GetixHealth Podcast

When Financial Counseling Becomes Case Management

Alex Oey · July 13, 2026

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Shawn Gretz(0:13) Welcome to the RCM ReFrame podcast by GetixHealth. (0:16) Today, I'm excited to have Jonathan Davis, who is the Executive Director of Patient Access, joining me from Yale New Haven Health. (0:25) So Jonathan, welcome to the podcast.(0:27) Thank you for joining me today. (0:29) I'm really excited for this conversation. (0:32) So, Jonathan, welcome.
Jonathan Davis(0:34) So am I. (0:34) Thank you very much. (0:35) I'm happy to be here.(0:37) Just a little bit about myself, Executive Director of Patient Access and Revenue Cycle Analytics at Yale New Haven Health. (0:44) Yale New Haven Health is an internationally recognized academic health system based in New Haven, Connecticut, but we have hospitals all throughout Connecticut, as well as the hospital in Rhode Island. (0:56) We are approaching roughly an $8 billion health system with significant footprint in ambulatory care, off-site, with the partnership with our university partners at the Yale School of medcine
Shawn Gretz(1:10) So one of my favorite things about Jonathan, I love to follow his LinkedIn posts. (1:16) So if you have not followed Jonathan, please do so, because I think it's worthwhile, because he has topics out there ranging from the conferences that he attends to what he's seeing in the industry. (1:27) And what a prolific poster, which I love about you.(1:31) So thank you for doing that. (1:32) That always something that you share back to the community and give. (1:36) And I think that's important to call out when people do that.(1:38) So thank you.
Jonathan Davis(1:40) No, I appreciate it. (1:41) It's really become meaningful to me to give voice to a community. (1:46) It's very easy to talk and be proud of the places you are and the people you work with, because I am very proud of them.(1:53) But there's also a voice to the industry too, and the challenges we are sharing together. (2:01) And I think really what I've learned as I've gotten to know peers throughout the years, attended conferences, attended to events, really met some great leaders out there is that we are not alone in this journey of revenue cycle or finance, or honestly even clinical care. (2:22) We are really not alone in this.(2:24) We're all trying to do the best for our patients, for our health systems, for our communities. (2:29) There is no reason we shouldn't necessarily be sharing how to do it best or sharing what may not be represented in the community, because there's just so much going on. (2:38) It's not possible for every CEO, CFO, leader to understand what everybody's doing.(2:45) These systems, it's just too big. (2:47) So having that voice, having that transparency, I think is important because it really helps bring to light how everybody is a piece of this journey.
Shawn Gretz(2:59) Yeah, one of the topics that we've discussed previously was the endless battles that is going on in healthcare today. (3:05) And it feels as though it's coming at us from so many different directions. (3:09) So tell me more about how you think about all the areas that actually are impacting you and your rep cycle and the battles that you're having as an organization at new haven.(3:21) How do I think about it or how do I stop thinking about it? (3:23) Because as you said, did you tell me how you stop thinking about it? (3:27) I'm good with that too.
Jonathan Davis(3:29) Yeah, that's not a problem. (3:30) It's like you're constantly thinking about it. (3:34) You are trying to face one battle at a time, but you're looking over the ledge and you're seeing an army out there gathering at your gates.(3:44) Okay, now you have new payer policies coming at the door. (3:47) Now you have new regulation that's changing how you operate it. (3:51) Now you have new technology that may be good, but maybe very different, has its own bugs, has its own workflows.(3:57) And now you have to adapt to that. (3:59) At the same time, you're trying to manage just the day-to-day, the patients being treated, the physicians wanting to be able to treat their patients and with their challenges get the prior off. (4:11) They wanna be able to make sure that patient gets treated, the insurance and their communication and all that back and forth.(4:19) So it is truly an endless battle, an endless journey, however you wanna call it. (4:27) And we're all trying to figure out how to overcome those hurdles while managing what seems to be new events happening every day that we need to adjust to.
Shawn Gretz(4:40) Let's take one of those new events and peel a thread back. (4:43) Let's then have the conversation. (4:45) How are you thinking about the big, beautiful bill?(4:47) Because I know you posted about this and what's coming down the pipeline and conversations in regards to, yeah.
