1 00:00:00,080 --> 00:00:02,799 Hello, everyone. This is Erica Spicer Mason with 2 00:00:02,799 --> 00:00:05,200 Becker's Healthcare. Thank you so much for tuning 3 00:00:05,200 --> 00:00:07,779 into the Becker's Healthcare podcast series today. 4 00:00:08,240 --> 00:00:10,400 So today, we're going to cover why health 5 00:00:10,400 --> 00:00:13,299 plans are rethinking fragmented pricing operations 6 00:00:13,804 --> 00:00:16,144 and some strategies to break through those silos. 7 00:00:16,685 --> 00:00:18,765 And joining me for this conversation is Jay 8 00:00:18,765 --> 00:00:19,265 Deedy, 9 00:00:19,565 --> 00:00:21,265 the president of price optimization 10 00:00:21,565 --> 00:00:22,304 at Xelliss. 11 00:00:22,925 --> 00:00:25,005 Jay, welcome to the podcast. Thank you so 12 00:00:25,005 --> 00:00:26,304 much for joining us today. 13 00:00:26,685 --> 00:00:28,925 Thank you. So nice to be here. Appreciate 14 00:00:28,925 --> 00:00:29,425 it. 15 00:00:29,859 --> 00:00:32,260 Oh, we're thrilled to have you. And before 16 00:00:32,260 --> 00:00:34,420 we talk a little bit more about pricing 17 00:00:34,420 --> 00:00:36,840 operations, I wanted to learn more about you 18 00:00:36,979 --> 00:00:38,659 and share more about your background with our 19 00:00:38,659 --> 00:00:40,579 listeners. So can you just give us kind 20 00:00:40,579 --> 00:00:41,560 of a broad overview 21 00:00:41,865 --> 00:00:44,024 of yourself, your work in health care, whatever 22 00:00:44,024 --> 00:00:46,045 feels helpful for our listeners to know? 23 00:00:46,745 --> 00:00:49,704 Sure, Erica. Thanks. Yes. As as you mentioned, 24 00:00:49,704 --> 00:00:52,125 I I run the, price optimization 25 00:00:52,825 --> 00:00:54,045 division of Xelliss 26 00:00:54,745 --> 00:00:55,245 where, 27 00:00:55,550 --> 00:00:57,810 you know, the team and I really focus 28 00:00:58,109 --> 00:00:58,609 on, 29 00:00:59,550 --> 00:01:00,210 two items. 30 00:01:00,750 --> 00:01:03,469 One is the pricing of of a claim 31 00:01:03,469 --> 00:01:05,630 in health care, and the other is payment 32 00:01:05,630 --> 00:01:06,130 integrity. 33 00:01:06,829 --> 00:01:09,915 You could think about it like a restaurant 34 00:01:09,915 --> 00:01:12,734 check, if you will, that payment integrity ensures 35 00:01:12,795 --> 00:01:15,134 that the correct items are listed, 36 00:01:15,915 --> 00:01:18,174 on the check you receive. And then 37 00:01:18,634 --> 00:01:21,274 the pricing part, of course, whether it's out 38 00:01:21,274 --> 00:01:23,375 of network, in network, network replacement, 39 00:01:24,850 --> 00:01:25,350 verifies 40 00:01:25,730 --> 00:01:28,450 sort of the optimized price of the correct 41 00:01:28,450 --> 00:01:31,170 items. So that's what we focus on on 42 00:01:31,170 --> 00:01:31,909 at Xelliss. 43 00:01:32,850 --> 00:01:35,329 I've been here it'll be five years this 44 00:01:35,329 --> 00:01:35,829 December, 45 00:01:36,355 --> 00:01:39,295 and it's it's been an amazing opportunity to 46 00:01:39,474 --> 00:01:41,015 help grow this great organization. 47 00:01:41,715 --> 00:01:44,454 Prior to Xelliss, I ran a number of 48 00:01:44,834 --> 00:01:47,474 AI based companies on the revenue cycle side 49 00:01:47,474 --> 00:01:49,494 and clinical side, Recondo Technology 50 00:01:50,290 --> 00:01:51,030 in Denver, 51 00:01:51,649 --> 00:01:53,269 on the revenue cycle side, 52 00:01:53,729 --> 00:01:54,869 as well as, 53 00:01:55,649 --> 00:01:56,149 Javion, 54 00:01:56,530 --> 00:01:59,349 which is a clinical AI company. And previously, 55 00:01:59,810 --> 00:02:01,269 I really kinda grew up, 56 00:02:01,729 --> 00:02:03,864 in the e m EMR explosion. I've been 57 00:02:03,864 --> 00:02:05,784 in health care IT for over thirty four 58 00:02:05,784 --> 00:02:06,284 years, 59 00:02:06,744 --> 