Hello, and welcome to the Becker's Healthcare podcast. My name is Will Riley from r one. I am joined today by Jim Heilsberg. Jim is chief financial officer at TriState Health. Jim, welcome to the podcast. Thank you. Jim, I'm looking forward to talking to you. Can you to start us off, can you tell us a bit about yourself, Tri State Health, and the community that you serve? Yeah. I'm Jim Heilsberg. I'm from Tri State Health in Clarkston, Washington. We're a larger rural critical access hospital, full service for all hospital services along with physician practices, both specialty and large primary care presence in the valley. The hospital's been there since the mid-50s and continues to be a very independent entrepreneurial type facility. They have continued to provide services to the local community in a spirit that you don't always see in the current environment. We work with other area providers. It's a primarily rural environment, but it's a great environment to be in, we look forward to the future. Cool. Yeah. Tell tell us a bit more about the environment, the community that you serve. Tell us about some of the key priorities that you have in for twenty twenty six in terms of meeting their needs. So trice the valley is Lewiston Clarkston. So we're right on the Idaho border. Lewiston Clark came through there and and notoriously, they identified went all the way down to the ocean down the Snake River, which meets the Columbia. So it's a long history of both port activity, a lot of agriculture. As far as serving the community, we serve not only the agriculture rich in an agriculture area that goes north, south, east, west, both grains and cattle. So there's a lot of historic and traditional values that are there. Our main focus is to continue to provide for those needs that are in the valley as best as we can. We don't do everything, neither does the other larger for profit hospital, but we do provide a lot of services that are needed for the valley. Our real goals are to continue to be able to provide all the services possible, expand where appropriate so that we can meet the needs of the community. As far for the future, one of the things that's happening is that we are expanding our surgery services. The local orthopedic presence has made a change. The for profit hospital has purchased that orthopedic group along with an ASC, and we're involved in creating our own orthopedic group now where we were both hospitals just use the one. We will continue to serve those that are physicians that are part of that orthopedic group. They'll continue to do services at our hospital. But we have almost fifty percent of the primary care population. Over time, it's become clear that we both need our own presence and the ability to serve our physicians and our community. We are the provider of choice in the valley. The other thing that's happened that we're having to deal with is a primary care group was also part of that orthopedic group. They did OB, and they were also purchased as part of the for profit by the for profit. Our goal really is to continue to serve all the patients that want to come our way, Clarkston and Lewiston and the surrounding area. Our general surgeons, we are expanding from basically two to two and a half physicians. We've because the OB providers with this transition decided that they didn't necessarily want to go work for the for profit, they've come to work for us with the exception of one. We don't deliver babies, but we're providing those services to the community for both OB and OBGYN because it's a needed thing to do. A lot of great opportunities that that we see. And on the other side of that coin, nothing's free. So we are investing in infrastructure. We did remodel two clinics that we had on-site for both OB and then ortho. And we're continuing to look to the future to say what do we do with our surgery building, sterilizing and processing area. We're expanding into that and we'll be adding an SPD in the near future looking at a surgery building, but we're trying to figure out how do we fund all that. Some of our big challenges are saying how do we fund in this time where there's nothing that's certain. All all of our revenue streams are at risk with the big beautiful bill act relating to Medicaid and changes there. Everything seems to be in flux. Yeah. Okay. So you've got big capital projects. You've got workforce projects. Where does, so where does technology fit in that agenda too? Right? Because that's moving quickly, and you probably, wanna use that to expand access and make life better for your providers as well. It's interesting in listening at this conference and others. One of the big challenges I've seen over my career of thirty five, close to forty years has been related to how many times we've talked about reducing revenue cycle cost. At the same time, we've had conversation of how do we, it's evolved to how do we allow all of our physicians and our nurses, technologists, etcetera, to work up to their license. To me, technology is gonna have to solve not only the revenue cycle, it has to solve all of our issues. I think that there are many initiatives that are out there that could be helpful. AI is certainly evolving quickly. Three years ago, four years ago, we implemented Experian, and that product allowed us to rejuvenate our revenue cycle. We have Meditech Expans as our main EHR. And with Experian, it allowed us to move a lot of manual workflows that we didn't find solutions completely in Meditech to a much more automated and streamlined solutions. They were partial AI. We just implemented one of their modules, which is denial AI, which allows for work to be done prior to a claim going out. A AI tool tells the things that need to be fixed. The claims go out. If they're denied, they come back. And that tool then builds both an understanding of what happened, looks at the needed fix and puts that back into the initial engine so we can fix them, fix the new claims that have been denied with different reasons and uncover new trends. It gives us a way to categorize all of our claims that came back in both a financial strategy, so with our largest claims and those that have the highest propensity to pay. That's a great example of what I see will develop. I think right now, we're still in the infancy of AI. We're still having people tell what's going to happen. I listened to a solution yesterday, which is about automated calling. It still has a pause when it thinks. And just like we do, but different. And I think people pick up on