GetixHealth Podcast

Building Payer Relationships, Aligning Teams, and Preparing for Cybersecurity Threats

Alex Oey · August 17, 2026

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Transcript — follow along with the video

Elizabeth Allen(0:11) All right, thanks, Evan, for being with me today and just talking through all things RCM. (0:18) And you're a perfect candidate just because being with the Wilshire Group for how many years have you been with them?
Evan Martin(0:25) Three years with them, over 20 in the industry.
Elizabeth Allen(0:29) Yes, extensive, extensive background in revenue cycles. (0:33) So really appreciate your time today and, of course, your experience is invaluable. (0:38) So a couple of things I was thinking about that would be helpful for our audience is you have a unique position in the fact that you're consulting through the Wilshire Group, which gives you many different clients' perspectives and many different challenges that you see.(0:55) And I know currently you're with Scripps in an interim form of revenue integrity. (1:01) So prior to that with other academic and large facilities. (1:06) So kind of talk through or help our audience understand just the challenges that you see in your position and kind of what the issues more commonly you see and just kind of just talk through some of those things that we're all seeing, maybe not talking about or we are talking about.
Evan Martin(1:27) Yeah, I think I'll start with what we're talking about. (1:30) I think we continue to see that ever engaging payer challenge that everybody has it. (1:36) It's not it's no difference in the mix of reimbursement.(1:40) We're constantly having to keep a pulse on is Medicare and Medicaid services across the nation going to start to cut funding to fund other parts of government operations? (1:50) And what does that put our vulnerable more at risk that we're all trying to give back to these communities? (1:56) And then the ever challenging requirements coming from regulatory affairs.(2:01) I mean, we're recording this right at the peak of a new pricing transparency post to be required and that taking umpteen hours and industry time to put together. (2:14) I mean, the team that I'm working with right now in my interim capacity, we've been working on it for six months and prior to me joining their organization to help them with it. (2:24) And we're just pushing the final button today for something that's due July 1st.(2:29) Right. (2:29) And that that those challenges of having those resources that understand that complexity. (2:35) But then at the same time, how do I just manage getting cash in the door?(2:39) We're watching denials continue to go up, even though health plans are saying they're going down. (2:44) We see the complexity of health plans writing new policies that don't even go along with standard billing guidelines per CMS. So if you're billing commercial than a governmental agency as a secondary, you're going to run into challenges there and total different denial patterns. (3:03) And then that cybersecurity, that is, I think, on everybody's pressing topic right now.(3:09) And what do we do as industry leaders to even come from a finance background or I was a patient registrar and now I'm going to be a VP of revenue cycle 6-10 years later because I was fast-tracked in my industry in leadership. (3:24) And I don't know how to assess an organization. (3:28) What's their cyber components?(3:29) And I don't even know if my IT department knows that specific for what my revenue cycle data, security, and infrastructure will need to be. (3:38) And I think then just how do we educate our staff is the final thing that everybody's still dealing with. (3:44) Structures are changing with acquisitions and mergers.(3:47) And how do I now educate the future leader? (3:50) But also, how do I educate those non-formal leaders who are independent leaders in the department to just get regular education like at a conference? (4:02) Funding's not there to send anybody.(4:04) So we're being strategic in which leaders we go. (4:06) And then how do you make requirements to bring it back? (4:08) So I think those are the common threads that have always been there, but are at the height of keeping our VP partners awake at night, keeping senior directors even more awake because they have to come down that next level from that thousand-level foot and say, how do I operationalize this with my managers?(4:27) So I would say those are the common trends. (4:30) And then I think regionally, we all have differences. (4:34) I'm blessed to be in the Pacific Northwest right now.(4:38) And those states tend to have a lot of more state legislation on the West Coast that is more driven specific to different departments. (4:47) I can think of like in Oregon, you're dealing with the insurance commissioner and you're dealing with Medicaid requirements and totally two different departments that are structurally going against each other. (4:57) So you see that in some states, but not in all.(5:01) And those are challenges to understand how do I partner across barrier lines(5:06) And how do you do that with health plans that are national plans now? (5:10) And they don't always geographically look at what those geographic impacts are that you're also trying to face.
