Inside The Innovation At Intermountain (2024)

Few health systems receive as much recognition as industry innovators than Intermountain Healthcare. Chief Revenue Officer (CRO) and Connex Member, Kerry Gillespie, gave us a behind the-scenes look at the challenges facing healthcare today, and how they intend to stay ahead of the curve.

Intermountain is a fully integrated healthcare system, and is one of the top five in the country alongside Mayo, Kaiser, Cleveland Clinic, and John Hopkins. Based out of Salt Lake City, the already impressive system merged with SCL Health Group in April of this year, bringing their footprint to a whopping 33 hospitals across nine states, plus a multitude of outpatient locations and services. Complete with their own health plan, they serve an area with one of the lowest per capita healthcare costs in the country. They’ve received countless awards and accolades for their service quality, community work, leadership, workplace environment, and most important to today’s conversation, innovation.

Helping them stay the course is their CRO, Kerry Gillespie. Like the rest of his organization, Gillespie is deeply committed to helping patients live the healthiest lives possible, which he facilitates by guiding them towards sound financial decisions – Intermountain believes that by having a strong balance sheet, they can better support the community. To do that, Gillespie keeps his ear close to the ground, constantly on the lookout for ways to make their processes more streamlined, and their revenue cycle more integrous and profitable. This mindset, shared by his colleagues, has driven Intermountain to invest heavily in value based care, telehealth, automation, and a plethora of other cutting-edge strategies, all of which Gillespie was more than happy to share with us...

Thank you for joining us today. There’s really a hundred different ways we could approach this conversation given the work you’re doing at Intermountain, so in the interest of our readers, I’ll be trying to focus on the high-level aspects of their most pressing challenges. Starting with labor – sourcing labor, retaining them, controlling labor costs. How is Intermountain approaching today’s labor market?

Labor is an area we began making strategic changes to well before the pandemic, and over the last several years, one of our most impactful strategies has been building partnerships with local nursing schools. Nursing has been one of the most challenging areas to staff even dating back before 2020, and while we’re seeing shortages across the board, this one is particularly concerning. Having the right bedside care is absolutely critical, and those teams have been stretched far too thin in the wake of COVID. Worst of all, it’s a problem that exacerbates itself. The lack of staff means everyone must take more onto their plate than they otherwise would, and that’s driving both burnout and the rise in nursing angst we’ve seen. A lot of nurses are reconsidering their careers, or deciding that traditional employment isn’t for them and transitioning to higher-paying arrangements like travel-based nursing.

By building partnerships with nursing schools, we’re able to bring those students in before they graduate, give them real-world experience so they’re better prepared for the realities of today’s healthcare field, and get them placed in nursing apprenticeships. They get a more valuable education experience, and we get a steadier stream of nurse applicants that already know us and how we operate. That said, those partnerships alone won’t be enough to solve the problem.

This is where many of the organizations we’ve spoken to have gestured towards automation and AI as a way to close the gaps in the labor market. Is that the direction Intermountain is headed as well?

Precisely. Addressing labor shortfalls is one of the biggest opportunities for automation and AI today. They can enable nurses and other staff members to work at the top of their license by handling the rote, detail work that happens behind the scenes. All that time-consuming documentation and administrative work that comprises a third to a half of a nurse’s daily schedule can be essentially solved by automation. And that means you can do more with fewer nurses, bringing your labor requirements more in line with what the market can realistically supply, and ensuring that the nurses on your payroll can spend more time meaningfully engaging with patients. The more sophisticated we can make automation, the more those benefits will begin to compound.

There are several substantial opportunities for AI and automation to shine in revenue cycle as well. For example, most of the frontend could be streamlined and made more patient friendly. If I have a physician order in-hand, why do I need to talk to someone to schedule service? Why can’t I just self-serve my needs online like I do with every other consumer service I engage with, at my convenience, without ever having to talk with a live human being?

Self-service isn’t just convenient and less costly, but also gives the patient more peace of mind because they don’t have to worry about whether their appointment actually got scheduled, or if the scheduler got their information correct. We’re testing that process now at Intermountain with our mammography screening services.

Registration is another area where automation is going to become increasingly important. We’ve got a few ways patients can preregister for services online, and then it’s a quick, 10 second confirmation process when they walk in the door to tell the registrar they’ve arrived. Just a brief check to make sure their information is all entered correctly, including the submitted digital copies of their driver’s license and insurance cards. There’s really a ton of work that patients can do within the comfort of their home rather than having to handle it at the point of service. Patients are more satisfied with it, it’s a huge time saver for them, and it’s a huge time saver for staff.

Lastly, technology should be used – and I think it will become the norm – to move a patient’s account all the way from the middle through the end of revenue cycle; from the point it hits a work queue through to payment. A human being really shouldn’t have to touch that, and removing the need for a human allows for smaller teams and generates fewer mistakes. This is where we’re layering artificial intelligence on top of automation to drive patient accounts to the right location in the system to get them paid in a timely fashion and we’re already seeing impressive early success.

One of the areas we’ve heard about self-service, automation, and digital tools being used the most is remote care, and we believe it’s a bit of a standout because it dovetails into this idea of reimagining care delivery and the revenue streams behind it. Is that an area you’re examining as well?

Great question, and it’s one that’s equally loaded with opportunity and concerns. For example, if you take remote patient monitoring (RPM), as well as the home-based inpatient services that we’re now beginning to provide to our less acute patients, that accomplishes a couple of things. It makes the care much less expensive for the patient and insurance company, but there’s the caveat that it has the possibility of being a financial burden on the provider. Hospitals have this large amount of fixed overhead costs between the facility, equipment, and supplies, and while these homebased care modalities free up bedspace, you lose out on incremental on-site revenue the patient would have otherwise generated. And I expect this will create some implementation hesitation within the hospital community.