00:02:09,645 and I've held senior management officer positions 60 00:02:10,264 --> 00:02:11,965 at companies like Cerner, 61 00:02:12,745 --> 00:02:15,004 ADAC Healthcare, McKesson, and Eclipses, 62 00:02:15,770 --> 00:02:19,050 where I focused on electronic medical records and 63 00:02:19,050 --> 00:02:19,949 then the patient 64 00:02:20,569 --> 00:02:22,830 billing experience. And now, 65 00:02:23,530 --> 00:02:24,349 at Xelliss 66 00:02:24,650 --> 00:02:25,870 looking at the entire 67 00:02:26,250 --> 00:02:29,209 sort of health care journey from both a 68 00:02:29,209 --> 00:02:29,709 provider, 69 00:02:30,009 --> 00:02:31,925 payer, and member perspective. 70 00:02:32,465 --> 00:02:35,685 So dedicated my entire career to health IT 71 00:02:35,905 --> 00:02:37,685 on one side or the other and 72 00:02:38,224 --> 00:02:40,724 certain certainly enjoying my career here at Xelliss. 73 00:02:41,344 --> 00:02:43,425 Mhmm. It's great to learn more about you, 74 00:02:43,425 --> 00:02:45,569 Jay. Thank you so much. And I love 75 00:02:45,569 --> 00:02:47,030 how when you were describing 76 00:02:47,330 --> 00:02:49,430 the work that Xelliss does, you were 77 00:02:49,889 --> 00:02:51,810 sharing a metaphor of it, thinking of it 78 00:02:51,810 --> 00:02:53,409 as a restaurant check, and I think that's 79 00:02:53,409 --> 00:02:54,150 really helpful, 80 00:02:54,769 --> 00:02:56,610 as we're we're kinda talking about some more 81 00:02:56,610 --> 00:02:59,330 complex topics here, like payment integrity, pricing of 82 00:02:59,330 --> 00:02:59,830 claims. 83 00:03:00,555 --> 00:03:01,375 So, again, appreciate 84 00:03:01,915 --> 00:03:03,915 the metaphor, your background, and sounds like you 85 00:03:03,915 --> 00:03:05,435 have a ton of experience in this field. 86 00:03:05,435 --> 00:03:05,935 So, 87 00:03:06,555 --> 00:03:08,955 just excited to dig into pricing operations here 88 00:03:08,955 --> 00:03:09,935 a little bit more. 89 00:03:10,715 --> 00:03:12,895 Let's go. Yeah. Let's go. 90 00:03:13,510 --> 00:03:16,409 I know pricing ops have really been fragmented 91 00:03:16,790 --> 00:03:17,930 across health plans 92 00:03:18,389 --> 00:03:20,389 to date. So what do you see as 93 00:03:20,389 --> 00:03:22,010 some of the most common inefficiencies 94 00:03:22,310 --> 00:03:23,930 or even missed opportunities, 95 00:03:24,550 --> 00:03:27,430 and what risks come with continued fragmentation in 96 00:03:27,430 --> 00:03:28,090 this space? 97 00:03:29,395 --> 00:03:31,335 Sure. I I think it's fairly 98 00:03:31,875 --> 00:03:32,375 analogous 99 00:03:32,754 --> 00:03:33,735 in some ways 100 00:03:34,275 --> 00:03:37,014 to the electronic medical record industry, 101 00:03:37,794 --> 00:03:39,474 quite a bit. And that's when I first 102 00:03:39,474 --> 00:03:41,495 interviewed at Xelliss and saw the opportunity, 103 00:03:42,030 --> 00:03:43,889 It was sort of like I was rewatching 104 00:03:44,030 --> 00:03:44,689 a play 105 00:03:44,990 --> 00:03:45,810 in my mind. 106 00:03:46,110 --> 00:03:47,650 And what I mean by that is, 107 00:03:48,030 --> 00:03:50,909 in the nineties and early two thousands on 108 00:03:50,909 --> 00:03:51,569 the clinical 109 00:03:51,870 --> 00:03:53,090 side of health IT, 110 00:03:53,789 --> 00:03:56,734 you had individually sold solutions 111 00:03:57,275 --> 00:03:59,055 like laboratory and radiology 112 00:03:59,435 --> 00:04:02,314 and emergency room and surgery, and there were 113 00:04:02,314 --> 00:04:04,014 probably 12 to 14 114 00:04:04,555 --> 00:04:05,614 different segments 115 00:04:06,314 --> 00:04:08,715 of solutions that each of which had probably 116 00:04:08,715 --> 00:04:11,590 three to five pretty developed good companies. 