Elizabeth Allen(5:18) So I would say I've heard all of those challenges. (5:21) I wouldn't even know how people would prioritize. (5:24) But if you sitting where you sit and coming into a position like a new interim, where do you start?(5:31) Where do you, how do you approach the priority kind of strategy? (5:37) Because those are all equally important. (5:41) And kind of talk us through when you're coming into an interim role that you're new to a health system, what does that look like from a priority standpoint?
Evan Martin(5:51) Yeah. (5:51) I mean, for me, I look at it first to say, what are your big pressing issues? (5:56) I'll ask my director teams.(5:58) I'll ask my CFO. (6:00) What are the hot topics that you're already challenged with and you were moving the needle before you needed an interim to come in and sit in a capacity so that I could get just kind of what's their initial feel? (6:13) And then I go right to the data.(6:16) I'm in the system. (6:17) I'm looking at dashboards. (6:18) I'm looking at those capacities, looking at national KPIs for best practice through HFMA, through NAHAM, NARI, AHIMA, looking at all of our different areas of the revenue cycle to say, HFMA has blessed us because they have national for all areas.(6:37) But then our industry partners and peers, they have them broken down by those specialties and looking at those specialty KPIs are key to say, Hey, yeah, we might be hitting the national target here. (6:50) But in our industry, when we peel back that onion, we have opportunity. (6:55) And where is that opportunity from leveraging to go?(6:59) So I'll look at that first. (7:01) And then I asked the team, what's been your education plan in here? (7:05) I can remember a prior organization I was blessed to spend 18 months with in multiple interim capacities.
(7:14) Each of those times I would ask the team, have you been able to go to HFMA? (7:18) Have you been able to go to a private webinar through a business partner? (7:22) Because a lot of our business partners partner with their provider groups to do this type of education.(7:28) What podcast are you listening to? (7:31) What articles are you reading? (7:32) And from there, to help them strategically look at like, okay, for my billing department, here's free education we can do.(7:39) Here's what we're doing at Scripps right now. (7:42) That's been one of my things. (7:43) I haven't really seen my team go out and do webinars.(7:46) I'm lucky enough to be on one of the NARI subcommittees around education. (7:53) So since it's revenue integrity based, I've been throwing them webinars, journals, articles, read this on your free time, and also carving out time. (8:02) I've told them starting next month, every Friday, we're going to have an hour where it's blocked for them.(8:08) And I expect them to read something, do some form of education. (8:11) And then in our weekly huddle, I want them to report out what is that so that they can provide that back. (8:17) So that's how I get the landscape.(8:20) And then from there, looking at what's the organization's strategic initiatives and where do I plug those in? (8:25) And as we're assessing things and going through, you're going to pivot and shift. (8:29) But what's your true north?(8:31) And cash in the door is usually a firm VP and reduction of denials so that cash goes up. (8:37) So keep those true north tender, but your employees got to be there first and foremost. (8:42) That's the only way.(8:43) So I usually go in and invest a lot of my initial time into the team and learning the team and what's their processes. (8:50) And then start to, how do we shake it up to get it to national best practices and move the needle? (8:57) Sometimes I'm lucky to stay long enough to see the needle hit the move or hit a finish line, even on a big project.(9:04) A lot of times, no. (9:06) And I get to stay in contact and relationships. (9:09) I've been blessed at my last organization.(9:11) They're here. (9:12) I've got to be able to see them all and be able to have those conversations, see what's new, where are they headed next? (9:18) So yeah.