Jonathan Davis(4:53) And it's funny as you say that I have, I'm reading again, the interim comments, interim final rules that came out from CMS the other day. (5:03) Literally have it on my other screen because I wanna really understand some of those exemption definitions. (5:09) So it is critical.(5:12) And to me, I don't feel like it's being discussed enough around the community. (5:17) I actually was very surprised at a recent conference I went to. (5:21) It wasn't really brought up.(5:23) And I get that it's still fairly new that the interim rules just came out June 1st and we're June 25th right now. (5:31) So I understand that, but there's enough around to at least have a discussion to say, how are you thinking about it? (5:40) And I've been hearing what other peers are doing.(5:44) Some institutions are talking about how can they support volunteer hours for their patients to make sure that they can retain Medicaid. (5:52) So probably shouldn't assume that everybody knows what HR 1 and Big Beautiful Bill Act is doing. (5:58) So if anyone's listening that doesn't know, it's going to really dramatically change how patients are eligible for Medicaid.(6:07) Who can retain Medicaid today? (6:11) There really isn't work requirements that's changing. (6:14) That's probably the biggest part is now there has to be at least 80 hours of some sort of service to the community, whether it's work, volunteering, education.(6:25) Those need to be 80 hours per month in order to be eligible for the Medicaid. (6:29) So it's not an insignificant change. (6:32) And there's certainly still a lot out there about how that's going to be monitored and forced.(6:37) But for the health systems, those who are treating the community, listen, Medicaid never paid 100% of our costs, but it at least covered something. (6:48) And now the risk of that not covering anything, I think some of the early estimates out there, maybe a third or more of patients might lose Medicaid on this. (7:00) The question is, does that transfer to hospital care?(7:04) Because if they're coming in, we're still treating them. (7:07) How does that cost get spread out across a larger community? (7:12) I mean, and that's the challenge.(7:13) Or can we even sustain operations? (7:17) I'm fortunate in a system that has been very successful over years, but we're all facing the same challenges as everyone else has. (7:26) We're all facing these cuts.(7:27) We're all facing rising costs. (7:30) And even a system like ours, who came from an environment, cannot sustain that without covering its costs, covering its bottom line. (7:40) And there are many hospital systems that have not had the benefit we've had over the years and literally may have two weeks of payroll.(7:50) And I remember when I started in healthcare, listening to my chief compliance officers with a 100-bed hospital in Niagara Falls, New York, and she was telling me stories of driving to the insurance company to pick up its check so they could deposit it, so they can make payroll that week. (8:09) I mean, that's how tight some of these organizations go. (8:13) And when you're taking a significant part of the reason they're able to support the community, that's putting a lot of places at jeopardy.(8:20) So it is very concerning for me what's happening, the speed at which it's happening, and the lack of clarity, because all those creates a very dangerous mix.
Shawn Gretz(8:34) It sure does, especially when you look at it by state, every state is uniquely looking at this and identifying this. (8:41) And the applications are going by the state, but the federal government is the one that's really putting this implementation or putting this regulation out there. (8:49) So the work requirements, one is one where, even for us as an organization that does Medicaid eligibility services, we're looking at it and saying to ourselves, look, this isn't a one time and done to qualify for someone.(9:03) Now you have to really look at that patient population and say to yourself, how do I engage them throughout the entire cycle of their care to keep them on with the work requirements? (9:15) And you're right, I was just speaking, I can't remember who I was speaking with was talking through the regards of, look, volunteer hours is a capability. (9:24) Do we, can we get them volunteer hours here at the organization or whatever it may be in order for to keep them on Medicaid?(9:31) Because you need to do something creative sometimes when you have regulations like this. (9:36) How else are you thinking about the work requirements, especially with Connecticut, Medicaid programs?
Jonathan Davis(9:43) Well, we're still obviously working through that. (9:46) And part of it is the assessment as a hospital, what is our place? (9:53) Today, I'm fortunate, I have a wonderful team of financial counselors(9:57) They are, they're true community people. (10:01) They understand their community, they talk to the community. (10:04) So when a patient comes in and they're explaining these benefits, they honestly do it in a way, a quality I can never replicate.(10:11) I think they're an amazing team. (10:12) So the question is, are now, are we adding something more to already a full plate? (10:18) Are we saying, now it's our team's responsibility to call these patients and said, have you submitted your work requirements?(10:25) Have you gone through and updated everything? (10:29) How can I help you? (10:30) We've always assisted with applications.(10:32) Listen, these applications are not always the easiest thing to do. (10:36) So more than happy to assist it. (10:38) But now you're saying re-enrollment two times a year, you have all this additional requirements, it changes it.