117 00:04:12,290 --> 00:04:14,230 And then there would be interfaces 118 00:04:14,930 --> 00:04:17,589 to share a portion of the data 119 00:04:18,210 --> 00:04:21,029 that was available on each of those systems 120 00:04:21,410 --> 00:04:22,949 across a single patient. 121 00:04:23,435 --> 00:04:24,875 But it was it was only a little 122 00:04:24,875 --> 00:04:26,475 bit of the data that could be shared 123 00:04:26,475 --> 00:04:28,154 from one system to to the other. It 124 00:04:28,154 --> 00:04:31,134 was highly fragmented. It was expensive and inefficient 125 00:04:31,355 --> 00:04:31,935 to try 126 00:04:32,235 --> 00:04:33,455 to weave that together. 127 00:04:34,074 --> 00:04:37,514 And here on the revenue cycle side, it's 128 00:04:37,514 --> 00:04:38,335 pretty similar. 129 00:04:38,714 --> 00:04:40,250 When I went through what we 130 00:04:40,789 --> 00:04:44,009 do at Xelliss in the price optimization division, 131 00:04:44,149 --> 00:04:47,909 we have multiple pricing solutions so that we 132 00:04:47,909 --> 00:04:50,709 can do in network pricing, out of network 133 00:04:50,709 --> 00:04:51,209 pricing, 134 00:04:51,764 --> 00:04:52,264 network 135 00:04:52,805 --> 00:04:55,144 replacement, or essentially no network pricing. 136 00:04:55,604 --> 00:04:57,764 And then you have payment integrity as well 137 00:04:57,764 --> 00:05:01,384 where you're verifying those right menu items related 138 00:05:01,524 --> 00:05:04,425 to kind of supplies, but also highly complex 139 00:05:04,564 --> 00:05:05,064 expensive 140 00:05:05,879 --> 00:05:06,379 clinical, 141 00:05:06,840 --> 00:05:10,540 procedures, etcetera. And so, you know, our approach 142 00:05:11,319 --> 00:05:14,139 is to take a single claim in 143 00:05:14,680 --> 00:05:17,340 and be able to offer all those solutions, 144 00:05:17,560 --> 00:05:20,300 which is a multiplier effect, if you will, 145 00:05:20,845 --> 00:05:23,264 of being able to to do that similar 146 00:05:23,645 --> 00:05:27,485 once electronic medical records became integrated in single 147 00:05:27,485 --> 00:05:27,985 platforms. 148 00:05:28,605 --> 00:05:30,925 And instead of having to do business with 149 00:05:30,925 --> 00:05:33,665 eight, ten, twelve, fourteen, 16 different companies, 150 00:05:34,290 --> 00:05:36,689 you could get a single complete platform. And 151 00:05:36,689 --> 00:05:39,009 that's really what we're trying to do here 152 00:05:39,009 --> 00:05:41,829 at Xelliss on the revenue cycle side is 153 00:05:42,129 --> 00:05:44,389 allow our clients not have to 154 00:05:44,850 --> 00:05:47,730 try to integrate, which again is expensive, and 155 00:05:47,730 --> 00:05:48,230 coordinate 156 00:05:48,610 --> 00:05:50,544 and have, you know, time consuming 157 00:05:51,084 --> 00:05:54,284 relationships with five, six, seven, eight, nine, ten 158 00:05:54,284 --> 00:05:55,344 different vendors. 159 00:05:56,685 --> 00:05:59,104 But in addition to that, get the multiplier 160 00:05:59,404 --> 00:06:02,044 of the data effect of it coming from 161 00:06:02,044 --> 00:06:02,784 us. So 162 00:06:03,189 --> 00:06:05,449 it's it's that's the approach. The fragmentation 163 00:06:06,629 --> 00:06:09,050 really drives up the cost and the inefficiency 164 00:06:09,189 --> 00:06:10,470 of health care at the end of the 165 00:06:10,470 --> 00:06:10,970 day. 166 00:06:11,670 --> 00:06:13,350 Yeah. Jay, thank you so much for the 167 00:06:13,350 --> 00:06:16,154 overview. I was going to ask you what's 168 00:06:16,154 --> 00:06:17,694 kind of driving this urgency 169 00:06:18,074 --> 00:06:18,975 to address 170 00:06:19,355 --> 00:06:21,514 fragmentation, but it sounds like to your point 171 00:06:21,514 --> 00:06:23,694 that you just made, cost concerns, 172 00:06:24,074 --> 00:06:26,394 perhaps administrative burden. Do you see those as 173 00:06:26,394 --> 00:06:28,714 really making this a