Elizabeth Allen(9:19) Well, I love the idea that you're investing in the education piece because that helps you align the goals from the bottom up, top down, which I think is so important. (9:30) As you know, when we're working with different teams, everybody has to be aligned on that same goal. (9:35) And again, you're against the amount of pressure that you guys are moving against, whether it's the insurance, whether it's the legislation, whether it's the next thing that's coming down the pipe, you've got to have everybody moving in that same direction.(9:53) So I love to hear that. (9:54) So with that, I mean, those are all so important. (9:58) Those are all real challenges.(10:01) Give us kind of a, I wouldn't say day in the life, but maybe like a month in a life or a week in a life. (10:10) Does that look like weekly meetings? (10:13) Does that look like, walk us through what your kind of day and week and months look like?
Evan Martin(10:21) Yeah. (10:21) I was blessed with great leaders who wanted to invest in me. (10:25) And one of the leaders who taught me a ton, both...(10:31) I think you learn from your leaders, both what you want to do and what you don't want to do. (10:35) But one thing I've taken away is when I'm in a more of a senior level role is daily huddles or at least three times a week huddles. (10:44) So currently, I have my manager of revenue integrity, my manager of the charge master and I meet for 30 minutes every Monday, Wednesday, Friday.(10:52) Even when I was on vacation, I'm calling to make sure that they're meeting when I'm not there. (10:58) Going over key KPIs, staffing challenges, issues, because if you're not hearing that from your team in that capacity, even at the senior level, you aren't always aware of what their daily challenges are and how that's going to impact what might surface from another senior leader to you. (11:15) So it's better to just huddle and get those measurements.(11:19) Know what are going to be the challenges or what the current challenges are in case you need to pivot as a group. (11:24) And how do you pivot as a group? (11:25) And it's a great think tank session area.(11:28) So that's the one thing I do pretty much on a daily basis. (11:32) Always looking at my KPIs on a daily basis. (11:35) First thing I open up usually around 5 or 6 o'clock in the morning.(11:38) I'm there looking to say, what are the questions I need to ask? (11:41) Is something ticking that I need to reach out to my IS counterparts about to say, this doesn't seem right. (11:47) I got $3 million into this work queue that normally has $100,000 in it.(11:51) What happened last night? (11:53) Did you guys integrate a build, change, modification? (11:56) And then from there, it's really meetings, meetings, meetings at a senior level.(12:01) But really being strategic too. (12:02) I am a believer. (12:04) I don't need to be at everything.(12:05) And I don't need to be CC'd on everything. (12:08) CC me on the important stuff that you feel is important that you need my partnership on. (12:13) And let me know what meetings you're going to.(12:15) But I don't want to attend every meeting. (12:17) You're only going to grow as a leader if I'm not there. (12:20) Or if you need me there, then let me know that.
Elizabeth Allen(12:24) So it sounds like you have a proactive, very proactive approach.
Evan Martin(12:29) I try to be.
Elizabeth Allen(12:30) Proactive, but you're not micromanaging.
Evan Martin(12:33) Yeah, I don't want to micromanage. (12:34) Yeah, like for me, you're paid to do your job. (12:38) My job is to remove your barriers and mentor you.(12:41) And look at it from a strategy perspective. (12:43) The reason I want the huddle is so that I can pick up on things that you might, as a leader, not know yet. (12:51) Because I don't know always, especially being in an interim capacity, I don't know what your development has been.(12:56) I don't know who your mentors have been. (12:58) You don't know me either. (12:59) The only way for me to build a relationship is to meet with you and not just send an email or a text message communication.(13:06) So I think that's so key and critical for a new leader or even for a leader who's like, hey, I need to reassess because my KPIs are not where they're at for employee satisfaction or work. (13:20) Usually, if you see a health system struggling in the KPIs, you run an employee satisfaction. (13:26) It's tied unless it's really a payer-related issue.
Elizabeth Allen(13:29) Right.
Evan Martin(13:30) So that similarity. (13:32) So going and looking at that. (13:33) And trust me, I've been called a horrible leader.(13:37) I've had bad approach. (13:39) I get it. (13:40) But I'm also learning from that.
Elizabeth Allen(13:41) Always learning.
Evan Martin(13:42) And it's asking for feedback. (13:44) I think that's the key thing. (13:46) Don't give me feedback in a team meeting, please.(13:48) That's not my style. (13:50) But if you pull me aside and say, hey, can we have a talk? (13:53) Hey, I didn't like this approach.