(10:45) And I'm all thinking, is this more like, does it change Medicaid to almost become like a case management type of service because of all the medical exemptions now? (10:55) Now you actually have to not only think about their financial situation, are they eligible for Medicaid financially with the limited assets? (11:05) But medically, do they have conditions that exempt them from the work requirements(11:10) I mean, let's face it, people are usually coming to our doors, not when they're healthy. (11:16) I mean, they're coming because they have cancer, they're coming because they need surgery, they're coming because they're sick. (11:23) Now, how do we have to support the medical reasons that say these people cannot work?(11:29) And that's a very different ask to our financial counseling teams, financial advocate teams than has ever been done before. (11:37) And I think we need to figure out how does that ask managed? (11:42) Because that changes it.(11:43) I actually more worry, well, I listen. (11:46) I worry about hospitals because they're already lean. (11:49) But I also worry about the community providers that are really trying to benefit the community.(11:54) And now this is being taken from them as well. (11:58) Because your FQHC is your community providers that are critical to taking care of a community. (12:07) The at risk is actually that the healthier people are not coming in anymore because they're losing Medicaid if they're not working.(12:14) Now you're really limiting to the sick people who have the exemptions or you're waiting for people who avoid healthcare and now they're going to show up to the hospital when they are sick. (12:23) And I'm really concerned that it's going to end up with a much sicker population.
Shawn Gretz(12:28) It's interesting you say that because I read a modern healthcare article last week regards to the MCOs or Medicaid MCOs. (12:35) And they're concerned they're having with that as well in certain states, whereby they're actually trying to devise a plan to get to outreach to the community. (12:44) Because otherwise they're going to take on the sicker patients is what's going to be left in their MCOs and they're not going to have the healthier patients.(12:50) Which is interesting where this is one area where I think the MCOs and the healthcare providers can work together to try to solve for it where potential could be. (13:01) But that's not always the case. (13:04) So it's kind of a unique situation there.(13:08) The other one, one of the things I'd say as a director or executive director of patient access, you set the stage in so many regards or your team sets the stage, I should say in so many regards for the entire health system to do the job that it needs to do for REB cycle work. (13:27) How do you think about that overall and really talk to your teammates in regards to, you know, the prior authorization world, the making sure the registrations are done accurately and correctly, timely for patients as well. (13:42) How do you think about that from an endless battle?
Jonathan Davis(13:47) So I, in some respects, I would say the prior off challenge is a continuous challenge. (13:52) It's a never ending changing story. (14:00) So when I think about them, I wish I could say altogether, but I have to break it out because otherwise I'm probably just gonna be overwhelmed.(14:08) I mean, honestly, yeah. (14:09) Take financial estimates, take prior off, take registration. (14:12) They all are significant challenges and important factors on their own.(14:18) When it comes to prior off, the challenge is the game keeps changing. (14:26) The goalpost keeps moving. (14:27) You know, once we figure out something, you get a policy memo from a payer and suddenly it changes.(14:34) Suddenly something you never needed a prior off for now needs a prior off. (14:39) And it's different across the many payers. (14:42) So I think it would be much more manageable system if at the very least, all the different payers followed the same playbook.(14:53) Like there was a standard across the board that at least they had a standard. (14:57) Everybody can, we're a free market. (15:01) You know, it's about individual choice.(15:03) I will, I advocate for that to the day I die. (15:07) But having a standard, that's a very different story. (15:11) I mean, think about if you were driving down the road, highway, and you went from miles per hour to kilometers to knots, I don't know, like I'm like, and it just kept switching every little bit.(15:26) And at some point it was a mix of different things. (15:28) Like there'd be car accidents all over the place. (15:30) That is the road our teams are on.(15:34) Our clinical teams, our prior off teams. (15:35) I mean, it's to the point where the physicians, and when you work with thousands of physicians, there's no way they're going to remember every substitute drug that a different, that different payers. (15:48) They're going to, or at the end of it, it's frustration and overwhelm.(15:52) They're just going to order what they think is best. (15:54) And it's up to our teams to communicate back, this is not covered, this is not. (15:59) And it just, it's that frequency that happens because it's, this is jointed network.