more urgent need in 174 00:06:28,714 --> 00:06:29,454 health care? 175 00:06:30,350 --> 00:06:33,170 Yeah. Absolutely. I I would say there's there's 176 00:06:33,949 --> 00:06:36,189 maybe three. One is that health care in 177 00:06:36,189 --> 00:06:37,490 general is becoming 178 00:06:38,350 --> 00:06:40,750 more consumer driven. It's taken quite a quite 179 00:06:40,750 --> 00:06:42,910 a while, but I think the digital tools 180 00:06:42,910 --> 00:06:43,725 that are in 181 00:06:44,125 --> 00:06:47,985 members and consumers' hands have really helped them, 182 00:06:48,125 --> 00:06:50,125 you know, shop as well as help to 183 00:06:50,125 --> 00:06:51,345 manage the financial, 184 00:06:52,444 --> 00:06:55,024 aspect of health care. And so there's just 185 00:06:55,245 --> 00:06:56,464 increasing demands 186 00:06:57,250 --> 00:06:58,550 for more comprehensive 187 00:06:59,490 --> 00:07:02,310 single solutions coming from the members themselves. 188 00:07:03,410 --> 00:07:06,310 I also think that just the cost pressure 189 00:07:06,449 --> 00:07:08,769 is mounting. If you look recently in the 190 00:07:08,769 --> 00:07:09,269 earnings 191 00:07:09,714 --> 00:07:11,714 and what's happening in the number of CEO 192 00:07:11,714 --> 00:07:15,014 changer changes in the health care insurance industry, 193 00:07:16,035 --> 00:07:18,115 you can see that the industry is under 194 00:07:18,115 --> 00:07:19,814 a lot of pressure right now. 195 00:07:20,435 --> 00:07:23,569 And so cutting costs and increasing efficiency 196 00:07:23,949 --> 00:07:26,430 is a big focus and driver for the 197 00:07:26,430 --> 00:07:27,810 payers of health care. 198 00:07:28,350 --> 00:07:30,589 And then not to be underestimated though is 199 00:07:30,589 --> 00:07:33,729 the continued regulatory pressure and compliance where 200 00:07:34,045 --> 00:07:35,025 you have federal 201 00:07:35,564 --> 00:07:36,064 regulatory, 202 00:07:36,925 --> 00:07:39,884 compliance, items like no surprise billing act and 203 00:07:39,884 --> 00:07:42,064 requirements associated with that and 204 00:07:42,365 --> 00:07:44,145 processes on how to 205 00:07:44,525 --> 00:07:47,425 arrive at fair pricing and appeal those decisions. 206 00:07:48,189 --> 00:07:50,670 But for fully insured markets, you also have 207 00:07:50,670 --> 00:07:51,490 state based 208 00:07:51,949 --> 00:07:53,170 solutions that, 209 00:07:53,629 --> 00:07:55,550 take the place of some of the federal 210 00:07:55,550 --> 00:07:58,750 requirements in 14 or 15 states, including Texas, 211 00:07:58,750 --> 00:07:59,970 which is getting incredibly 212 00:08:00,589 --> 00:08:01,875 complex. So, 213 00:08:02,834 --> 00:08:05,714 for small companies only doing a piece of 214 00:08:05,714 --> 00:08:08,035 what I've described in terms of the solution 215 00:08:08,035 --> 00:08:10,834 capabilities or for some payers that are trying 216 00:08:10,834 --> 00:08:11,735 to do it themselves, 217 00:08:12,274 --> 00:08:14,774 you know, the combination of those financial pressures 218 00:08:14,915 --> 00:08:18,810 and increased regulatory and compliance investments, it's very 219 00:08:18,810 --> 00:08:21,470 challenging to do that unless you're at scale. 220 00:08:22,569 --> 00:08:23,470 Yeah. Absolutely. 221 00:08:24,410 --> 00:08:26,110 Appreciate those add ons, Jay. 222 00:08:26,569 --> 00:08:28,569 And I know you've touched a bit already 223 00:08:28,569 --> 00:08:30,110 on kind of how the technology 224 00:08:30,995 --> 00:08:33,394 works and and how Xelliss is helping to 225 00:08:33,394 --> 00:08:35,095 address some of these issues with fragmentation. 