13:55) Or you were right what you said, but can you do it a little softer next time? (14:00) And I try to remember that when I'm having the conversation too. (14:03) I'm like, yeah, I get that.(14:06) But I also go here. (14:08) I'm very much a... (14:09) It's funny.(14:10) Strength Finder. (14:11) I believe everybody should take Strength Finder. (14:13) Because it will tell you about your personality in the sense of...(14:16) I grew up in a military household. (14:18) I had a command and control dad and mom. (14:21) My mom's a former chief nursing officer.(14:24) So it was very much like, you did what you were told. (14:26) And this is how you're doing it. (14:28) And I hated that.(14:29) I wanted that self-desire to grow. (14:31) But at the same time, in an urgent or emergent situation, you need a chief who's going to be the person who goes down with the ship. (14:38) So that's critical as you're developing is how to have that soft skill, but knowing that other skill needs to pop in.(14:46) And that's a struggle. (14:48) And I think it's a struggle when you're working with business partners too. (14:51) I have to remember, while I'm a client, these are my friends in the community who I'm learning from and growing from.(14:59) So I have to have a softer approach.
Elizabeth Allen(15:02) You gotta fake it till you make it a little bit. (15:04) That's what I always say. (15:05) So I think that's true.(15:07) I think that's really good. (15:07) Yeah, that humanistic approach in anything you're doing, we always are focused on bottom line revenue, bottom line revenue, top line, bottom line revenue. (15:18) But you do lose that human touch, which we all require in order to keep doing what we're doing or show up every day.(15:28) I think it's important. (15:29) But you touched on something about the payers that I just want to circle back to in a second. (15:33) Um, you know, everyone obviously knows who their problem payers are(15:40) What have you seen? (15:42) I know you're kind of in this region, and I know nationally, it's pretty much all the same. (15:48) What would you tell a new or even seasoned revenue cycle director VP?(15:57) What can they do to work with their payers? (16:00) What can they do internally? (16:02) What can they do externally?(16:03) What have you seen? (16:04) It's been kind of a it's worked.
Evan Martin(16:07) Yeah, I think it's remembering them. (16:10) One, they're our colleagues. (16:12) We don't know what challenges that our provider reps are facing within their organizations, just as they don't always know what ours are.(16:21) And having that communication is key. (16:24) And I believe while health plans hate it because it's making a provider rep have a smaller footprint with providers, it's that relate one-on-one relationship with your provider rep and their VP and their directors is so critical. (16:41) So have lunch.(16:43) You as a provider, take your payer partner out to lunch. (16:47) Ask them for a lunch meeting. (16:48) Don't talk about what your AR is.(16:51) Get to know them as a human and an individual. (16:54) Build a foundational relationship. (16:56) And that's going to lead for you to be able to have that person to help you maneuver and navigate through the system.(17:03) It's funny. (17:04) At my last organization I was supporting, they had a provider rep at one facility. (17:10) And AR was great.(17:13) That provider rep left. (17:15) They weren't able to get things moving and going through. (17:18) And it was because they just assumed, oh, we had a relationship with the health plan that we should expect the same.(17:26) No, they had a relationship with a provider rep. (17:28) So as soon as they got that provider rep, I somehow got reassigned back. (17:32) I don't remember the whole story.(17:34) AR went back for that payer, back to being, oh, they're a payer we watch because they're one of our top five for our revenue stream. (17:43) But our communication is better. (17:45) Denials, appeals are going down.(17:47) Things are flowing back through the system. (17:49) And I do think it's that relationship portion. (17:52) If you have bad relationships with your employees, they don't care.(17:55) They just process a claim, right? (17:57) And they're not committed to the job because they're not having it. (18:00) Why would somebody at your counterpart want to work with you if you're not getting to know them?(18:05) And that's been so key in the approach. (18:08) You also need to know when do you turn up. (18:10) So knowing those levels to say, okay, I got to pull the trigger.(18:13) And I've been nasty with health plans. (18:15) Like, no, you're going to pay me. (18:16) No, I have communicated.(18:18) No, I've done this. (18:19) But have your trail of paper. (18:23) And I think the key thing is though, have weekly, have monthly calls.(18:27) Do not say, oh, we'll check in once a quarter. (18:30) We'll do it via email. (18:32) No, if you can't meet, we'll communicate via email.