But the dynamic changes once you’re looking at groups of patients that are covered by value based care agreements. It makes a significant amount of sense when an organization is getting percentage-of-premium dollars, because now you have more control over that dollar and don’t have to spend it on hospital-level care. And if you can simultaneously control your costs within the hospital and efficiently manage your overhead, you’re going to be quite successful in accumulating additional revenue and margin by taking these patients out of your four walls.

It ends up working out similarly to something like an ambulatory surgery center or an outpatient imaging center, where there’s a lower amount of reimbursem*nt revenue coming in, but the provision of care for the patients is better. It’s more accessible and delivered at a lower overall cost.

Switching gears for a moment, we’d love to get your perspective as an industry innovator on both recent and upcoming regulatory and legislative changes. Are there any that you’re particularly preparing for, or wary of?

That’s really a packed question, because there have been a lot of changes over the last few years,starting with the price transparency requirements that came out of the Trump administration. We, like other providers, had a choice to comply or not, and we decided very early on that we would be fully compliant. We underwent a significant amount of work that first year to make our prices transparent and get where we wanted to be. As we went into the second year, we got very good at price transparency.

There’s an organization called Turquoise Health that essentially accumulates all price transparency disclosures for hospitals across the country, and they’re now doing the same for health plans. We were able to achieve five star status this year according to their rankings for both the original Intermountain Healthcare facilities and those that belonged to SCL Health before the merger back in April. We’re very proud of that, and believe wholeheartedly that price transparency is really integral to the future of healthcare. Providers will be competing not just on quality and the services provided, but on the actual value of care they deliver to the consumer. The shift is here, and we will need to be transparent and open.

Related to that discussion is the No Surprises Act, which is designed to protect consumers from unexpected balance billing, including out-of-network patients receiving emergency care in your facility. Number one, you can’t balance bill them, and number two, you then must work with the insurer to get paid appropriately for that service – even if that means taking it to an Independent Dispute Resolution (IDR) arbiter to make that happen.

We’ve been very successful in implementing those two parts of the No Surprises Act, but the third part is much more difficult. You must provide patients with a Good Faith Estimate (GFE) and both the calculation of those and the process of getting them out to patients is incredibly time consuming. It’s very resource intensive, and there’s a ton of work that goes into it. We’re building out the capability to be more sophisticated with those GFEs across the system, but since January of this year we’ve had to do our best to be compliant.

In January of 2023, the GFEs will expand from covering just the hospital in the provision of care to all providers who deliver care to a patient in the hospital, such as anesthesiologists and some surgeons. Meeting that requirement is going to be incredibly difficult for us and all our hospital organization peers. We’ve determined a path to get us there, and it’s going to take us a while to perfect it, but we think that by the end of the first quarter of 2023 we’ll have all the tools necessary to make that happen. A significant element of that will be working and liaising with other providers to get accurate, consistent cash pricing data for the services they provide.

Another thing we’ve noticed is our friends at CMS eventually plan to move this GFE to not only uninsured patients, but all patients. We expect they’ll likely exclude Medicare and Medicaid since those are government patients anyway, but it’s very likely we’ll be required to give GFEs for both our services and those of our affiliates to patients covered by all other payers. We’re working on it, but it will be a difficult road, fraught with errors and labor challenges. In fact, it presents yet another opportunity to use automation and artificial intelligence, as these tools can help us produce better, more accurate GFEs with significantly less manual involvement.

Speaking of payers, what is Intermountain doing to improve its relationships with them, defend itself from unreasonable denials, and secure all the money owed in a timely fashion?

First and foremost, we’re making sure our relationships with payers are on solid footing. We try to have joint operating council meetings every quarter with our markets’ major players – and that’s more than a few payers. At those meetings, we cover relationship details to make sure that everything is transpiring as it should be according to the contract. That comes on the back of working closely with both the payers and our own revenue cycle teams to understand what our pain points are.

If the revenue cycle is having issues with rightful payment, we’re very upfront with payers and say, “Look, you’re not fulfilling your end of the contract and need to step it up and pay us what we’re owed.” Of course, we recognize that some of their issues stem from the same labor shortages we’re experiencing ourselves, so there is some empathy, but at the end of the day we both agreed to our contractual terms and those need to be honored.

And lastly, if we’re seeing pain points that aren’t currently reflected in those terms, we’re making sure we get those into the contract during the next round of negotiations.

Intermountain is clearly one of the innovative healthcare systems to watch and learn from, so in closing, are there any trends, changes, or innovations you want to draw attention to that aren’t getting the coverage they should?

We have a ventures group, and through that, we’re investing heavily in several organizations within the healthcare industry that we think will help define the future of healthcare. There’s one in particular that we believe is going to be very impactful going forward, and what they do is personalized medicine: using genetic mapping to determine the optimal way for a patient to receive care. We believe this will be critical – especially for patients with cancer or precursors to it – not just for optimizing treatment, but helping us reach our value-based goals.

If you can provide appropriate, preventative therapy to a patient before they get cancer, it’s a much less expensive treatment option than chemotherapy and radiation. It also helps avoid the high costs of care associated with the last 6 months of a patient’s life by prolonging their life expectancy. Not to mention the patient gains a significantly higher quality of life. This will all be possible by identifying if the patient has genetic precursors and then fast-tracking them for treatment. The same is going to be possible for precursors to diabetes, kidney disease, et cetera. Once we see that in a patient’s genome, we can arm our physicians to better guide patients’ personal health journeys and more proactively drive them towards a healthier future. This is at the forefront of what’s happening in medical science today, and it will be the future of value-based care.