226 00:08:35,714 --> 00:08:37,075 But can you say a little bit more 227 00:08:37,075 --> 00:08:37,815 about how 228 00:08:38,195 --> 00:08:41,554 infrastructure data and technology are really shaping the 229 00:08:41,554 --> 00:08:44,355 future of pricing for health plans? And how 230 00:08:44,355 --> 00:08:46,080 is this paving the way for a more 231 00:08:46,480 --> 00:08:49,519 connected or seamless financial experience across that care 232 00:08:49,519 --> 00:08:50,019 continuum? 233 00:08:51,360 --> 00:08:53,460 Sure. I think part of it is just 234 00:08:53,519 --> 00:08:55,220 now starting to use AI, 235 00:08:55,920 --> 00:08:58,559 on top of what historically had more recently 236 00:08:58,559 --> 00:09:00,500 been referred to as predictive analytics 237 00:09:01,174 --> 00:09:04,375 is incredibly important so that when you're trying 238 00:09:04,375 --> 00:09:05,834 to arrive at, 239 00:09:06,534 --> 00:09:09,034 a a balanced price, let's say, 240 00:09:09,495 --> 00:09:10,794 that would maximize, 241 00:09:11,735 --> 00:09:13,975 savings and be appropriate, but at the same 242 00:09:13,975 --> 00:09:14,475 time, 243 00:09:15,200 --> 00:09:18,480 have abrasion, meaning, let's say, an appeal from 244 00:09:18,480 --> 00:09:20,420 a provider who doesn't like the price, 245 00:09:21,120 --> 00:09:23,139 I think there's a big misper misconception 246 00:09:23,840 --> 00:09:25,460 in health care that payers 247 00:09:25,920 --> 00:09:27,299 are really trying to 248 00:09:27,705 --> 00:09:30,105 drive to every penny that that they can 249 00:09:30,105 --> 00:09:32,825 when in fact they're highly concerned about member 250 00:09:32,825 --> 00:09:33,325 satisfaction, 251 00:09:34,105 --> 00:09:35,884 but also provider satisfaction. 252 00:09:36,264 --> 00:09:39,945 And they'd like to maintain abrasion at a 253 00:09:39,945 --> 00:09:42,889 relatively low level so that they have good 254 00:09:42,889 --> 00:09:43,389 relationships 255 00:09:43,769 --> 00:09:46,250 with providers and, of course, their members. And 256 00:09:46,250 --> 00:09:49,929 so using predictive analytics and and AI on 257 00:09:49,929 --> 00:09:50,829 how to balance, 258 00:09:52,089 --> 00:09:52,909 those two 259 00:09:53,610 --> 00:09:55,544 vectors of abrasion 260 00:09:55,845 --> 00:09:57,065 and price optimization 261 00:09:57,524 --> 00:10:00,565 are incredibly important, and you can't really do 262 00:10:00,565 --> 00:10:03,924 that across nine, ten, 11 different systems. You 263 00:10:03,924 --> 00:10:05,445 need to be able to do that at 264 00:10:05,445 --> 00:10:07,225 a consolidated data level, 265 00:10:07,764 --> 00:10:10,424 in order to help make those decisions. And 266 00:10:10,440 --> 00:10:11,740 I think that's really, 267 00:10:12,600 --> 00:10:13,100 how 268 00:10:13,639 --> 00:10:15,960 it it is starting to pull those those 269 00:10:15,960 --> 00:10:18,460 three factors that you described together, 270 00:10:19,799 --> 00:10:23,500 is is really that advanced technology that offers 271 00:10:23,995 --> 00:10:24,495 benefits 272 00:10:25,035 --> 00:10:28,075 to all the major stakeholders, the the the 273 00:10:28,075 --> 00:10:28,894 member themselves, 274 00:10:29,675 --> 00:10:31,774 as well as the provider and the payer. 275 00:10:32,235 --> 00:10:34,795 And that's really causing, you know, even in 276 00:10:34,795 --> 00:10:36,875 the last year year or two, you know, 277 00:10:36,875 --> 00:10:37,375 leapfrogging, 278 00:10:38,235 --> 00:10:39,615 investments in this area. 279 00:10:40,289 --> 00:10:40,789 Mhmm. 280 00:10:41,250 --> 00:10:43,809 Yeah. It's an important perspective that I think 281 00:10:43,809 --> 00:10:46,610 you're you're sharing, Jay, about how payers are 282 00:10:46,610 --> 00:10:48,389 invested in equally, 283 00:10:49,090 --> 00:10:52,289 you know, pleasing members and also providers avoiding 284 00:10:52,289 --> 00:10:54,610 that abrasion. And it's interesting to see how 285 00:10:54,610 --> 00:10:57,004 technology is playing a role in this. 286 00:10:57,384 --> 00:10:59,225 And I'm curious if, you know, you've ex 287 00:10:59,304 --> 00:11:01,164 you've described the advanced technology 288 00:11:01,865 --> 00:11:03,404 single solution need. 289 00:11:03,784 --> 00:11:07,625 When you've seen payers implement that strategy, what 290 00:11:07,625 --> 00:11:09,884 kind of benefits have you seen? Do any 291 00:11:09,980 --> 00:11:12,080 case studies or success stories come to mind? 292 00:11:13,259 --> 00:11:14,639 Sure. There's there's a couple. 