The Future of Healthcare Finance: 4 Themes from the HFMA Annual Conference

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Daniel Marino:

Welcome to Value-Based Care Insights. I am your host, Daniel Marino. In June, early June, HFMA, Healthcare Financial Management Association, had their annual conference. And I'm not sure how many of our listeners have attended the HFMA conference in the past. I've had the pleasure of attending HFMA conferences for probably a good 20 years or so, and been very fortunate to speak at quite a few of them, and I'll tell you, it's a fantastic conference. You know, I think from a business perspective, I always get a lot out of the conference. There's always some really great trends, great themes, great discussions that occur with a lot of the industry leaders. And what I often find about conferences such as HFMA, is it, is it does get a lot of really strong thought leadership together and really working through some of these challenging problems or issues that we all tend to struggle with day in and day out. And there's no better way of solving that than maybe listening to how others have approached that problem or really networking with your peers. So I want to recap a little bit of the HFMA conference, and I'm really excited today to have, someone from HFMA join us. Katie Gilfillan is Director of Healthcare Finance Policy at HFMA. She leads the national initiatives focused on value-based payment transformation, healthcare finance strategy and policy. She's worked at HFMA for a number of years. Excited to have you in the program. Welcome, Katie.

 

Katie Gilfillan:

Thank you for having me, Dan. I'm glad to be here and excited to talk about this with you.

 

Daniel Marino:

Well, and congratulations to you and your colleagues for a wonderful conference. I understand you had about 3,500 attendees or so at the conference this year.

 

Katie Gilfillan:

That's right. Yes. Great attendance. Provider organizations, physician organizations, our business partners. So, a good crowd there, talking about a lot of different things that are happening in healthcare finance today.

 

Daniel Marino:

You know, one of the things that I've found that has been great with HFMA over the years is it used to be just focused really in the finance sector with CFOs and particularly CFOs of hospitals, but you really expanded that to where now physician leaders are part of it and you get a lot of medical group, operations folks that are part of it, and even the payers that are part of it. And I give a lot of credit to HFMA, and really expanding the network and the participation. I think it's just a fantastic way to cover a lot of these topics of the day.

 

Katie Gilfillan:

That's right. And I think it's really reflective of the changes that are going on in the industry that across the C suite you need different representation to really ensure that the business model underlying, you know, hospital and physician practice operations and healthcare in general is managed by the entire organization, so.

 

Daniel Marino:

Yeah, I agree. I agree. So, thinking back on the conference that you had in June. Reflecting on it, what were a couple of the key themes that you've seen that were maybe good, either good discussion points or maybe good takeaways as part of the conference?

 

Katie Gilfillan:

There were a few, themes that were very ubiquitous across the sessions, at our event this year. One being, you know, we've talked about value-based care for a long time, and a lot of And you know, we've thought about it as kind of a contracting strategy, but it's really become more about operating model transformation. So that would be one main theme. The other is, you know, organizations are thinking about their investment strategy and how that supports care model transformation. And then AI, of course, was a major theme throughout nearly every session at our event, and how AI can be used to better manage patient care. And then finally, we were hearing a lot about affordability. So organizations are facing increasing pressure to improve outcomes while also reducing the cost burden to the patients that they serve.

 

Daniel Marino:

Yeah, you know, I think these are all key topics that I know in conversations that I'm having with folks, there's certainly thinking about that, you know, definitely around some of the investment strategies. But let's touch on the first one that you brought up because obviously that's an area that's near and dear to my heart. When you think about value-based care, you know, I agree with you. I think we've evolved over time from value-based care initially being a contracting strategy where the payers really pushed some type of a performance base or an incentive that laid on top of a fee-for-service contract or chassis, if you will. But it has really evolved to more of an operating model, right? Where you need to have the infrastructure in place in order to drive the success around a contract, but also then to identify the new contract parameters. What were some of the key themes or the key discussion points that some of the leaders who attended, what did they bring to the table around that topic?

