Healthcare Voices podcast series: with Michelle Joy, Carson Tahoe Health

Hello, and welcome to the Becker’s Healthcare podcast. My name is Will Riley from r one. I’m joined today by Michelle Joy. Michelle is president and chief executive officer at Carson Tahoe Health in Nevada. Welcome to the podcast, Michelle. Thank you, Will. I’m looking forward to talking to you today. To start us off, tell us a little bit about yourself, your background, and tell us about Carson Tahoe Health. So Michelle Joy, president and CEO of Carson Tahoe Health. I’ve been with the organization for eleven years now, three as the CEO and prior to that as the Chief Operating Officer. My past background prior to coming to Carson Tahoe was working for Banner Health in multiple different locations and a variety of executive leadership roles. So have been on the large health system side and now have the opportunity with Carson Tahoe to lead a small private independent, not for profit system. So we are comprised of a two hundred in bed acute care hospital that includes behavioral health services, as well as an employed medical group with one hundred physicians and APPs with about twenty ambulatory care sites spread throughout Northern Nevada, really Carson City, the surrounding rural communities, so taking care of that Eastern Sierra front. Got it. And your community that you serve is predominantly rural, would you say? Or what’s what’s the demographic and population sort of mix? Yeah. So Carson City, state capital of Nevada, is roughly sixty thousand individuals. And then there’s a large swath of rural Nevada to the east and south of us. So we tend to take care of that area as the only acute care sole community hospital for that area. There are several critical access hospitals in those rural counties. But we’re the main acute care facility. We’re twenty minutes from Reno, but tend not to be in that Reno market. So our total service area population is about two hundred thousand, mainly rural. Got it. Got it. Okay. Great. Thank you for the background. And tell us a little bit what’s on your priority list for twenty twenty six. What are some of the initiatives that you’re pursuing? This is perfect timing because we have been working through our strategic projects with our board as we finalize our budget for twenty twenty six. So one of the areas that has been a key focus the last couple of years is really around behavioral health. So Nevada ranks fifty first in the country for youth mental health services. Youth mental health is a crisis across the country, definitely more than a crisis in Nevada. So we have made huge investments over the last, really, year with support from the state of Nevada to open adolescent inpatient beds, a youth crisis stabilization center, outpatient treatment space. And then we have what is called Carsten Tahoe vehicles of change. So not your typical mobile outreach clinic concept. You really have to think of these as ice cream trucks, bright colors, lots of activities, whatever we can do to draw in the kids, break down the stigma, and be able to connect with them through sound, food, play, art. So our sound truck actually folds into a sound stage, has a podcast studio built in the truck. And so really trying to give these kids an opportunity to create versus just always ingesting off their phones, and giving them tools to build resiliency, and just kind of thinking back to probably when we grew up as kids, the time we spent outside. And so huge initiative for us, something that we’re really excited about, has tons of community support. So that’s number one. The other piece is looking at our people and our culture. So we’ve made a lot of investments in our workforce. We have over two thousand three hundred employees. What differentiates us from a market perspective is we really try to focus on family. Coming to work at Carson Tahoe, you’re becoming part of the Carson Tahoe family. And so we’ve seen that play out through employee engagement surveys, recognitions that we’ve received. So this year, we’re a top Nevada employer by Forbes. Becker’s has recognized us as well. We’re a top workplace in Nevada, top health care workplace, top female led workplace. So we’re really leaning in to how do we continue to grow our own and retain all of our great employees. So that’s our second initiative. And then, obviously, with the OBBA facing us, what’s the impact the Medicaid cuts are going to have, along with potential 340B changes, site neutrality? So the board has really asked us to look at what’s our cost structure, what’s our service line profitability, where can we expand into new partnerships, collaborations, affiliations? We are seventy five percent government funded. And so any changes in any of those programs really has a huge impact to us. Very good. So you mentioned efficiency, for example. Let’s key in on that perhaps because I want to ask you a bit about technology and the adoption of technology at a facility or health system like Castle Tahoe. How are you thinking about the adoption of AI technologies? Because it seems to offer promise in terms of finding efficiency in areas like supporting clinicians and their care for patients, some of the administrative processes that support the back end, like revenue cycle, for example. How are you looking at? So we one of our strategic pillars in our twenty twenty two thousand and thirty strategic plan is transform and innovate. And so this falls right into those initiatives. We have brought in an ambient AI product for our medical group. We use that to replace live remote scribes, which absolutely brought a significant cost savings to us on the medical group side. Mixed adoption, depending on whether you’re primary care or specialist. But that is our first sort of step into AI. We have some independent groups that come into the hospital or are hospital based that are also piloting their own AI products from an ambient AI perspective. And so we have really tried to figure out, what’s that governance structure when there’s outside groups bringing in different technology. And then we know that probably the next area that we will expand into is revenue cycle. We just haven’t had the time or the resources to really drill into into that piece of it yet. You mentioned some physicians using it, adopting it adopting enthusiastically, others