293 00:11:15,180 --> 00:11:16,320 One where 294 00:11:17,420 --> 00:11:18,879 instead of dealing with 295 00:11:20,059 --> 00:11:20,559 multiple, 296 00:11:21,500 --> 00:11:22,960 disconnected vendor solutions, 297 00:11:24,315 --> 00:11:27,034 we can take a a claim in a 298 00:11:27,034 --> 00:11:28,954 single claim, and let's say it's an out 299 00:11:28,954 --> 00:11:31,695 of network, highly complex clinical claim. 300 00:11:32,634 --> 00:11:33,615 We can simultaneously 301 00:11:34,315 --> 00:11:34,815 apply, 302 00:11:36,330 --> 00:11:38,750 both our out of network engine 303 00:11:39,370 --> 00:11:42,350 as well as our expert claim review, 304 00:11:43,450 --> 00:11:46,649 capabilities in order to deliver both of those 305 00:11:46,649 --> 00:11:47,149 solutions 306 00:11:47,529 --> 00:11:50,029 off of the single claim at one time. 307 00:11:50,355 --> 00:11:52,674 The result is that it's going to come 308 00:11:52,674 --> 00:11:53,174 back 309 00:11:53,554 --> 00:11:56,434 through an adjudication engine to the payer in 310 00:11:56,434 --> 00:11:58,534 a greatly reduced period of time. 311 00:11:59,394 --> 00:12:00,214 It maximizes 312 00:12:00,674 --> 00:12:01,654 savings opportunities. 313 00:12:02,519 --> 00:12:03,899 It gets the communication 314 00:12:04,680 --> 00:12:07,259 out to the provider and to the member 315 00:12:07,560 --> 00:12:09,899 in terms of what they may owe faster. 316 00:12:10,440 --> 00:12:11,500 And so providers, 317 00:12:12,440 --> 00:12:15,384 you know, will benefit based based on, you 318 00:12:15,384 --> 00:12:18,105 know, the faster speed, and the member will 319 00:12:18,105 --> 00:12:19,084 also benefit, 320 00:12:19,865 --> 00:12:22,504 similar to the payer based on the reduced 321 00:12:22,504 --> 00:12:23,004 savings. 322 00:12:23,464 --> 00:12:25,225 It wouldn't be possible to do that if 323 00:12:25,225 --> 00:12:27,544 you were gonna run that through multiple different 324 00:12:27,544 --> 00:12:30,365 vendor engines, and it would take longer and 325 00:12:30,699 --> 00:12:32,699 arrive at a higher level of discontent with 326 00:12:32,699 --> 00:12:33,360 the provider. 327 00:12:33,740 --> 00:12:37,820 So, that's certainly one. Another is we offer 328 00:12:37,820 --> 00:12:40,000 for our out of network clients, 329 00:12:40,940 --> 00:12:42,959 health bill assist. Many members 330 00:12:43,524 --> 00:12:44,345 don't understand 331 00:12:44,964 --> 00:12:46,804 when they receive a balance bill, they're not 332 00:12:46,804 --> 00:12:49,125 sure what a balance bill is. They don't 333 00:12:49,125 --> 00:12:51,065 know when they should receive it or not. 334 00:12:51,764 --> 00:12:53,845 And so we offer a free service to 335 00:12:53,845 --> 00:12:56,504 the members of our auto network clients where 336 00:12:56,600 --> 00:13:00,279 there's website education that explains these different billing 337 00:13:00,279 --> 00:13:00,779 functions. 338 00:13:01,399 --> 00:13:03,820 They can scan a QR code on their, 339 00:13:04,360 --> 00:13:06,540 explanation of benefits or EOB, 340 00:13:07,399 --> 00:13:09,980 and then even engage in a phone conversation 341 00:13:10,840 --> 00:13:12,139 with one of our 342 00:13:13,045 --> 00:13:15,845 experts to explain it to them, and then 343 00:13:15,845 --> 00:13:18,185 we'll even engage on their behalf with providers 344 00:13:18,805 --> 00:13:19,785 and negotiate, 345 00:13:20,725 --> 00:13:22,105 reduced out of pocket 346 00:13:22,565 --> 00:13:25,829 payments from them in exchange for, let's say, 347 00:13:25,829 --> 00:13:27,209 a more rapid payment. 