(16:05) There's no standard for care when it comes to the payers, what should be approved or not. (16:10) I think it would be a much more different story if we knew across the board, if there was like, that was regulated. (16:18) That would be a dream because otherwise, we're trying to do technology.(16:22) We're trying to make it easier because the difference in healthcare is hospitals. (16:30) You can't just raise revenue, like most individual businesses. (16:35) If you raise a contract rate, it's coming from patients.(16:39) It's coming from providers. (16:41) It's coming from taxpayers. (16:43) There's a cap on what we can do, yet we're facing inflation just like anybody else.(16:49) So to just, all these policies that come in, the answer can't be anymore. (16:54) You just throw bodies. (16:56) The body quota has pretty much hit a limit on what we can afford or find for all the people.(17:02) But because it's so diverse, so changing, the technology isn't really able to take advantage of the automation that it is technically capable of doing, but the sameness, the standardness is not there. (17:20) So even AI today is frankly not at a level that it can just add a dime, change process to a new policy and update it. (17:28) I mean, you have to have that human agility still, but that requires a lot of bodies, a lot of training, and this human element that just ends up being overwhelmed for many reasons.(17:41) So I think that is the end. (17:44) It's like people are, I remember for years going to conference, oh, AI is going to make prior off standard. (17:50) You just turn it on, it's going to happen.(17:52) Yeah, that's been one of the biggest hypes. (17:56) I would say it was like a prior off AI bubble a couple of years ago. (18:01) Every company had it and nobody really did it.(18:04) So outside of a couple of small statusing or I have actually seen some progress on documents when it comes to some of the chemotherapies and drugs, which are very voluminous and complex, that is a lot of potential there, which I think AI is starting to come in, but still the traditional policy management submissions, that is still too disconnected to really have technology. (18:29) And I think that's my challenge as a leader is communicating to my leadership teams why we can't just turn on a computer, somebody leaves, why I need to replace them, why United comes up with a new policy. (18:43) That policy has to be an extra FTE for me because of all these extra touches.(18:50) In an environment where healthcare, we just talked about HR1, that's revenue loss on top of everything else, they're making choices. (19:00) Really, the systems should be able to invest in doctors and nurses. (19:04) I mean, that's why we come to, that's the care.(19:07) But we need the people who do prior op and everything else to make these systems go. (19:13) And unfortunately, they keep throwing, payers keep throwing policies at us that require to add more and more. (19:21) And we're fighting, we're spending more to keep the revenue we should have been earning in the first place to treat the patients we've been treating in the first place.(19:31) This isn't growth, this isn't new revenue. (19:33) This is extra barriers and costs to continue the same service we've always been providing.
Shawn Gretz(19:40) It's interesting, it says the insurance companies are finding an effective manner, constantly looking at effective ways. (19:46) And this is one of those where it's working for them. (19:49) It's painful for any health system to go through as the prior authorization works.(19:55) It's, as we talked about before, it's an endless battle that I don't think they're not gonna give up on. (20:01) And it's, there's not easy ways to go about solving for. (20:05) AI would be great if it could, if it could actually manage to that complexity.(20:10) But it's still not capable of having that large of swath of information and change on a dime. (20:20) You know, you talked about the, or I talked about the patient access team and the work that they really do for the health system and the open the front door of the reb cycle. (20:30) How do you think about that from the endless battles they're going through as well every single day?(20:35) And not only the fact of what their job is, but also for us as individuals that hire teammates, how do you think of recruiting for that position as well?
Jonathan Davis(20:48) Yeah, and once again, it's all about the different positions. (20:52) So your front desk people, your registration, those, you know, they really have to, and I think many of them do, and I've talked about this on LinkedIn posts, like they're there because they actually feel value in the work. (21:06) There is, you know, where a lot of this work is at a very competitive pay range for a lot of competing services.(21:14) So it's really a choice to be in healthcare, and that's really what we look for is people that aren't just looking for a paycheck. (21:21) Like they actually find meaning in being that first presence when it comes to patients. (21:30) I think the challenge is, you know, like anything else is finding people who wanna be present.