less so. Can you tell me more about that? Yeah. I think for our specialists, the tool that we implemented was really primary care based. And so it didn’t necessarily capture the information in a way that was beneficial to the specialists. We know through the vendor that they continue to update and refine the product, that it will get easier for those specialists. But the initial feedback coming from our providers is they’re leaving at the end of the day. They’re not having to stay hours later trying to get all their notes completed. Like, they can walk out of the room, do a quick review, sign off on it, and be done with that chart, and then move on to the next one. So it really has, I think, improved their productivity, but just also their own well-being by giving them a little bit more balance. You brought up the topic of governance and different solutions sort of popping up. Can you tell us more about how you’re thinking about governance of some of these new projects? Yeah. So we not saying that we’ve done it right, but we have really tried to identify who within the organization, from our compliance officer to our IT director, to our CMO, making sure that we have the right group of individuals reviewing everything. It is constantly evolving on what’s the consent form, what’s the communication, communication, is the technology safe from a network perspective. And so really trying to make sure that we’re protecting the organization, protecting our patients with that structure. And this is our first for everybody, first try at this. And so I’m sure it’ll continue to change as others gain more learning too, and we do as well. Yeah. I can imagine it’s bringing new conversations into your c suite s, leadership meetings as people are looking at this from their different vantage points. And Yeah. And really, also, a lot of credit to our board because they have asked for more information, more education around AI. Really, not just the technology part, but what are the future workforce implications? And how are we going to adjust as potentially positions change, positions are no longer there. What are those positions that might be replaced by AI? Those are all questions that our board is asking. And so in early twenty twenty six, we will be doing a deep dive with the board into implications of AI. It feels like I mean, you’ve touched on it on revenue cycle being an area where it’s traditionally been very labor driven with technology playing a support role. But it feels like that equation can be flipped with this techno with this advancement. Right? That it can be technology driven with labor, playing a supporting role now. Yeah. Absolutely. And especially when we look at the payer relations that we have and the amount of AI that we see the payers starting to use and how we compete. I shouldn’t say compete, but how do we protect ourselves within that space and making sure that we have all the coding and the documentation that is needed so that it doesn’t get kicked out by the payer’s AI? And then we spend all that administrative burden trying to resubmit and justify what we’re doing. And so, it’s it’s definitely a huge huge opportunity and and could be a game changer in that space. What are some of the as you think about that and imagine that future, what are some of the hurdles that you might have to get through between with your own workforce and with your payer relationships as you sort of try and do this? I think from a workforce piece is finding ways to make sure that folks know we want to keep them within the organization wherever we can, and that we are not looking at just eliminating those bodies, but let’s retrain and use them where we can. But change is always hard, especially when you have we have a lot of folks that have worked for the organization fifteen, twenty years, and now you’re gonna ask them to learn something totally different. And so especially for us, oftentimes when you’re in a large system, a lot of that rev cycle team is concentrated and consolidated at the corporate office system level. But all of these folks are living in our community. We see them every day. And so making sure that we’re taking care of our staff through this change. And then I think with the payer piece is payer relations ebb and flow. Right. Like, we have one payer that we have been you know, I don’t wanna probably the right word is battling for three years now. And so, you know, we know their editor tools are kicking our claims out, everything else. And so I do think that it is an opportunity with some of our payers to make adjustments to our contracts and try and figure out how do we leverage some improvement on our side to show to the payers that, yeah, we are trying, we are trying to code correctly. Just want to get paid for the care that we’re providing and continue to we have to work with them all. So figuring that You have to, don’t you? Because you’re somewhat on the back foot, right, as a smaller provider. So you got to look for advantages where you can. Yeah. And it’s, you know, in our last payer issue that we had, we were negotiating, trying to settle around four million dollars in unpaid claims. The payer views that as this is not substantial Yeah. But for us, that’s a huge impact Yeah. To our organization because of our size. And so we ran into a lot of discrepancy on that piece of it. And so we just were were that little organization that just keeps nipping and fighting back wherever we can because every every dollar makes a difference for us. What are your to conclude, Michelle, what are your hopes from a patient perspective? Next year, you talked about your behavioral health initiative. What else? For us, Person Tahoe has been serving that rural Northern Nevada community for seventy five years now. And so it is making sure that we continue to serve that community, meet their needs as we have the last seventy five years, continue to build trust and confidence within hospitals and healthcare because there have been a lot of challenges over the last several years post COVID on that level of trust. And so just making sure that we are doing the absolute very best that we can for our community and that they know that and trust us with their with their care. Michelle, thank you so much. It’s super. I really appreciate talking to you. Thank you, Will. Thank you. Thank you.