348 00:13:27,509 --> 00:13:30,230 I think so far, our biggest single benefit 349 00:13:30,230 --> 00:13:32,230 has been a $55,000 350 00:13:32,230 --> 00:13:32,730 reduction, 351 00:13:33,509 --> 00:13:35,429 to a family out of pocket based on 352 00:13:35,429 --> 00:13:38,254 doing that. But, you know, we we've so 353 00:13:38,254 --> 00:13:40,995 far achieved millions of dollars for this benefit, 354 00:13:41,054 --> 00:13:43,534 and it's really because of the the technology 355 00:13:43,534 --> 00:13:45,554 and the capability that we've talked about. 356 00:13:47,134 --> 00:13:49,934 Yeah. Such great examples. Thank you, Jay. And 357 00:13:49,934 --> 00:13:52,254 it's sounding like this approach really does help 358 00:13:52,254 --> 00:13:54,250 to drive speed, savings. 359 00:13:54,629 --> 00:13:55,910 I love learning a little bit more about 360 00:13:55,910 --> 00:13:59,690 that education component that, Xelliss is offering. So 361 00:13:59,750 --> 00:14:01,450 thank you so much again for that overview. 362 00:14:02,230 --> 00:14:03,509 And in light of all of this, you 363 00:14:03,509 --> 00:14:05,509 know, as you look ahead, how do you 364 00:14:05,509 --> 00:14:08,309 see pricing operations evolving within the next few 365 00:14:08,309 --> 00:14:10,555 years? And perhaps there's advice that you'd give 366 00:14:10,555 --> 00:14:12,634 to leaders who are really working on breaking 367 00:14:12,634 --> 00:14:14,735 down these silos to build a more connected 368 00:14:15,035 --> 00:14:16,654 experience and pricing system. 369 00:14:17,754 --> 00:14:19,675 Sure. I I think from a health IT 370 00:14:19,675 --> 00:14:21,134 standpoint, we've heard 371 00:14:22,220 --> 00:14:25,040 for five to ten plus years about personalized 372 00:14:25,259 --> 00:14:28,720 medicine, where for the individual member or patient, 373 00:14:29,899 --> 00:14:32,480 that a solution could 374 00:14:33,019 --> 00:14:36,004 be created individualized for them versus just receiving 375 00:14:36,004 --> 00:14:37,684 standard care, if you will. And I I 376 00:14:37,684 --> 00:14:39,605 think the same is starting to happen on 377 00:14:39,605 --> 00:14:41,764 the revenue cycle side and the pricing side 378 00:14:41,764 --> 00:14:42,264 that, 379 00:14:43,125 --> 00:14:44,745 similar to the clinical side, 380 00:14:45,285 --> 00:14:48,424 not every member is is created equal. People 381 00:14:48,990 --> 00:14:50,690 have, you know, different financial, 382 00:14:51,309 --> 00:14:51,809 situations. 383 00:14:52,190 --> 00:14:54,669 And so I I think we're gonna start 384 00:14:54,669 --> 00:14:56,850 to see more personalized medicine where 385 00:14:57,230 --> 00:14:59,809 things such as if somebody can 386 00:15:00,350 --> 00:15:01,409 afford to pay 387 00:15:01,789 --> 00:15:03,330 out of pocket and quickly, 388 00:15:03,725 --> 00:15:06,445 they might receive an incentive of a discount 389 00:15:06,445 --> 00:15:08,285 in order to do that. If someone else 390 00:15:08,285 --> 00:15:11,085 is in a situation where perhaps from a 391 00:15:11,085 --> 00:15:12,785 financial standpoint, they can, 392 00:15:13,325 --> 00:15:15,644 they can't do that, they'll be offered a 393 00:15:15,644 --> 00:15:16,384 no interest, 394 00:15:16,860 --> 00:15:18,779 you know, loan in order to extend the 395 00:15:18,779 --> 00:15:21,519 payments and make it more, you know, appetizing 396 00:15:21,579 --> 00:15:23,039 for them. There's still, 397 00:15:23,419 --> 00:15:25,500 Erica, a