Optimizing revenue cycle operations, streamlining workflows and maximizing technology investments are top of mind strategies for healthcare leaders as they look for ways to bolster margins and drive sustainable growth. In an interview on The CereCore Podcast, Kim Waters, Principal Revenue Cycle Consultant at CereCore, shares her multipronged approach for discovering root causes and quick wins to show early value during a consulting engagement.
Drawing from her extensive leadership experience spanning managed services, payers, health systems, and clinical teams, Kim explains how she uses organizational readiness assessments and data-driven storytelling to help organizations align on strategic goals and determine a game plan forward. Kim concludes the conversation with a care navigation success story that led to significant cost savings for the health system that also improved patient outcomes.
Find conversation highlights below that have been edited for clarity and brevity.
Stream the episode to hear more as Kim and host Phil Sobol, Vice President of Business Development at CereCore, as they discuss how to attain productive change through strategic partnerships, starting with initial conversations and assessments.
Phil Sobol: You bring a unique perspective and set of real-world experiences given your background to meetings with CIOs, CEOs, and CFOs. What are those initial conversations usually like and how do things develop from there?
Kim Waters: Each of these roles have a different perspective and problem they're trying to solve. And a different version of what success looks like. It’s about understanding what pain points they feel, taking a consultative approach. You don't get to solve all the problems in one phone call, unfortunately.
But if there's a way to provide value in that initial conversation—maybe calling out something that might be a really quick win for them or a different way to look at something—I'd love to be able to provide that value, even in those first conversations. And, build trust, because it's really about building a purposeful relationship first, and then you can dive in and start solving problems. That's how we start, and that conversation can take a lot of different avenues.
Phil Sobol: This question often comes up in those conversations—what areas should an organization handle themselves versus when should they turn to someone from the outside?
Kim Waters: A lot of us like to think we can do everything, right? It's not usually a lack of not knowing there's a problem, or even feeling like you have a solution for that problem. I think a lot of the groups I talked to understand where most of their issues are.
Oftentimes the named problem isn't the actual problem. So, diving into we think that's the problem, but let's ask the “five whys,” if you want to use a framework. We really want to get to the root cause of what's going on and where that might be stemming from.
Everybody's moving fast and short staffed. When you can identify there's a problem, that's great. Then understanding your team and if you have the talent in place that can actually execute that change—maybe that is the question to ask. And if you don't have that talent there, it's a great opportunity to reach out and see what augmentation could look like. I don't think it has to be a full outsourcing. It could be support and augmenting that team through change.
Being able to align people is so key, and sometimes when you're embedded, that's a hard thing.
Phil Sobol: Sometimes a board might request an outside evaluation to validate strategy, help assess gaps, among other things. What are common areas that healthcare organizations are often looking to improve through a consulting or advisory type engagement?
Kim Waters: There are a few buckets. How do we improve patient outcomes, how do we improve financial outcomes? And how do we improve experience, both for patients and for our internal staff? Whether that's to tackle resource issues from a financial standpoint or resource issues from a staffing and burnout standpoint.
You know so many healthcare organizations are sitting in single digit or even negative EBITDA numbers. Those financial outcomes end up supporting patient outcomes because patients can achieve care and have a better experience.
There’s one thing about the revenue cycle piece—it's end to end. If you think about the way revenue cycle works, it's a great place to start, not because it's everybody's favorite place to start, but because it touches that patient from pre-registration all the way through the end and transition of their care to the next provider. It not only gives you a chance to evaluate your technical issues, whether in your EMR, but workflow issues as well as—journey map of issues. You uncover things that impact the revenue cycle that aren't directly revenue cycle.
Phil Sobol: What does the ideal situation look like in order to have a productive partnership between a principal consultant like yourself and a hospital or health system?
Kim Waters: A great partnership starts again with those relationships, but it is also the mindset of an organization. Are you ready to embrace a change? Are you ready to work across the aisle? Bringing CIOs and CEOs and CFOs and COOs together to be business partners is a way that I like to approach it, because it is so siloed today. So if you're seeking alignment amongst your team, and you're ready to kind of make those changes, that will really impact your culture.
Phil Sobol: There's a lot of framework behind your conversational approach. You're working through the checklist and you're working through all of the areas that you need to touch on. What are hallmarks, or must do's, from your questioning or assessment process?
Kim Waters: You're right. I try to make it conversational, so it doesn't feel transactional. It's a combination of data and storytelling. Being able to take a look at the data, be very objective, but also bring in people's experiences to that. Initially it's just being incredibly clear on expectations because when you are conversational and consultative, it can take rabbit trails and so being very intentional on the expectations and very disciplined on what you're trying to solve for is something that I have to be intentional about and also make sure that the partners are intentional about.
In a lot of these engagements, it's evaluating what your current state is, and understanding what you want the future to look like, what does success look like, and then helping develop and build a roadmap to get there. I like to do zero based planning and zero based road mapping. I think a lot of times people get stuck in this is how we do it mode. So if we just go build something or automate something the way we do it, we haven't really fixed anything.
I really enjoy sitting with a team and talking about what would best case scenario look like for you? What would an optimized workflow for this situation look like? Forget about how you do it today, like no limitations. Let's think outside the box. That's always a fun process and then how we get there is a little tactical.
Phil Sobol:
Without breaking client confidentiality, can you share one story about the work you were able to do to help an organization that truly delivered just amazing results for them? Or something where at the end they said, “Kim, thank you for X.”
Kim Waters: I worked with a group that was really trying to make sure patients were getting where they needed to go when they needed to get there. A care navigation effort. There was a lack of technology in place to do it. The data was disparate, missing. A lot of it had to do with claims data. And they're trying to get into a place where Man, how do we save some dollars, but how do we really impact care and provide valuable insights to patients so that they can make the best decisions for themselves earlier and not when they're in crisis?
I had a chance to identify issues and opportunities, work with claims teams, customer service teams, data teams to bring in the right technology solution, as well as help them build out the team to actually execute those care navigation strategies. It was millions of dollars in savings from a claim standpoint. Also patients saved a ton of money because they were able to be proactive. It allowed us to intervene with patients early in care situations.
There's nothing like getting a phone call from a patient. I want to make sure whatever I put in worked, right? So I would get on the phones every once in a while just QA it myself. Even though we had a QA team. It was amazing. There's nothing like talking to a patient and knowing that you were part of building something that allowed them to take care of their son. We had so many situations where it ended up being a life-saving situation. Or, it financially saved them as a family because if they had gone down a different path, it would have bankrupted them. So at the end of the day, I like being able to do all those things and then see how it truly impacts the life of the patient—it is a beautiful thing.