 

Katie Gilfillan:

Yeah, I think a lot of what was talked about is that success really depends on redesigning clinical operations, redesigning physician incentives, care coordination, and then finance, you know, being involved in all that so they can better support, you know, better outcomes and lower total cost of care. So, moving away from my contract-by-contract sort of mindset and thinking about their full portfolio of value-based care, and then really building the operating model so that it supports that. So, thinking about. You know, hospital at home programs, care management, their post-acute networks, their ambulatory strategy, access points within their system, ensuring that physicians are aligned and building a culture in a workforce, that supports overall an operating model that would be successful in value-based care. I think about an example from one organization where they had multiple contracts with multiple payers and each requiring different quality metrics. And rather than asking their physicians to kind of navigate all these different measures with every payer, they standardized their clinical dashboards, and their workflows across these contracts. So that, instead of allowing each payer then to kind of have their own unique reporting structure, their own metrics, they developed these standard set of metrics, and then they went to the payers and they said you can adopt our framework that we have, or you can choose from a limited set of metrics. And then they knew that their physicians were, you know, working towards this consistent workflow, this dashboard, the physicians were clear in what they were doing, and it didn't matter what the contract said.

 

Daniel Marino:

Well, and I tell you what you pointed out is is definitely an evolution. As organizations think about advancing both their clinical and operational models and around value-based care. Because a lot of times at first, you know, and even today, right, the payers come to the organizations and say, here's how we're gonna measure quality. Here are the HEDIS measures we're gonna look at. And each one are a little bit different, especially when you get into the commercial contracts. And before you know it, you end up having, you know, over a hundred different quality elements that you're trying to track. And it's unmanageable. One question that I had, though, as you were kind of talking, you know, when you think about value-based care, and especially clinical integration. There's always this balance between having physicians and the clinical folks lead it and drive some of the performance versus the finance folks thinking about the ROI and the financial benefit that comes out of it. Was some of those topics incorporated into the discussions around the value-based care operating model?

 

Katie Gilfillan:

First of all, you know, finance helps…to define the strategy, but physicians and operational leaders are really the ones that are kind of bringing that strategy to life every day. And so I think, you know, sophisticated organizations and sophisticated finance leaders are moving beyond sort of evaluating every intervention or standalone ROI, and they're thinking more in terms of how does this investment you know you know, help…give us the capability to create value across the organization. So rather than kind of looking it at, you know, at the P&L, at the department level, they're thinking, how are these investments really supporting the operating model that we're trying to achieve? So I think you're seeing more alignment between finance and clinicians. And in kind of driving success in value-based care and being able to kind of move along that risk continuum.

 

Daniel Marino:

Yeah, yeah, I agree. And I think the more that that alignment between finance and clinical operations occur, you know, that's where you really start to see a lot of the, or really the value drivers of value performance. Let's pivot to the second one that you had mentioned, investment strategy. Right? You know, capital investments, capital dollars versus the operating dollars. Most organizations across the country, if not every healthcare organization across the country, is really working through this, or really struggling with it. Where do you put your dollars? You know, there's not an unlimited black box of money sitting somewhere that you can tap into. What were a couple of the key elements as organizations were working through the investment strategy components? What were some of those things that came out of the meeting?

 

Katie Gilfillan:

Yeah, I think, you know, the value of the investments, are now shifting more towards, you know, preventing unnecessary utilization, improving long-term outcomes, things like care management, behavioral health, Ambulatory expansion, digital health, AI, home-based care, those things that are supportive of moving upstream in the patient care continuum, preventing, you know, higher cost episodes from happening, preventing expensive emergency department visits. So evaluating investments that support long term value-based care success. It sounds like.

 

Daniel Marino:

It's a lot of those things that are changing the care delivery models, right? You know, as you mentioned, the technology and investing in care management and a lot of those areas. I'm happy to hear that because, you know, I think for many within the finance committee, the community rather, they've struggled a little bit with how to incorporate some of those dollars into new care delivery technologies, if you will, that are really driving some of the performance outcomes.

 

Katie Gilfillan:

Yeah, I have an example. There was an organization that had invested in a lot of home based services. So home infusion, home health, palliative care at home, hospital at home. And so they had made these investments which were very satisfying to patients to be able to receive care in the home, but created some complexity and maybe some confusion about moving between these different types of care models and so they made an additional investment into educating their staff, their care managers, and their patients. To kind of explain what these different care models are and how they can access the services in them and what that means for them, and then they really kind of optimize that home care strategy, and we're really able to kind of maximize the benefit of this larger investment by making a small investment just in that workflow redesign and the care redesign.

