erica. It is 696 00:26:48,470 --> 00:26:49,849 definitely going up. 697 00:26:50,150 --> 00:26:52,150 I think it's still a a ways away 698 00:26:52,150 --> 00:26:52,650 because 699 00:26:53,750 --> 00:26:55,994 people have to get that understanding of what 700 00:26:55,994 --> 00:26:57,914 that cost is in that model. And I 701 00:26:57,914 --> 00:27:00,174 think that's a missing component to really 702 00:27:00,714 --> 00:27:03,454 springboard us forward in these payment models. 703 00:27:05,035 --> 00:27:08,234 Yeah. Fantastic points, Brian. Thank you. And, Laurie, 704 00:27:08,234 --> 00:27:10,654 before we close, just wanna check-in with you. 705 00:27:11,140 --> 00:27:13,299 Any final thoughts on value based care or 706 00:27:13,299 --> 00:27:14,599 anything else from our discussion? 707 00:27:15,859 --> 00:27:18,179 No. This has been great. I appreciate the 708 00:27:18,179 --> 00:27:20,519 opportunity to be able to dig into these 709 00:27:20,900 --> 00:27:23,779 very near and dear topics to our hearts. 710 00:27:24,339 --> 00:27:26,599 And it so this has been really helpful 711 00:27:26,794 --> 00:27:28,095 to be able to talk through. 712 00:27:28,875 --> 00:27:29,694 Yeah. Fantastic. 713 00:27:29,994 --> 00:27:32,154 Well, Brian, Laurie, it's been great having you 714 00:27:32,154 --> 00:27:34,734 both and your expertise on the podcast today. 715 00:27:34,954 --> 00:27:36,954 So thank you so much again for being 716 00:27:36,954 --> 00:27:38,794 here. And, of course, we'd like to also 717 00:27:38,794 --> 00:27:40,954 thank our sponsor for today, the Crane Ware 718 00:27:40,954 --> 00:27:41,454 Group. 719 00:27:41,890 --> 00:27:43,809 Listeners, be sure to tune into more podcasts 720 00:27:43,809 --> 00:27:46,609 from Becker's by visiting our podcast page at 721 00:27:46,609 --> 00:27:48,789 beckershospitalreview.com.