(21:37) And that has, I mean, I'm not the only one who's noticed in the environment that it's become a crisis to find people in this for these roles. (21:48) The reality is pre-COVID used to have a line of applicants. (21:53) If somebody left, yeah, you know, you have some men, you have a good pool of qualified people to choose from.(22:01) Now it's getting a lot harder. (22:04) Then you work from home options has grown dramatically, and I realize there's still push and pull, work from home, come in the office. (22:13) Well, this is a role that historically has been in the office.(22:18) On top of that, some of the hours can be very demanding. (22:21) You start out when the doctors start out, really, if not before, because you have to be there to arrive the patient. (22:28) You have to be there to take that information that is critical.(22:33) And unfortunately, if you're not there, it's going to fall on the clinical team nurses who that's not really what they should be focusing on, nor they're worried about caregiving. (22:42) They're not worried about all the rules, the paperwork. (22:44) They, do we have to give this patient an advanced beneficiary notice, ABN, or what other services, paperwork do they need because of state regulations?(22:57) That, unfortunately, is a whole job on its own. (23:00) You're not just saying you're here and giving them a checkmark. (23:02) There is so much to do to make sure that that claim, everything goes through correctly down the road.(23:10) So, where I think about that, and I apologize, I get a little wordy and get sidetracked, is it's an endless battle. (23:23) Can we have all the people we need to do? (23:27) Or, it feels like it's an endless cycle of you find somebody that, and maybe six months down the road, they get a job they can work from home or somebody else.(23:39) Maybe within the health system, maybe out, they figure out it's not there. (23:42) So, you spend a lot of time training them, and now the manager has to cover again because it's still going to take a couple months to find that replacement. (23:50) I wish we were at a point we had access to just cover them, but that's just not the reality.(23:54) So, once again, it's what is the technology you can use to try to help supplement? (24:03) What sort of other things that help make that arrival or registration happen? (24:09) Without a loss of some of that connection, that is important because we're not trying to have a McDonald's kiosk where you come up.(24:18) I don't think that is the future of healthcare, but there are tools out there to still help connect patients to people, maybe remotely, or maybe there's a growth of people comfortable using the self-service technology on their phones. (24:34) It's just finding that mix of options to really help address that challenge.
Shawn Gretz(24:39) The capability for a patient to be able to really get through that registration process quickly, efficiently, and really from the hospital system standpoint to effectively, right? (24:53) Because that's the important part of the piece of the puzzle because everything that happens on that front, that front step for the patient access, that creates the doorstep to everything else you all do. (25:05) It's important.(25:07) And remote work has changed so much the way we look at hiring for positions. (25:14) I remember back when we, for my company, we had over 300 teammates and we started going remote. (25:24) One of the biggest things, the biggest collisions we saw was the capability of those individuals to learn from someone else by sitting side by side.(25:31) You can't replicate that. (25:33) And that's such an important piece that even in patient access as well, I'm sure that's a, how do you think about that part of it when you are looking at a remote workforce capability?
Jonathan Davis(25:46) So there's mixes. (25:48) So I'll give you an example. (25:50) I have call centers that during COVID, we let a lot of people go home or from home.(25:55) Call centers, like the scheduling centers, they were in there. (25:59) You had to monitor them. (26:00) And what we found is there were certain people that really succeeded.(26:05) And if you hit a goal, many of them achieved that goal if it meant staying home. (26:11) So staying home really became a perk, but it also gave us that line of people who are struggling and maybe need that one-on-one. (26:20) So what it came from a management perspective is really let the ones who are truly self-sufficient get that perk, get that benefit.(26:29) Because it's an incentive to them. (26:31) It's a benefit to help them stay. (26:34) I mean, we want, it's tough work.(26:35) I mean, all of this is tough work, but we bring in the people who need that extra help. (26:42) Because I do believe when we're talking this, when you say remote, you don't wanna have like somebody in Wyoming do the work. (26:51) I mean, you need to have them still regionally that if they need to come in, if you need to give them that little extra training, they come in.(27:00) So that's why for most of our, at least, remote workers, there is some onsite training and onsite development first. (27:08) So, because what you said is critically important. (27:11) They need to have that contact and ask the questions.(27:14) Otherwise, yeah, especially with what we're doing, just being left on your own right away is not the right way to do this.