large percentage of care in The 398 00:15:25,500 --> 00:15:26,000 US 399 00:15:26,379 --> 00:15:28,240 that sometimes gets scheduled, 400 00:15:29,179 --> 00:15:31,820 many times just ordered from a physician, and 401 00:15:31,820 --> 00:15:34,815 it actually never gets completed with the member 402 00:15:34,815 --> 00:15:37,315 and patient. And one of the leading reasons 403 00:15:37,375 --> 00:15:37,875 is 404 00:15:38,254 --> 00:15:41,134 because the the patient, you know, comments that 405 00:15:41,134 --> 00:15:42,034 they are unsure 406 00:15:42,575 --> 00:15:44,254 of what the cost of the care will 407 00:15:44,254 --> 00:15:46,654 be or how they will pay for that 408 00:15:46,654 --> 00:15:49,200 cost to care. And so I just think, 409 00:15:49,660 --> 00:15:50,960 for the entire system, 410 00:15:51,420 --> 00:15:53,899 we need to move to the personalized revenue 411 00:15:53,899 --> 00:15:56,399 cycle to kinda match up with the personalized 412 00:15:56,620 --> 00:15:57,120 medicine 413 00:15:57,420 --> 00:15:59,179 that we've been seeing on the clinical side 414 00:15:59,179 --> 00:16:00,000 for a while. 415 00:16:00,985 --> 00:16:02,584 Yeah, Jay. I was just going to say 416 00:16:02,584 --> 00:16:03,884 we hear about personalization 417 00:16:04,184 --> 00:16:06,264 and patient and member experience so much from 418 00:16:06,264 --> 00:16:08,664 the clinical standpoint, but I think as you've 419 00:16:08,664 --> 00:16:10,985 highlighted from the RCM standpoint and the patient's 420 00:16:10,985 --> 00:16:13,564 financial journey, it's just as important. So, 421 00:16:14,290 --> 00:16:16,529 really important things that you've highlighted for our 422 00:16:16,529 --> 00:16:18,710 listeners. I wanted to give you the opportunity 423 00:16:18,850 --> 00:16:21,009 before we close today. Is there anything we 424 00:16:21,009 --> 00:16:22,769 didn't touch on or any final thoughts that 425 00:16:22,769 --> 00:16:24,149 you wanted to share with listeners? 426 00:16:25,090 --> 00:16:27,590 Appreciate that opportunity, Eric. I would say, 427 00:16:27,965 --> 00:16:29,105 you know, at Xelliss, 428 00:16:29,884 --> 00:16:32,705 what we're focused on is trying to be 429 00:16:32,764 --> 00:16:33,825 at the center 430 00:16:34,684 --> 00:16:35,504 of the wheel 431 00:16:36,205 --> 00:16:36,705 where 432 00:16:37,165 --> 00:16:40,304 we can help find solutions that benefit 433 00:16:41,279 --> 00:16:41,779 members, 434 00:16:42,559 --> 00:16:43,940 payers, and providers 435 00:16:44,720 --> 00:16:46,899 at not just one spoke. 436 00:16:47,360 --> 00:16:49,459 And sometimes that's harder than others, 437 00:16:49,759 --> 00:16:51,620 but it it is really the mission 438 00:16:52,159 --> 00:16:54,959 of of why Xelliss was created, and we're 439 00:16:54,959 --> 00:16:57,384 very committed to executing on that mission. 440 00:16:58,164 --> 00:17:00,404 That's a great mission. Jay, I wanna thank 441 00:17:00,404 --> 00:17:02,644 you again for spending time with Becker's today 442 00:17:02,644 --> 00:17:04,404 and for sharing all of your insights and 443 00:17:04,404 --> 00:17:05,144 your expertise, 444 00:17:05,684 --> 00:17:07,765 especially in the health IT and financial space, 445 00:17:07,924 --> 00:17:09,785 with our listeners today. Thank you. 446 00:17:10,599 --> 00:17:12,539 Erica, thanks so much, and appreciate, 447 00:17:12,919 --> 00:17:13,899 you and your listeners. 448 00:17:14,679 --> 00:17:16,919 Yeah. Of course. And we'd also like to 449 00:17:16,919 --> 00:17:19,659 thank our podcast sponsor for today, Xelliss. 450 00:17:20,293 --> 00:17:21,973 Listeners, be sure to tune in to more 451 00:17:21,973 --> 00:17:24,853 podcasts from Becker's Healthcare by visiting our podcast 452 00:17:24,853 --> 00:17:27,753 page at beckershospitalreview.com.