(18:35) But when's that rescheduled? (18:36) And yeah, that might mean we're going to meet three times this month versus twice. (18:40) Because I expect us to have that touch base and that constant.(18:45) Do it with your top 10 if you can. (18:48) But you as a senior leader, pop in top 10. (18:53) But you need to be present on those top trial ones.(18:57) So that those provider reps know that you're there to support your managers who are facilitating those meetings. (19:03) You only facilitate when they need the big guns. (19:07) And you don't decide that.(19:09) Ask your team, do you need me? (19:13) If they say no, let it go. (19:16) If they say no more than once, it's time for you to say yes.(19:20) And this is a moment for me to mentor you. (19:23) I'm going to come in and redirect the conversation. (19:25) So it's all about that relationship, though.(19:28) That's the only way we get things done.
Elizabeth Allen(19:30) I mean, I have a very important piece of information. (19:34) That is excellent. (19:35) Excellent, excellent, excellent.(19:36) I don't, I'm not sure it'd be interesting to find out how many people are doing that and what their success has been. (19:43) I think that is overlooked.
Evan Martin(19:47) I think it's hit or miss, too.
Elizabeth Allen(19:48) Yeah.
Evan Martin(19:49) And it's really about, oh, well, this pair has been great. (19:53) And then they have a hiccup. (19:55) Well, they were great until that hiccup.(19:58) But you didn't have that foundational communication going to be able to pivot quickly. (20:04) So now you're trying to buy time on your rep's calendar, which you didn't already have established.
Elizabeth Allen(20:09) So do it to make it a part of the cadence. (20:11) Yeah, make it a regular cadence. (20:13) I think that's really important.(20:15) And again, like identifying the fact that they might have their own challenges that we just don't, we always assume, oh, my gosh, they're just working against us and they just don't want to pay us. (20:26) But there might be other things that you can work on that would actually work for both of you. (20:30) So I think that's really important.
Evan Martin(20:31) I do remember as a director, Beth, I am reporting to a VP, a very talented VP. (20:38) I let her be my heavy. (20:40) Because I, as the director level, have to partner with this person every day.(20:44) So when I knew I needed help, I was like, hey, you have to be on this call. (20:51) I can't. (20:51) You have to be on this call.(20:53) Here's my issue. (20:54) Here's my email tread. (20:55) It's now or never.(20:58) Or we're going to be not hitting fiscal year end where we want to be. (21:03) I had that metric to know when I needed that heavy. (21:08) With one health plan, it was about once a quarter.(21:11) I had to have that VP on the call once a quarter to re-level set. (21:15) Like, nope, we've gone back the other direction and you've stopped your communication again. (21:21) Two months was great.(21:22) Now, all of a sudden, we're in the middle of this one. (21:25) What's going on?
Elizabeth Allen(21:26) Right, right. (21:27) I think that's really important. (21:28) And okay, one other thing that we pointed out that is top of everybody's mind.(21:33) All those things are very top of mind for everyone in the industry is the cybersecurity. (21:40) So how I know, obviously, we have zero IT coding. (21:48) We don't really know what we should be doing.(21:51) Who are the hackers? (21:52) Cybersecurity people know who the hackers are, what the risk is. (21:56) But how do you advise or what do you do when you come into a new role to integrate or to get acclimated on that front?(22:06) What's your exposure?
Evan Martin(22:07) I've only had to do it recently, right? (22:10) When we had the big national line occur. (22:15) And then even now recently, they're not one of Wilshire's clients, but a former colleague from Wilshire is now working at a major national health system and had to reach out and was like, downtime, Evan, what do I do?(22:30) We're not even live. (22:32) Like none of our systems can even go up.
Elizabeth Allen(22:34) They have to go to paper.
Evan Martin(22:36) But how do we get that paper out of our cybersecurity? (22:40) What is some of the best practice downtime? (22:42) And we were able to go and talk with clients quickly who have gone through cyber attacks and go through that.(22:48) It's funny. (22:49) I'm going to do a plug for Western Region Symposium. (22:52) We are doing a whole, how do we value, how do you recover from a cybersecurity attack as a health system or as a business partner?(23:00) So it's a business partner and health system.
Elizabeth Allen(23:03) Which we've all worked at.