Shawn Gretz(27:21) Not at all, not at all. (27:23) You talked about AI before. (27:25) You talked about the, from your perspective, how close are we where you feel there's an AI capability to help your team and your staff in the next, I don't know, 10, five, three, two, one?(27:44) Where do you think that is coming in that really drives a 10xing of your teammates' capabilities?
Jonathan Davis(27:54) So there's a balance. (27:57) The 10x is interesting because the 10x of abilities is one thing. (28:04) Unfortunately, sometimes the 10x of cost to benefit is not.(28:09) And I think we are at a challenging point where there's a lot of money being invested into AI resources and tools with a lot of investors saying really positive about the future. (28:24) And I get it. (28:26) It has amazing technology.(28:27) I am an avid user of Claude and ChatGPT myself. (28:33) But I also try to really set a perspective. (28:37) If you're giving me very small margins, there's just so much risk in moving to technology versus the people that we trained, we developed.(28:48) In that black box, if something goes wrong, it goes wrong broadly. (28:54) So 10x is what I really try to strive for. (28:58) At best, most technology with the cost and the margins they're trying to get, we're lucky if we get 3x most of the time.(29:05) And that's unfortunate because it takes a long time, a lot of investment and resources that honestly don't get into that margin calculation just to come up with that. (29:15) As far as what can be done, that where I'm more positive. (29:24) So I also have analytics and reporting.(29:25) I was actually an accountant by training. (29:29) I was a forensic accountant in the past. (29:30) So data is something that I was always into.(29:34) So I am very ambitious about what AI can do from a data standpoint, really helping us own into where is most important. (29:46) When you're looking at revenue cycle and what can be millions of claims, there's just too much going on through the eyeballs to keep track of. (29:55) You would need 5x the army of people you have today to manage it.(30:00) And that just doesn't make sense. (30:02) So AI, I think really has an opportunity to digest some of that information that is not obvious. (30:08) We'll tap, not obvious that this payer is denying all of these small dollar transactions because of this one code that isn't there, but they never told you they needed that code.(30:22) It just happened. (30:24) And within the plethora of data that just gets pushed through, you just don't have the bodies to go through all of the little things. (30:36) You use vendor partners, you use resources, but they're in the same boat, realistically.(30:42) We spend a lot of our time on the bigger accounts of dollars because it's time value. (30:48) So I'm very ambitious of what can be done from the analytics standpoint, because helping us narrow down on impactful things or policy changes that we can work with our managed care partners to direct. (31:02) Otherwise, it's the analytical tools, which is a lot of individual slicing and dicing to figure out the best opportunity.(31:12) And that's not necessarily efficient with the volume we're talking about. (31:16) In terms of interaction with patients or payers, I think there's potential there. (31:26) I don't think it's as dramatic as people have made it out to be.(31:30) First is, I do think the cost of AI is going to skyrocket. (31:34) I think we are hitting a capacity usage out there. (31:39) And I think martial art cat videos AI generated are going to take over some of that processing power, not leave enough for us to truly use it cheaply.(31:53) So those voice AIs, I think they have a place. (31:58) I think there's still work for them to be not annoying when it comes to talking to them. (32:05) But if you're like really just trying, hey, can I confirm my appointment?(32:09) I just have a couple of questions. (32:11) I do believe there's a lot of potential for those to happen. (32:15) I think when it comes to the payers, I make a ridiculous joke, and it's not a joke unfortunately, is I look forward to when we have our voice AIs that can call the payers and talk to their voice AIs and they have an AI conversation about arguing for approval of a claim.(32:35) I think it's just a ridiculous concept, but the reality is we still have to make phone calls. (32:40) We still talk to their digital agents. (32:42) At some point, our digital agents will talk to their digital agents.(32:46) Ignore the fact that with a simple button from our EMR, we could push all of this. (32:52) These are some of the rules we have to go through because we're following how they want the interaction done. (32:59) So I think it's not the savior of everything.(33:04) I'm not talking about medical. (33:05) There's amazing things being done with AI and medical, but from a revenue cycle standpoint, I think there's a lot of ambitious claims out there that they haven't gotten into the weeds enough to really figure it out because don't forget, I talked about the payers being different. (33:23) All of us providers are different.(33:25) I can walk into any small, medium, or large health system, and I would say maybe 70% of our processes are the same, but there is significant variation over the rest. (33:38) And even though processes are the same, there's some variation there too in the flow and the mappings and everything. (33:46) So you know one provider, you know one provider.(33:49) You can't just take what Yale did and say, that's going to apply to every other major health system in the country. (33:55) I think you can do 10 different health systems, and you'll still only probably get, however, maybe 20% of the rest in terms of efficiency. (34:06) Everything else, you're almost building it from scratch.(34:09) And I think that is also a major barrier and impediment from growing AI to wide usage.