that. I have listened to another one where it was related to a follow-up for insurance. It was much more seamless. So I think in the next twenty four months, we're gonna see major changes in both the language models that are out there and the other solutions that allow us to be much more efficient and find ways to manage the revenue cycle. But what I think we really have to find ways to deal with is how do we help all of our clinicians work up to license to eliminate those tasks that they don't have to be doing anymore that the AI can do for them. Yeah. Okay. Maybe let's talk about both of those examples a little bit more. Let's go to revenue cycle first. Revenue cycle's been an area historically that has always been very labor centric. Right? It's always been human powered with technology aids and supports that have got sort of better and better over time. It does feel like based on what you were talking about and what we've seen that it that the equation is flipping, and it can now be technology driven and human supported. Right? It's a complete reversal of how it's been. Do you do you agree with that? Do you see do you see it going that way? That it will be essentially autonomous with human aid and human support? I I think that we're beginning to see that. I'll cite a couple projects that we're working on. One is related to bots. So not AI where it is more of a programmatic workflow redesign and rediscover with electronic solution. Payment posting is a notorious issue. Where do the payments go? How do you get them posted? There's clicks that people have to do, keystrokes they have to do. In the end, they provide no limited value. A human has been needed because we want to make sure it's right. We've just implemented a payment posting bot solution, which is nothing more than an Excel macro from the past that allows for keystrokes to not have to be done. The information can be both typed in and then copied into Meditech by a bot. That eliminated forty, fifty percent of a workflow. Yeah. That's significant. There are many workflows like that in the revenue cycle that if you can discover them and you can program that in a way that don't that it doesn't regularly break. One of the big challenges is any macro anybody that has ever done a macro in Excel knows that it can break if you bring new data, a new data set, new other factors in. We see that. And so we're experimenting with old tools in a new way. AI in theory is going to provide a different set machine learning. So the ability to merge bots with AI in the future can make it much more efficient, that's where we're gonna see a change. Right now, we're having to create, which is timely and its highest potential to break. Right. Yeah. Okay. And how about on the clinical side? You talked about that too, using technology to make clinicians' lives better. Obviously, you've got some advantages as a as a local independent not for profit provider that clearly are attracting providers to you. But, like, how are you trying to enhance their experience of working with you? I I think that they're we're doing a lot of things to work to expand in traditional ways, which is to, look at their workflows and understand, what can we do within Meditech. What I think we will see in the next twenty four to forty eight months is something that allows us to take they're no less manual than other people's. They do typing, etcetera. But there's the algorithm or the perspective that they're different. What they do is is it is special, but what they do is in a way that it can't be duplicated. I think that there are many things when we look at the new solutions that are relating to their dictation, relating to listening in on their conversation, creating coding that could not be done before. I think we're starting to see the opportunity where we can help our physicians, where we can help our nurses, we can eliminate manual work that they do to allow them to be much more efficient, see more patients, allow for our nurses to actually work up to their license. Maybe at some point there will be less in the same way if there's less steps, but it's yet to be discovered. Yeah. Okay. Okay. And let's round it out then, Jim, with a view on patients and how do you continue to put the patients at the heart of the experience. What are some of the things that you're doing to make patients' lives better and easier? Yeah. Like every hospital, we have Presque Any. We have other solutions that record, you know, what they've felt about the experience. I I think that as we continue down the AI path, we will be able to have more of our caregivers be more more consistently focused with the experience during the stay. We work at trying to get that connection now. It's what allows us to have our ratings that we do. We're one of the few that received the CMS rating as, you know, a five star for the state of Washington. So we're doing a number of things right. On the outpatient side, we have a lot of our staff that is equally as focused, but it's not as easily seen as some of the ratings. But we work hard both to connect with them with AI, call them ahead of time, provide opportunities for fitting them into schedules. We have a large minor care presence that allows people to get in if they can't get into physician through a traditional way. There's many different ways that work. We continue to work to try to allow the patients to be seen when they're most ill, when they need to see somebody, along with then how do we get, when they're trying to get in to see a specialist, to have their time be valued and place them in a spot, in a queue that's more efficient for them and us. Wonderful. Jim, bring us home. Is there anything else that you want to bring up that we haven't talked about? I I think that in general, as we look at health care, we always have to make it personal. If we don't experience health care individually, it's hard to make it personal. Our caregivers are on the front line. They're able to see that every day. As support staff, one of the challenges I've seen is how do we continue to gain that experience? I fell into health care. I never sought it out. It's been a great journey that's allowed me to actually make a difference where I don't see that I would have in other industries. I'm not producing a widget. We're not. We're producing solutions that allow people to get, at times, healed, to have their life better than what it was before. And I don't know of a greater career than you could have than doing that. Jim, thanks so much. Thank you. Thank you.