Evan Martin(23:05) Conversation together. (23:06) Morning session. (23:08) I'm super excited for it.(23:10) And actually have some great, everybody on it going to be leading it. (23:16) And it's to talk about that. (23:18) Even on the Wilshire IT webcast, we've taught, brought on cybersecurity experts.(23:23) We've talked about it briefly and little snippets of it as well. (23:28) So I think to evaluate, it's really as individuals, we have to learn what is at risk for our organization in a regular natural disaster and we can't touch electronic documents. (23:43) Start there and then go and say, okay, now who are we interfacing data exchanges with?(23:50) What is my revenue cycle data that I'm interfacing? (23:54) Whether it's claims data, maybe it's not even claims data. (23:57) If I look at it from a revenue integrity lens, we're sending our pricing, all of our charge master items.(24:05) If they, while it's not always patient data, we're sending a number of used charging codes and everything so that we know is it being utilized. (24:15) What if that goes down and you are in the midst of an annual update(24:18) How are you going to know what your usage is?(24:21) What you need to term? (24:22) What you might happen? (24:24) So I think it's really learning your data exchange.
Elizabeth Allen(24:27) Yes, yes.
Evan Martin(24:29) Proponents and then be involved with your IT team and whether you call it materials management or purchasing contracting departments, be part of that review, the IT review. (24:44) Learn what your IT review is. (24:46) What are the questions they're asking?(24:48) What's the amount of insurance? (24:50) What's the plan if something goes down? (24:53) See what is their actual downtime?(24:55) Having an escalation, our escalation process in your contract. (25:00) I mean, I remember when I was first learning contracts, it was like, oh, two business days. (25:06) Well, it's two business days for that data exchange.(25:10) Reasonable or is it a 20? (25:12) We need a 20 minute response based off of this type of data exchange. (25:16) So learn that and then say to yourself, how long can you live without that?(25:22) Because even as a health system, you, if you get a cyber attack, you're down for five days for just your plan to get approved by the government before you can come back up. (25:35) So really that's 14 days because you have to get your plan approved and then five, seven to 10 days to implement. (25:42) You're looking at down for a potential month that in some cases, depending on what it is.(25:46) So what is your plan to know what I can live with for out for 14 days? (25:52) What's my plan that I can live without 30 days and still have cash coming in and revenue at the door? (26:00) Because what is it?(26:01) Cash is king still.
Elizabeth Allen(26:02) Right, and I think the most important piece that you touched on there is evaluating what data is affected and what that means for your department. (26:12) Like that is, people just think of it all as one month. (26:15) Some, it's not.(26:16) One thing affects the other, but one is so important to the other. (26:20) So I think that was a really, really important point. (26:23) So all really good information.(26:26) Well, I think we've covered everything until next time. (26:30) This is great talking with you, by the way. (26:32) I mean, none of these problems are going to be fixed overnight, but the more we can share about best practices, the more people can identify issues that you're pointing out and what you're doing, I think is really helpful.(26:45) So appreciate your time today.
Evan Martin(26:47) Thanks for having me.
Elizabeth Allen(26:48) Yeah, awesome. (26:48) Thanks.

Executive summary

In this insightful discussion, Evan, a seasoned revenue cycle consultant, shares his perspective on the top challenges facing revenue cycle leaders today. From navigating ever-changing payer requirements to managing cybersecurity risks, Evan explains his approach to evaluating an organization’s revenue cycle health and developing effective strategies for improvement. He highlights the value of investing in team education, fostering strong payer relationships, and proactively preparing for potential system disruptions. Evan’s real-world experience offers valuable lessons for revenue cycle professionals at every level.

Key takeaways

The importance of building relationships with payer provider representatives to improve the revenue cycle
Educating and aligning revenue cycle teams on key goals and priorities
Evaluating cybersecurity risks and preparing for system downtime

Building Payer Relationships, Aligning Teams, and Preparing for Cybersecurity Threats

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Meet The Speakers

Evan Martin

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Meet The Speakers

Evan Martin

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The core behind care.