 

Daniel Marino:

Yeah, wow! That's a great example. And you can tell how kind of incorporating that in. They probably saw a different way of seeing of tracking those performance outcomes, but tying it into the financial improvement and the overall opportunities for the organization. That's a great example. If you're just tuning in, I'm Daniel Marino. You're listening to Value-Based Care Insights, and we are recapping the recent HFMA Annual Conference. I'm here with Katie Gilfillin, and Director of Healthcare Finance Policy at HFMA, and, we're talking through many of the key topics, key themes that were covered there within the conference. So, Katie, I want to turn to one of the other areas, kind of building on what you had mentioned with the investment strategy and a lot of the care models. And that's the integration of AI with the with access and with the care models.

 

Katie Gilfillan:

Yeah. Okay.

 

Daniel Marino:

These days, obviously, can't go to a conference without talking about artificial intelligence in one way, shape, or form. I've had the opportunity to attend a number of conferences just within the last year, and I can tell you every vendor that is out there has AI somewhere in their banners. What were some of the themes that you saw coming out of the conference related to AI? Anything interesting, different, unusual, or at least, you know, exciting as you kind of reflect on it?

 

Katie Gilfillan:

Yeah. So I agree. AI is in every conversation we have as it relates to healthcare now. And I would say the past few years, largely at our events, AI is very focused on creating efficiencies in the revenue cycle, clinical documentation, ensuring claims are paid efficiently. And, you know, addressing things like prior authorization. But this year, I feel like the conversation is now expanding to how AI can proactively improve patient access and care management and population health. As organizations are taking on, you know, more financial risk, they're thinking about, again, their in their investment portfolio and what that looks like as they move into more value-based care? Are, you know, are these AI investments helping with care management, predictive analytics? Are they able to help identify patients who may be rising risk and intervene at the appropriate time and get them into the care setting that's most appropriate to address them? So AI is following, I think, the economic model as organizations are being paid for outcomes and lowering total cost of care. And quality, AI tools are gonna follow, and that's where the investments will follow. So I think we're starting to see that shift towards thinking about technology in support of that.

 

Daniel Marino:

Yeah, I would agree with you there. Anything with regard to AI and you, you mentioned care management and I've, and talked a lot about how AI can really help aggregate information and, and help care managers. Anything with regards to, let's say, covering patient access, or even patient navigation, where we're maybe redirecting patients you know, into certain providers or helping to become more proactive or prospective in the care that we're delivering. Anything come out of the conference there?

 

Katie Gilfillan:

One of the, I guess one of the sessions I'd like to talk about, we did have a CMSchief AI and tech officer attend. His name is Jacob Schiff, and he is leading a model which conveniently is called the access model.

 

Katie Gilfillan:

And that is the model that rewards based on, patient outcomes and management of chronic conditions. So, it provides the digital tools to providers and patients in order to manage conditions like diabetes, hypertension, obesity, behavioral health conditions, and heart disease. And by providing those tools, patients are better able to monitor their condition, clinicians are better able to monitor their conditions and manage those conditions. In a proactive way, and then, you know, kind of creating that. So you can't always get into your primary care office, and you may not need to be in your primary care physician's office. You can manage that at home, and if you have a digital tool that reminds you to manage your care, that can be done remotely. And so this is a federal initiative that is really pushing more towards that, you know, digital tool, AI enabled outreach to engage patients and keep them, you know, healthy.

 

Daniel Marino:

Yeah, I've heard a little bit about that program, so I'm glad you brought that up. I definitely would wanna look into that a little bit further. I really feel like the integration of AI within some of these digital tools, within some of these technologies is really gonna help to personalize the care to the patients because like you said, access is a challenge. Every organization probably across the country is struggling with access, getting patients in when they need to get in. And if you can start to create or leverage this technology to meet the patients really where they are, right, and deliver the physician or the providers to the patients really based on what their needs are. Not every patient has to go into the office, right? But we've got to figure out what that right structure is, because at the end of the day, the patient still has a need, and that need needs to be addressed. So, it's exciting to see where that direction is going. Talk a little bit about the last one, interesting that, yeah, I guess it isn't all that, that interesting or that, that, surprising that the concept of making care more affordable came up, right? I think we talk a lot about that. We talk a lot about providing healthcare equity and ensuring that we're delivering care to everyone who needs that care, and again, making that delivery of care affordable. What were a couple of the key points that came out of that concept of care, affordability, affordability.