Shawn Gretz(34:19) Yeah, I think you come at it from a unique experience, not only is the patient access side the input of the data throughout the organization, but also from the analytical side. (34:30) When you really think about AI, it's junk in, junk out for the data that comes through. (34:35) And if you're not really solving for the data to begin with to make sure it's AI capable, it's going to be junk.(34:42) It's going to be any solution you throw at it, junk. (34:45) But if you really think about it from that perspective of starting from the data that's coming in, and that's how, you know, for Chedx, how we've been thinking about it a lot has been, look, there's a lot of times when you're looking at, you know, even the, you know, example, how did the hospital system put in the payer name? (35:05) Did they put it in accurately?(35:06) Is it the correct name? (35:07) Is it the correct name that the patient will know? (35:10) Was it a name that it was there 10 years ago and it's still the same name?(35:13) It's been 10 years because the name has changed because someone was too, you know, someone didn't change out the contract name, right? (35:20) Those little things matter. (35:22) And it's going to matter what the data is for AI to be able to solve for all of it.(35:26) So, yeah, it's interesting because I think where we're, in my mind, where AI has the biggest payoff is upsizing our teammates constantly by helping them hear, see, learn, educate faster by seeing, you know, whatever it may be that AI can kick out. (35:48) Now, you're going to get the, you know, there's the famous example of a Tesla engineer who at night would sit there and label stop signs. (35:57) I don't know, did you ever hear that, the label of the stop sign, the gentleman that was, yeah, he was one of the highest engineers at Tesla.(36:04) And every single night he'd sit there and label a stop sign. (36:07) Now, this is a stop sign. (36:08) This is a stop sign.(36:09) This is a stop sign because not every stop sign is the same. (36:12) But Tesla had to get that basic thing down in order to get self-driving. (36:17) What's our stop sign, Jonathan?(36:18) What's the one thing, if you said, you know, starting tomorrow, we got to start with something, what is the junk data that we got to solve for? (36:25) Do you have one off the top of your head?
Jonathan Davis(36:28) And I wish I could narrow it down to one. (36:30) I wish, you know, I hate to say it because it wasn't as simple as the stop sign, but the reality is we have too many, too many signs. (36:41) And I think that is it, is why is there so many different types of signs?(36:48) Why isn't it just a stop sign or a red light, green light, yellow light? (36:52) Why isn't it that simple? (36:54) Why does it have to be so complex that I can't tell you one thing?
Shawn Gretz(37:01) You're basically thinking about it, even solving from one pair is too complex because even that pair alone is way too hard to understand. (37:10) And how do you solve for the entire picture and the complexity of healthcare? (37:15) But I think that's why we go back to the conversation where we started with is the endless battles that we're fighting in healthcare today.(37:23) Jonathan, I really appreciate the time that you took with us to talk through some of the endless battles that you're facing on your side at Yale New Haven. (37:33) We really, truly appreciate you taking the time with us.
Jonathan Davis(37:36) I appreciate being here, thank you.
Shawn Gretz(37:38) Jonathan, that was fun, I appreciate it.
Jonathan Davis(37:41) You too.

Executive summary

In this episode of RCM Reframed, host Shawn Gretz, President, Sales and Marketing for GetixHealth, and Jonathan Davis, Executive Director of Patient Access and Revenue Cycle Analytics at Yale New Haven Health, talk about how revenue cycle strain is no longer just a denials problem. They discuss how pressure is coming from three directions at once and how it is a daily operating model problem.

Key takeaways

The "endless battles" that RCM leaders are facing daily
HR 1 / Big Beautiful Bill and Medicaid work requirements
Financial counseling becoming case management
The 3x-not-10x reality of AI and where AI actually pays off

When Financial Counseling Becomes Case Management

Key takeaways

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Meet The Speakers

Jonathan Davis

Shawn Gretz

Let's talk!

Key takeaways

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Meet The Speakers

Jonathan Davis

Shawn Gretz

Let's talk!

The core behind care.