 

Katie Gilfillan:

Yeah, so as I mentioned, you know, providers are really feeling the pressure of addressing the issue of affordability as costs have risen and continuing to provide that access to patients. If it's not affordable, the patient's not going to be able to access it. So really value-based care is an affordability strategy for patients. Under a traditional fee-for-service model, you might think about the encounter and what that costs, and is it a profitable service line for a hospital? But under value-based care, the question becomes whether that service is making care more accessible and more affordable for patients. So, one example might be, a patient with diabetes, and, the cost of an A1C test might be too much for them. And you think of it as a discrete service, and it's a necessary service. But if the cost is too high and the patient doesn't have access to it long-term, that could be a very expensive, you know, hospital admission or exacerbation of a condition for that patient. But if you think of it as a care strategy, investing in, You know, providing that service for that patient can be, you know, when you think about total cost of care and you think about patient access and affordability. Having access to that test, makes a lot more sense.

 

Daniel Marino:

Oh, absolutely, because you're able to provide that proactive service to the patient, and, you know, that had to be a fascinating discussion to be part of. I'll tell you, we're working with one organization right now, and they're really focused on preventative care, and it's a pediatric group, and the pediatric group has, frankly, high utilization in preventative care. But that is part of their care philosophy, and their approach is that if we drive that care through prevention, it's going to save patient costs down the road. It's going to help us get in front of those issues around, say, juvenile diabetes, or issues around juvenile hypertension, or things like that. But the interesting part about that is some of the payers have been pushing back a little bit, because prevention drives a little bit of short-term cost. So…Part of it, and I think what you're talking about is really that balance, right, between the short-term cost versus the long-term opportunity. And in value-based care, we have to really think of both of those.

 

Katie Gilfillan:

Exactly, exactly. And I think, you know, that's the right mindset of that practice to think we're thinking of, you know, the investment now, but not looking at the ROI in the short term, but in the long term.

 

Daniel Marino:

Yeah, absolutely. Well, Katie, thanks for coming on. A great conversation. A lot of, I bet you we just probably barely scratched the surface on the topics that were discussed. Certainly at the conference, like I said, you usually have a whole broad view of different topics. If any of our listeners are sort of interested in finding out a little bit more about HFMA or maybe some of the things that, were discussed at the conference, can you direct folks to the website? What's maybe you can help?

 

Katie Gilfillan:

Yeah, the website, so it's Healthcare Financial Management Association, so hfma.org is our website, and they certainly can reach out to me directly if you'd like. My email is K-G-I-L-F-I-L-L-A-N at hfma.org. And I am happy to kind of navigate the website with anyone who's interested in finding some resources. We have a number of events, we have education, we have policy resources, we have webinars, we have podcasts and articles. All kind of talking about these things that we talked about today, plus many other things. So if anybody wants to reach out to me or take a look at our website and has any questions, I'm happy to have a conversation.

 

Daniel Marino:

Great. Well, thank you so much. And again, I would encourage a lot of our listeners to visit the HFMA website, because I agree with you, a lot of great information. I go on there quite regularly. Well, thank you again for coming on, really appreciate it, and again, congratulations to you and your colleagues for a fantastic conference, and keep up the good work, looking forward to another great conference next year.

 

Katie Gilfillan:

Thank you for having me.

 

Daniel Marino:

Special thanks to many of our listeners for tuning in. If you're interested in learning a little bit more about this topic, or any of the topics that we discuss on Value-Based Care Insights, please visit luminahp.com/insights or you can visit ecgmc.com for all the information on this topic and many others. I want to thank again our listeners for tuning in. Until our next Insight, I am Daniel Marino bringing you 30 minutes of value to your day. Take care. Bye.

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners