Podcast
Exploring Health System Finance and Revenue Cycle Purchase Plans
Trish Rivard
CEO
On this episode of Healthcare Market Matrix, host John Farkas is joined by Trish Rivard for an insightful conversation about the HFMA Health System Purchase Plans 2023 report that Trish and her team at Eliciting Insights published this month. Trish is a healthcare technology and revenue cycle expert, and she has a real passion for translating market feedback into actionable strategies and investments. With a decade of experience with the Federal Reserve, as well as stints with R1 and TriZetto Provider Solutions, Trish founded Eliciting Insights, a marketing research group that provides quality market feedback to healthcare companies and investors. Throughout the episode, John and Trish discuss the recent HFMA report, common frustrations with prior authorizations, why Trish created Eliciting Insights, and more.
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Transcript
Introducing Trish Rivard
John Farkas:
Welcome everybody to Healthcare Market Matrix. I’m your host, John Farkas, and today I am privileged to be in the Ratio Studio with Trish Rivard. And Trish is a healthcare technology and revenue cycle expert, and she has a real passion for translating market feedback into actionable strategies and investment. So how does one become a healthcare technology and RCM expert, you ask? Well, Trish began her career at the Federal Reserve because where else are you going to get great experience in revenue management? But she helped spearhead a strategic payments and research group there.
And then after about a decade at the Federal Reserve, she managed outsource revenue cycle for hospitals at R1 where she got a lot of hands-on experience with denials and prior auths. And then she moved over to the technology side as head of product for TriZetto Provider Solutions where she managed revenue cycle portfolio, about $135 million that included all RCM products and services, new solution development and operationalizing new products and product ideas for hospitals and physicians.
But then after she spent some time in that realm trying to understand the market that she was endeavoring to serve, she saw a really clear gap. And in 2015, she founded Eliciting Insights, which is a marketing research group that’s aiming to bring quality market feedback to healthcare companies and investors. And they’re working to really work to identify true market needs, to develop a blueprint for accelerating growth, to align product roadmaps with strategy, to learn what markets are going to be willing to pay for, to discover what factors drive actual purchasing decisions.
They’re looking at revealing the current and upcoming competitions, so are able to discern competition trends and working to understand what growth opportunities exist in the market and how you can capitalize on them. So it was a need that she saw lacking or that she was having a hard time finding resources to answer, and so she decided to jump in and make that happen. So other than the fact that Trish is a good friend and a part of the Ratio advisory board, we both share a passion for cycling. And we may or may not have stole away from a recent trade show to grab a quick 30 mile sanity ride along the Cumberland River in Nashville. We may have done that, but I’m really excited to talk to Trish today because Eliciting Insights just teamed up with the HFMA to release a fantastic comprehensive report that uncovers the health system’s finance and revenue cycle purchase plans for 2023. And so that is what we’re getting ready to dive into today. So Trish, welcome to Healthcare Market Matrix.
Trish Rivard:
Thank you. Thank you, John. Excited to be here today.
The HFMA Health System Purchase Plans 2023 Report
John Farkas:
So our opportunity today is to dive into some of this report. Tell us a little bit about your relationship with HFMA and how this report came to be, Trish.
Trish Rivard:
Yeah, so HFMA, so I’ve been going to the HFMA conference for, I don’t know, maybe 8, 10 years now. It’s a great organization overall and a really loyal member base. And last year, actually, Carol Romashko, one of our mutual friends, introduced me to Rita Walker who manages the channel partner relations. And Rita and I started talking and we shared some of the work we did, and they were looking to bring additional value to… they have a peer review program for the healthcare technology vendors that sell to hospitals, and they were looking to bring more value.
And so in our conversations with the peer review vendors, one of the things that the technology vendors said would be really helpful is “If we could get feedback from the market on what products and what outsource services, what additional services they’re looking to buy, that would be hugely valuable for us. We’d really love to know what the market is looking to buy so that if we have 3, 4, 5 solutions from a sales and marketing standpoint, we know which ones to prioritize from a product roadmap planning perspective, we know which ones are the ones that the market really cares about from a strategic planning perspective, these are the areas we can focus on.”
And they also wanted to know, a more granular level, so health systems with Epic versus Cerner versus Meditech, what solutions are they buying? Also look at the market by region, look at it by bedside. What are the larger health systems looking to buy versus the smaller health systems? So really that was the vision for the report, and then the HFMA decided to move forward with that. And so this is the first in a series of reports, but in addition to bringing value to the peer review, we thought this was also something that the HFMA membership base as well as investors and other health tech vendors would give value out of. So the report’s also available for purchase on our website.
John Farkas:
Awesome. And for those few of you who may not know what we’re meaning when we say HFMA, because the world is awash in acronyms, it’s Healthcare Financial Management Association, and this report, I’m curious because I think that it would be good for our listeners to know, Trish, how you even begin to approach a project like this. So how are you identifying audiences? What types of people are you talking to? How is that coming together?
Trish Rivard:
That’s a great question. So in the Eliciting Insights, we do a lot of market research. The way that we like to approach things and the way we approach this project is we started with interviews of CFOs. So we interviewed 15 health system CFOs and really, what are your challenges? What are your priorities? What are your pain points? What are you focusing on? Really got the context and landscape from the ultimate buyer for revenue cycle and finance solutions. And then from there, we designed a survey. We launched the survey, and altogether we got 321 responses. First survey we did, include the CFO VPN director, so we went down to the director level. And typically the director level in a health system, they may not be the final buyer, but they are a key influencer really because they’re looking at the feature functionality, they’re thinking about integration, they’re thinking about day-to-day workflow.
So we really wanted to get a view of purchasing from both the key influencers as well as the final decision maker. And for the HFMA with this really strong loyal membership base within the health system community, it was great. From Eliciting Insights, we have our own proprietary panel and typically our surveys will be able to get 100, maybe up to 200 responses for a project like this. And for this particular project, we were able to get, like I said, 321 respondents.
John Farkas:
And I know a number of you out there who are listening to this have direct application for an organization like Eliciting Insights that has already ready group of humans and they have a great methodology for getting the kind of information that you need to help inform your marketing plans. So lots of good there, but certainly some great insight in the context of this report. And we’re going to dive a little bit into some of what you learned because it does, I mean, there were a number of things that I saw that were really surprising to me, and in some sense just helping me define how hospitals are looking at things, there’s certainly been a major movement and how hospitals are addressing revenue, and some of the weight that they’re putting behind some of these initiatives.
And so based on the HFMA health system purchase plans 2023 report, that’s what we’re talking about here that you just released, 79% of health systems C-suites are planning to buy new solutions in finance or revenue cycle. So I know it surprised me, Trish, I’m curious if that surprised you.
Trish Rivard:
So no, actually it doesn’t surprise me. I mean, I think with the pandemic, purchasing has slowed down significantly, and we’ve all been sitting here saying, is there a recession coming or not? But revenue cycle is something that’s so important for health systems. So in order to get paid from payers, I mean payers are, they’re adding in layers of technology that’ll make it harder, make it more challenging. We see it with prior auths. So payers are constantly evolving and finding new ways of making it more challenging for providers to get paid. And so providers need to keep investing in newer technology, new ways of getting paid. And we’ve seen a new solution, it was included in this report, but it’s insurance discovery. So it’s a solution where the vendors are actually helping.
So if a patient’s insurance is denied for lack of coverage or the patient presents as a self-pay, then these solutions are really going out and looking at all the different payers and seeing if a patient has some kind of hidden coverage or unknown coverage and then attempting to bill for it. So that’s the next level of solutions out there. So there’s always new things out there and providers really need to stay on top of it in order to maximize their reimbursement.
Merging and Consolidating Health Systems
John Farkas:
Yeah, there’s definitely some movement in that realm and interesting to see how they’re responding. I know that Waystar recently announced plans to IPO, and I’m curious in light of some of that, what does that mean for the overall RCM ecosystem?
Trish Rivard:
So it’s been really fun to be in revenue cycle for the past 15, 20 years and watch it evolve because there used to be a lot of different point solutions. And then we’ve seen this kind of evolution and I really see the Waystar IPO as part of this overall evolution where you have a lot of small players and then the small players get… there’s some kind of rollup that’s happened on the technology side of revenue cycle and now one of these rollups, which is Waystar is now at a point where it’s going through and was about to go through an IPO. It’s really that maturity in the market.
From a provider perspective, hopefully when you get to that level of IPO maturity, we’ll start to see really good integration in these rolled up platforms. So that’s the hope, but integrating does take a lot of time and financial investment to get there. The other thing that’s interesting too is to see the difference between tech and services. So on the outsource side of revenue cycle, we still see a lot of smaller players out there, and we really haven’t seen… I’ve been kind of expecting that we’re going to see that level of rollup of the outsource services and we haven’t yet seen it. So it’ll be interesting to see that maturity in the outsource side starts to happen. We start seeing rollups and ultimately IPOs.
John Farkas:
Everything I’m seeing and reading and taking in right now says we’re going to see a lot of consolidation in this next 18-24 months, and I would expect that that would be part of it too. Just in knowing what some of the systems are demanding as far as simplicity and the ability to not have a whole bunch of different points of integration and connection and communication. The need to pull a lot of that together, I think is going to be important. Anything else around the Waystar movement that you’re seeing?
Trish Rivard:
Just to continue your line of thought, health systems are looking for fewer vendors. So one vendor is better than three vendors, but on the flip side, we’re also seeing health systems aggregating, and a lot of M&A is taking place in the health system side, which also lends itself to the more consolidation, the more single vendor. Because when you’re a larger health system, you don’t want to have to have 40 different vendors, each of your facilities increase more complexity.
John Farkas:
So you jumped into another thing I was curious to ask about, and that’s the whole M&A sequence. So I’ve got to think that with all the health system, the hospital health system, mergers, movements, combinations, that has some impact on vendors, what’d you see there?
Trish Rivard:
Oh yeah. And actually we dug into that in our study. So really what’s happening is as-
John Farkas:
That’s why I asked. I know you did.
Trish Rivard:
As health systems merge and become consolidated, so the goal for a health system is to standardize and streamline, save costs and also have more negotiation leverage with payers as they consolidate. So as they’re thinking about vendors, they’re looking to consolidate as well and really have fewer vendors. So from a vendor perspective, you have to be in with a corporate level, and sometimes you might be in with a corporate level and actually with an RFP at the corporate level, but you might be one of two or three vendors that win the RFP, and then you still need to sell the individual hospitals or sub health systems within that health system.
So from a vendor perspective, I’d say be on your toes here because if you are in with a health system and they get acquired, make sure you’re developing those relationships with the corporate portion of this health system and make sure you’re there at the table if they’re issuing an RFP because that’s how you’re going to stay in long-term with these health systems.
John Farkas:
And it has a lot of implications in the marketing realm too. If you are an organization that is already in a hospital or health system that’s undergoing some form of transaction, your proactive efforts in communicating into the acquiring party or however that might be happening is all in your best interest because the amount of affinity and awareness and understanding of your value proposition and what you’re bringing is no telling who the influencers are and the parties that are going to be pulling for you or for one of your competitors. And so it’s important to do that work and understand who you need to be communicating to, how you need to be building awareness and what that movement needs to look like.
Trish Rivard:
Yeah, no, absolutely.
Common Frustrations with Prior Authorizations
John Farkas:
So I noticed that prior authorizations are the top solution that health systems are planning to purchase. And I was curious what you saw as driving that, and I keep reading that payers are dropping prior auth requirements. Tell me what that picture’s shaping up to look like.
Trish Rivard:
Sure, great question. So prior authorizations, so they’re an important cost management tool by payers. I don’t think that surprises anyone. Prior authorizations, we saw them back in the start really in the HMO, Hillary Care days, but really prior authorizations, sorry, it was more expensive procedures. But what payers have presumably learned is the more prior auth requirements than the more money they make. Provider’s giving pushback though, because the number of procedures requiring prior auth keeps growing. And so there’s a lot of the provider community, various trade organizations, provider facing organizations are giving pushback. And so now we see payers, we see UnitedHealthcare was back in May, June where they said we’re dropping prior authorization requirements the same day they dropped prior authorization requirements, they actually released a whole new set of prior auth required procedures.
So I think we’re all scratching our head as to what’s going on here, but it seems to be more of a marketing play more than anything. It’ll be interesting to see if payers really do drop some of the prior auth requirements. But prior auths, it’s really hard and it’s really challenging for providers. So in order to get a prior auth, you need to know what the correct insurance is for the patient. That’s not always a given. The second thing you need to know is does this procedure for this particular payer require a prior auth? And then the third piece is you need the payer to actually give you the prior auth, that whole back and forth of providing the documentation.
John Farkas:
Lots of connect points.
Trish Rivard:
Yes. Lots of connect points. So just starting with what insurance the patient has. Well, a patient can walk into a hospital and say they have Medicare and the hospital can actually check to see if they have Medicare. And it says active coverage. Well, the patient might actually have Medicare HMO, but it shows up as active coverage when they check in the Medicare system, or at least it used to. I presume it still does that now. So if it’s Medicare, then the patient doesn’t need a prior auth, but if they have a Medicare advantage plan, then they do need a prior auth. So now we have the wrong coverage on a patient, patient receives the services, hospital assumes they’re getting paid, and then lo and behold, it turns out that they just didn’t have the coverage.
John Farkas:
Not a great impact on revenue.
Trish Rivard:
Yeah. So then it’s denied and you didn’t get the prior auth and you provided the procedure without checking with us first and whatnot. So this is a really challenging environment. I’ve also heard of other scenarios where a health system might call, let’s say they call the payer and they say, “I’m calling to get a prior auth in this particular procedure.” And the payer says, “Actually, you don’t need a prior auth, you fine.” Okay, no prior auth needed. Provides a procedure, and then the claim gets denied for no prior auth. So you kind of look at all this and you say, wow, this is a real hot mess. And it’s really challenging and frustrating for providers. And the amount of resources that they spend on prior auths, it’s crazy.
And if you look at the report, the second solution, number two, right behind prior auth is denials. And it’s funny, until a couple of years ago, denials was number one. Now, prior auth has taken that number one spot, but denials is still a close second, but the two are very closely related. So if you don’t have a valid prior auth, then your claim will be denied for no prior auth. And typically when it’s authorization related, these are typically higher dollar claims than the other maybe more technical denials that providers are working through.
John Farkas:
So safe to say that the whole prior auth ecosystem is pretty heavy on the minds of folks in this world and just worth knowing that that’s going to consume a lot of space and energy. If you have a solution that isn’t necessarily prior auth centric, you’re going to be coming up against a lot of current in that space right now, just trying to effectively solve for that problem, if that’s even close to possible, if the word effective even can belong there.
Trish Rivard:
And I mean the solution’s out there, I mean they’re doing their best. So a combination of creating a rules, platform of which payers require prior auth for what procedures, and then using RPA to go to payer website and pull the information and trying to automate as much as possible of the prior auth challenge.
Patient Self-Service, Coding Automation, and CDI Solutions
John Farkas:
So talk a little bit about what other areas of RCM are health systems looking at investing in. So we know prior auth, that’s up there.
Trish Rivard:
Prion auth and denial.
John Farkas:
What else? What’s coming in under that?
Trish Rivard:
So patient self service. So during Covid, what we saw is patient self service became really important. When I talk about patient self-service is that pre-check in, so Phreesia is a company we hear a lot that’s in this space. So you get a link and you can fill out your information before you walk into the hospital or the provider’s office. That’s a big area.
John Farkas:
I did it last week
Trish Rivard:
And it’s a great patient experience when it’s done well, especially when they have your information that’s pretty populated versus when you walk into the hospital, their physician’s office and you get a clipboard and you’re refilling the information they have on file for you that they’ve had for the past 20 years. So yeah, the patient self-service and another component of patient self-service is self-scheduling, that’s an area that patients want very much. We actually had done another study on the consumer side of self-scheduling and even the baby boomers want self-scheduling, which is fun to see. So patient self-service is definitely a category that we’re seeing a lot of traction and really we saw it take off during Covid.
And a lot of the health system executives really in that registration patient access area wanted to move forward with this patient self-service, but they weren’t getting the budget. But when Covid hit and became a patient safety issue, that’s where we really started to see this take off. Other areas of revenue cycle that there’s a lot of interest in is in that mid cycle, the mid revenue cycle. So coding, coding automation. So we asked about computer assisted coding, which we saw a strong demand for, and then a slightly higher demand. So about 26% of the market is looking for autonomous coding versus 23% said computer assisted coding. I think that really tells you that coding function. And we’ve seen the demographics on coding, a lot of coders are retiring. When we transitioned from ICD-9 to ICD-10, we saw a lot of coders retired at that time.
So we all know about the nursing shortage, but there’s also a coder shortage out there as well. So that’s a really important area of demand in the revenue cycle. And then also what’s called CDI, so clinical documentation improvement, so we saw 28% of the market is interested in CDI solutions. So clinical documentation improvement. Really it’s when you look at the medical record and you say, is all the information that should be there? Is it properly documented? Did the physician potentially go through this a little too quickly and not document some things that we could actually get reimbursed on? So that’s another area. There’s a lot of focus and some really interesting solutions out there.
John Farkas:
Gotcha. Was any of that surprising to you? Anything there that was a standout?
Trish Rivard:
No, actually, I guess I was surprised that in maybe the nuances of the order that patient self-service came above clinical documentation improvement. But no, I mean those are the solutions that we were actually expecting to see bubble to the top.
How Automation Will Affect the Revenue Cycle
John Farkas:
So I know that there’s a lot in there, and you just mentioned some, a lot in there about automation. What is the adoption for automation? What types of things are really catching traction right now? What do you see in there?
Trish Rivard:
So in healthcare, healthcare technology, revenue cycle, there’s a lot of AI out there and whatnot, and a lot of it is actually robotic process automation. And that’s fitting, right? Because when you think about revenue cycle and what revenue cycle is, revenue cycle is really just a lot of manual blocking and tackling to get claims paid by the payers. So we’ve seen a lot of RPA in things like backend follow up. So in that business office function, you get a denial. The payer’s not denying the claim because they’re requesting the medical record first. So you have to go, you pull the medical record and then you use the RPA to go pull the medical record, upload it to the payer website and really get that claim to the next status within the workflow.
Also prior auth. So prior auth is another good application of robotic process automation. Other areas of true AI we’re seeing in coding. So autonomous coding is using AI and machine learning, natural language processing to be able to code a claim. And then clinical documentation also, we’re seeing natural language processing. So fair bit of natural language processing in that mid rev cycle, which makes sense because you have this unstructured medical record that having that machine learning, that NLP machine learning come in can really help make things much more effective and efficient for the human.
The Pros and Cons of Full Outsourcing
John Farkas:
Yeah, there’s definitely a strong current, I’m catching nearly everywhere around the whole automation of documentation that I think we’re better situated to do now than we’ve ever been. And it’s going to be interesting to see how that plays itself out in the compliance realms and how we’re able to really watch AI replace a lot of the stuff that’s driving people crazy right now. So I hope we see some good movement there. What are you seeing happening with full outsourcing? I know you previously worked at R1. Is that a high area of growth right now?
Trish Rivard:
So interesting. So we’ve done a fair bit of work on looking at the market, trying to understand full outsourcing, and from our study, what we found is that 9% of the market currently is fully outsourced, and we say full outsourced, that’s-
John Farkas:
What percent of the market, did you say?
Trish Rivard:
9%. (% Of the market is fully outsourced. It’s really tough because the CFO is-
John Farkas:
It’s a lot of interface that needs to find its way to done in that.
Trish Rivard:
Yeah. And the CFO is used to being responsible for revenue cycle. So now taking that entire function, which is an operational function within the health system and having the entire thing managed by a third party is, it can be very intimidating.
John Farkas:
It feels a little unnatural.
Trish Rivard:
Yeah. But having worked at R1, I have colleagues who are at Ensemble right now, it can work very well. It can work very well because the outsource vendor brings in technology, it brings in people, it brings in experts and some best practices. So I’ve seen it work really well, and I actually think that over the next 10 years we’re going to see more of this full outsourcing. What we found is we found that 4% of the market who is not doing a full outsource, so 4% of the market has active plans to do a full outsource.
When we interviewed CFOs to start the project, we actually had several of the CFOs say “A way for us to improve our margins that we’re seriously considering is doing a full outsource of the RCM.” Then we had another CFO that said “If we weren’t actively looking to be inquired,” because that’s actually one of the ways that CFOs and health systems are looking to alleviate their margin pressure is if they have negative margins, they’re actually looking for an acquirer. “But if we weren’t in this position looking for an acquirer, then we would be actively pursuing full outsourcing.”
John Farkas:
Gotcha. What else would be good for us to know about this report, Trish? How are you seeing it being used currently?
Trish Rivard:
Yeah, great question. So we’ve gotten some really good feedback from the HFMA peer review vendors that it provides some really good information. Our hope is that it’ll be used by the strategy teams at the various vendors and the product teams for roadmap planning. So my background in product, and these are the data points I always wished I had. So those are some of the things that we’re hopeful. We have heard from one of our clients that does the strategic planning, that the information was exactly what they were looking for and needed. So excited about that. And then we’re hopeful that the private equity community that’s looking to invest in revenue cycle is aware of this report and gets a chance to take a look at the numbers and see where the investment areas are.
Why Trish Created Eliciting Insights
John Farkas:
Gotcha. Talk a little bit more, pull us into Eliciting Insights a little bit more and talk about what you all do, because obviously this report isn’t everything you do. It is a sample of what you do, but knowing that we’re talking to healthcare technology marketing professionals here, what would you want them to know about the kind of services that you can provide and the questions that you can answer?
Trish Rivard:
So I was actually at this small business event earlier this week and I said I had the greatest job in the world. So I get to interview health system CFOs, recently interview chief medical officers. We just get to be on the phone with various revenue cycle and other hospital executives, even sometimes the provider executives, we really get to ask them about what their challenges are, what they would like to see as a new solution in the market or how they think about various problems. So that’s really the core of what we do is we interview and we survey the market to understand what their challenges or pain points are. And the whole reason that I started Eliciting Insights back in 2015 is as a product executive managing up portfolio of healthcare technology, you have your investors, you have various executives, everybody’s got an opinion on what product we should build, but you don’t have the market data to say-
John Farkas:
We have opinions? Really?
Trish Rivard:
You don’t have the market data to say, we should really build a denials management solution because that fits with what we do, and oh by the way, the market will buy it, we build it. So you wind up building some solution that somebody champions or because it’s easier for the development team to spin up and then you spend a lot of time, or at least my experience, maybe this is very unusual, but my experience has been then a lot of time scratching your head saying, huh, I wonder why nobody’s buying our solution. So really that’s the genesis of Eliciting Insights.
So we have a proprietary panel. We have over 3000 panelists that we tap for surveys and interviews. Primarily health system, we do have some provider facing panelists. And really if you think about the core of what we do the foundation is the qualitative and the quantitative market research. Then the services we provide are really leveraging that qualitative, quantitative, this very robust panel we have. And so things like buyer personas or something that we do for clients, or we’ll do win-loss interviews, we’ll do NPS was really popular a couple of years ago. We’ll do roadmap planning, help our clients really which product should they be building, which they’re more of a market appetite, what feature functionality, competitive analysis. That’s something we had asked a lot.
Recently, pricing studies are something that we’ve been asked a lot to do. We also do content development. So we have health clients that want to create white papers or some unique content. They’ll say, “Hey, can we do some interviews and surveys so that we can come out with some nice citable market data?” That’s another area we focus. Strategic planning, love doing strategic planning type work. That’s really fun. And then M&A work, where an investor or strategic is looking to buy a company and add it to its portfolio.
John Farkas:
Yeah, I’m a big fan of the pragmatic marketing school. For those of you who are not aware of pragmatic marketing, especially those of you who are touching product marketing, you got to go check out pragmatic marketing, but one of their famous maxims is that your opinion, while interesting is irrelevant. I’m amazed at how many decisions get made in healthcare technology, any technology organizations around roadmap and stuff like that that are based on guesses really, or a very thin sample of experiences that people project out or multiply out to make major roadmap decisions. And there are ways to actually learn what the market is prone to do. And it’s not a cheap endeavor. It costs something, but it’s a lot less expensive than developing the wrong product or a product that is not going to get the kind of a market adoption that you are hoping because you pointed it in the wrong direction.
And that’s the kind of work that Trish and her team are ready to do. They are as well connected as any I know in this market and ready to help get the kind of insights that organizations need to make the kind of meaning and the impact that you’re wanting to make in the market. It is a critical tool because understanding product market fit, understanding who’s getting ready to buy what and what they’re actually looking for, and what’s critical in there, it’s not something best left a chance. Why guess when you can know or at least know better. Nothing’s ever certain, the world moves quickly, but what stuff like this report is demonstrating and showing is some really strong foundations to base decisions on. And I am just consistently surprised at how organizations are willing to go forward on conjuncture, not necessary, you can build a better foundation.
Trish Rivard:
And I mean, I think we’ve all had the experience, right? We’re in a room, we’re shopping with other people, and there’s a niceness factor and there’s a hierarchy. So if somebody at a higher level wants something to move forward, you just naturally give that higher weight and depending if you do a formal rating or not because that person is higher level or you don’t want to shoot down anybody else’s ideas in front of them. So in the absence of-
John Farkas:
We call it RCB, recent conversation bias, it’s very strong.
Trish Rivard:
So in the absence of good market data, there’s a lot of bad decisions that are made to be nice or because of biases. So I love what we do. I love the work that we do. It’s been fun. I just wish that Eliciting Insights existed when I was a product executive years ago because I had trouble finding a market research company to help us with our roadmap. It’s funny because in order to do good B2B market research, you have to know your space. So if you put me in the oil and gas industry and had me interview executives in oil and gas, I wouldn’t understand the nuances of what they were saying. I wouldn’t be able to speak the language. So good B2B market research is really contingent upon having interviewers or having survey designers or people doing the analysis really know their market and be able to interpret or expand upon what the market is saying.
Closing Thoughts
John Farkas:
Yeah, definitely. Good word. And really encourage folks, if you haven’t already, check out elicitinginsights.com. Trish, if people are hearing about this report and going, “Gosh, I need to get me some of that.” What’s their path? Where would you direct them?
Trish Rivard:
Sure, yeah. If you go to the elicitinginsights.com homepage, there’s a button on there that will take you to information about the report or there’s also a market studies page within the Eliciting Insights website that has our various reports out there. We also have, if anybody’s interested in the consumer study, we did the self scheduling that’s available for download as well on our website.
John Farkas:
Awesome. And we’ll be linking out to that too in the context of the Healthcare Market Matrix show notes, so you can access it there. If you’re already tuned into that channel, just follow the stream down the page and you’ll see the links to get those reports as well. Trish, anything else that would be good for folks to know? Anything else that you’re seeing in the market right now that has you interested and intrigued?
Trish Rivard:
I think automation, AI, it’s going to be really fun to see where this takes us. I think we’re all trying to get our heads around ChatGPT and what that means. It’s going to be really fun to watch how this plays out. In two or three years, are we going to have providers using appeal letters to payers and then payers using ChatGPT to create the denial letter, and we have ChatGPT arguing with one another back and forth. I think it’s going to be really exciting to see where automation will take us. I think we’re finally going to start to see the real payoff in the revenue cycle from investments in AI and machine learning.
John Farkas:
Yeah, I think it’s going to happen remarkably quickly. I think that the market is extremely ready for it and very incentivized right now. We can’t have clinicians spending time the way they’re spending it, and we can’t have administrators bogged down so deep that they can’t see their way straight. And some things have to change in order for our system to survive. And the incentives are extremely aligned to see automation come through. From a market perspective, we have to be very careful to understand what people are willing to do and spend on right now that is in their critical path. That’s where Eliciting Insights comes in. This is a great report that you can access right now to help in that world. It’ll give you a great picture. So follow the links here. We’re going to give you clear access to that.
Trish, thank you so much for spending some time with us today. And thank you too for your investment with the Ratio advisory board. We’re glad to have you there and looking forward to watching that relationship continue to grow as we work together.
Trish Rivard:
Awesome. And thanks for the opportunity to be on your podcast.
Transcript (custom)
Introducing Trish Rivard
John Farkas:
Welcome everybody to Healthcare Market Matrix. I’m your host, John Farkas, and today I am privileged to be in the Ratio Studio with Trish Rivard. And Trish is a healthcare technology and revenue cycle expert, and she has a real passion for translating market feedback into actionable strategies and investment. So how does one become a healthcare technology and RCM expert, you ask? Well, Trish began her career at the Federal Reserve because where else are you going to get great experience in revenue management? But she helped spearhead a strategic payments and research group there.
And then after about a decade at the Federal Reserve, she managed outsource revenue cycle for hospitals at R1 where she got a lot of hands-on experience with denials and prior auths. And then she moved over to the technology side as head of product for TriZetto Provider Solutions where she managed revenue cycle portfolio, about $135 million that included all RCM products and services, new solution development and operationalizing new products and product ideas for hospitals and physicians.
But then after she spent some time in that realm trying to understand the market that she was endeavoring to serve, she saw a really clear gap. And in 2015, she founded Eliciting Insights, which is a marketing research group that’s aiming to bring quality market feedback to healthcare companies and investors. And they’re working to really work to identify true market needs, to develop a blueprint for accelerating growth, to align product roadmaps with strategy, to learn what markets are going to be willing to pay for, to discover what factors drive actual purchasing decisions.
They’re looking at revealing the current and upcoming competitions, so are able to discern competition trends and working to understand what growth opportunities exist in the market and how you can capitalize on them. So it was a need that she saw lacking or that she was having a hard time finding resources to answer, and so she decided to jump in and make that happen. So other than the fact that Trish is a good friend and a part of the Ratio advisory board, we both share a passion for cycling. And we may or may not have stole away from a recent trade show to grab a quick 30 mile sanity ride along the Cumberland River in Nashville. We may have done that, but I’m really excited to talk to Trish today because Eliciting Insights just teamed up with the HFMA to release a fantastic comprehensive report that uncovers the health system’s finance and revenue cycle purchase plans for 2023. And so that is what we’re getting ready to dive into today. So Trish, welcome to Healthcare Market Matrix.
Trish Rivard:
Thank you. Thank you, John. Excited to be here today.
The HFMA Health System Purchase Plans 2023 Report
John Farkas:
So our opportunity today is to dive into some of this report. Tell us a little bit about your relationship with HFMA and how this report came to be, Trish.
Trish Rivard:
Yeah, so HFMA, so I’ve been going to the HFMA conference for, I don’t know, maybe 8, 10 years now. It’s a great organization overall and a really loyal member base. And last year, actually, Carol Romashko, one of our mutual friends, introduced me to Rita Walker who manages the channel partner relations. And Rita and I started talking and we shared some of the work we did, and they were looking to bring additional value to… they have a peer review program for the healthcare technology vendors that sell to hospitals, and they were looking to bring more value.
And so in our conversations with the peer review vendors, one of the things that the technology vendors said would be really helpful is “If we could get feedback from the market on what products and what outsource services, what additional services they’re looking to buy, that would be hugely valuable for us. We’d really love to know what the market is looking to buy so that if we have 3, 4, 5 solutions from a sales and marketing standpoint, we know which ones to prioritize from a product roadmap planning perspective, we know which ones are the ones that the market really cares about from a strategic planning perspective, these are the areas we can focus on.”
And they also wanted to know, a more granular level, so health systems with Epic versus Cerner versus Meditech, what solutions are they buying? Also look at the market by region, look at it by bedside. What are the larger health systems looking to buy versus the smaller health systems? So really that was the vision for the report, and then the HFMA decided to move forward with that. And so this is the first in a series of reports, but in addition to bringing value to the peer review, we thought this was also something that the HFMA membership base as well as investors and other health tech vendors would give value out of. So the report’s also available for purchase on our website.
John Farkas:
Awesome. And for those few of you who may not know what we’re meaning when we say HFMA, because the world is awash in acronyms, it’s Healthcare Financial Management Association, and this report, I’m curious because I think that it would be good for our listeners to know, Trish, how you even begin to approach a project like this. So how are you identifying audiences? What types of people are you talking to? How is that coming together?
Trish Rivard:
That’s a great question. So in the Eliciting Insights, we do a lot of market research. The way that we like to approach things and the way we approach this project is we started with interviews of CFOs. So we interviewed 15 health system CFOs and really, what are your challenges? What are your priorities? What are your pain points? What are you focusing on? Really got the context and landscape from the ultimate buyer for revenue cycle and finance solutions. And then from there, we designed a survey. We launched the survey, and altogether we got 321 responses. First survey we did, include the CFO VPN director, so we went down to the director level. And typically the director level in a health system, they may not be the final buyer, but they are a key influencer really because they’re looking at the feature functionality, they’re thinking about integration, they’re thinking about day-to-day workflow.
So we really wanted to get a view of purchasing from both the key influencers as well as the final decision maker. And for the HFMA with this really strong loyal membership base within the health system community, it was great. From Eliciting Insights, we have our own proprietary panel and typically our surveys will be able to get 100, maybe up to 200 responses for a project like this. And for this particular project, we were able to get, like I said, 321 respondents.
John Farkas:
And I know a number of you out there who are listening to this have direct application for an organization like Eliciting Insights that has already ready group of humans and they have a great methodology for getting the kind of information that you need to help inform your marketing plans. So lots of good there, but certainly some great insight in the context of this report. And we’re going to dive a little bit into some of what you learned because it does, I mean, there were a number of things that I saw that were really surprising to me, and in some sense just helping me define how hospitals are looking at things, there’s certainly been a major movement and how hospitals are addressing revenue, and some of the weight that they’re putting behind some of these initiatives.
And so based on the HFMA health system purchase plans 2023 report, that’s what we’re talking about here that you just released, 79% of health systems C-suites are planning to buy new solutions in finance or revenue cycle. So I know it surprised me, Trish, I’m curious if that surprised you.
Trish Rivard:
So no, actually it doesn’t surprise me. I mean, I think with the pandemic, purchasing has slowed down significantly, and we’ve all been sitting here saying, is there a recession coming or not? But revenue cycle is something that’s so important for health systems. So in order to get paid from payers, I mean payers are, they’re adding in layers of technology that’ll make it harder, make it more challenging. We see it with prior auths. So payers are constantly evolving and finding new ways of making it more challenging for providers to get paid. And so providers need to keep investing in newer technology, new ways of getting paid. And we’ve seen a new solution, it was included in this report, but it’s insurance discovery. So it’s a solution where the vendors are actually helping.
So if a patient’s insurance is denied for lack of coverage or the patient presents as a self-pay, then these solutions are really going out and looking at all the different payers and seeing if a patient has some kind of hidden coverage or unknown coverage and then attempting to bill for it. So that’s the next level of solutions out there. So there’s always new things out there and providers really need to stay on top of it in order to maximize their reimbursement.
Merging and Consolidating Health Systems
John Farkas:
Yeah, there’s definitely some movement in that realm and interesting to see how they’re responding. I know that Waystar recently announced plans to IPO, and I’m curious in light of some of that, what does that mean for the overall RCM ecosystem?
Trish Rivard:
So it’s been really fun to be in revenue cycle for the past 15, 20 years and watch it evolve because there used to be a lot of different point solutions. And then we’ve seen this kind of evolution and I really see the Waystar IPO as part of this overall evolution where you have a lot of small players and then the small players get… there’s some kind of rollup that’s happened on the technology side of revenue cycle and now one of these rollups, which is Waystar is now at a point where it’s going through and was about to go through an IPO. It’s really that maturity in the market.
From a provider perspective, hopefully when you get to that level of IPO maturity, we’ll start to see really good integration in these rolled up platforms. So that’s the hope, but integrating does take a lot of time and financial investment to get there. The other thing that’s interesting too is to see the difference between tech and services. So on the outsource side of revenue cycle, we still see a lot of smaller players out there, and we really haven’t seen… I’ve been kind of expecting that we’re going to see that level of rollup of the outsource services and we haven’t yet seen it. So it’ll be interesting to see that maturity in the outsource side starts to happen. We start seeing rollups and ultimately IPOs.
John Farkas:
Everything I’m seeing and reading and taking in right now says we’re going to see a lot of consolidation in this next 18-24 months, and I would expect that that would be part of it too. Just in knowing what some of the systems are demanding as far as simplicity and the ability to not have a whole bunch of different points of integration and connection and communication. The need to pull a lot of that together, I think is going to be important. Anything else around the Waystar movement that you’re seeing?
Trish Rivard:
Just to continue your line of thought, health systems are looking for fewer vendors. So one vendor is better than three vendors, but on the flip side, we’re also seeing health systems aggregating, and a lot of M&A is taking place in the health system side, which also lends itself to the more consolidation, the more single vendor. Because when you’re a larger health system, you don’t want to have to have 40 different vendors, each of your facilities increase more complexity.
John Farkas:
So you jumped into another thing I was curious to ask about, and that’s the whole M&A sequence. So I’ve got to think that with all the health system, the hospital health system, mergers, movements, combinations, that has some impact on vendors, what’d you see there?
Trish Rivard:
Oh yeah. And actually we dug into that in our study. So really what’s happening is as-
John Farkas:
That’s why I asked. I know you did.
Trish Rivard:
As health systems merge and become consolidated, so the goal for a health system is to standardize and streamline, save costs and also have more negotiation leverage with payers as they consolidate. So as they’re thinking about vendors, they’re looking to consolidate as well and really have fewer vendors. So from a vendor perspective, you have to be in with a corporate level, and sometimes you might be in with a corporate level and actually with an RFP at the corporate level, but you might be one of two or three vendors that win the RFP, and then you still need to sell the individual hospitals or sub health systems within that health system.
So from a vendor perspective, I’d say be on your toes here because if you are in with a health system and they get acquired, make sure you’re developing those relationships with the corporate portion of this health system and make sure you’re there at the table if they’re issuing an RFP because that’s how you’re going to stay in long-term with these health systems.
John Farkas:
And it has a lot of implications in the marketing realm too. If you are an organization that is already in a hospital or health system that’s undergoing some form of transaction, your proactive efforts in communicating into the acquiring party or however that might be happening is all in your best interest because the amount of affinity and awareness and understanding of your value proposition and what you’re bringing is no telling who the influencers are and the parties that are going to be pulling for you or for one of your competitors. And so it’s important to do that work and understand who you need to be communicating to, how you need to be building awareness and what that movement needs to look like.
Trish Rivard:
Yeah, no, absolutely.
Common Frustrations with Prior Authorizations
John Farkas:
So I noticed that prior authorizations are the top solution that health systems are planning to purchase. And I was curious what you saw as driving that, and I keep reading that payers are dropping prior auth requirements. Tell me what that picture’s shaping up to look like.
Trish Rivard:
Sure, great question. So prior authorizations, so they’re an important cost management tool by payers. I don’t think that surprises anyone. Prior authorizations, we saw them back in the start really in the HMO, Hillary Care days, but really prior authorizations, sorry, it was more expensive procedures. But what payers have presumably learned is the more prior auth requirements than the more money they make. Provider’s giving pushback though, because the number of procedures requiring prior auth keeps growing. And so there’s a lot of the provider community, various trade organizations, provider facing organizations are giving pushback. And so now we see payers, we see UnitedHealthcare was back in May, June where they said we’re dropping prior authorization requirements the same day they dropped prior authorization requirements, they actually released a whole new set of prior auth required procedures.
So I think we’re all scratching our head as to what’s going on here, but it seems to be more of a marketing play more than anything. It’ll be interesting to see if payers really do drop some of the prior auth requirements. But prior auths, it’s really hard and it’s really challenging for providers. So in order to get a prior auth, you need to know what the correct insurance is for the patient. That’s not always a given. The second thing you need to know is does this procedure for this particular payer require a prior auth? And then the third piece is you need the payer to actually give you the prior auth, that whole back and forth of providing the documentation.
John Farkas:
Lots of connect points.
Trish Rivard:
Yes. Lots of connect points. So just starting with what insurance the patient has. Well, a patient can walk into a hospital and say they have Medicare and the hospital can actually check to see if they have Medicare. And it says active coverage. Well, the patient might actually have Medicare HMO, but it shows up as active coverage when they check in the Medicare system, or at least it used to. I presume it still does that now. So if it’s Medicare, then the patient doesn’t need a prior auth, but if they have a Medicare advantage plan, then they do need a prior auth. So now we have the wrong coverage on a patient, patient receives the services, hospital assumes they’re getting paid, and then lo and behold, it turns out that they just didn’t have the coverage.
John Farkas:
Not a great impact on revenue.
Trish Rivard:
Yeah. So then it’s denied and you didn’t get the prior auth and you provided the procedure without checking with us first and whatnot. So this is a really challenging environment. I’ve also heard of other scenarios where a health system might call, let’s say they call the payer and they say, “I’m calling to get a prior auth in this particular procedure.” And the payer says, “Actually, you don’t need a prior auth, you fine.” Okay, no prior auth needed. Provides a procedure, and then the claim gets denied for no prior auth. So you kind of look at all this and you say, wow, this is a real hot mess. And it’s really challenging and frustrating for providers. And the amount of resources that they spend on prior auths, it’s crazy.
And if you look at the report, the second solution, number two, right behind prior auth is denials. And it’s funny, until a couple of years ago, denials was number one. Now, prior auth has taken that number one spot, but denials is still a close second, but the two are very closely related. So if you don’t have a valid prior auth, then your claim will be denied for no prior auth. And typically when it’s authorization related, these are typically higher dollar claims than the other maybe more technical denials that providers are working through.
John Farkas:
So safe to say that the whole prior auth ecosystem is pretty heavy on the minds of folks in this world and just worth knowing that that’s going to consume a lot of space and energy. If you have a solution that isn’t necessarily prior auth centric, you’re going to be coming up against a lot of current in that space right now, just trying to effectively solve for that problem, if that’s even close to possible, if the word effective even can belong there.
Trish Rivard:
And I mean the solution’s out there, I mean they’re doing their best. So a combination of creating a rules, platform of which payers require prior auth for what procedures, and then using RPA to go to payer website and pull the information and trying to automate as much as possible of the prior auth challenge.
Patient Self-Service, Coding Automation, and CDI Solutions
John Farkas:
So talk a little bit about what other areas of RCM are health systems looking at investing in. So we know prior auth, that’s up there.
Trish Rivard:
Prion auth and denial.
John Farkas:
What else? What’s coming in under that?
Trish Rivard:
So patient self service. So during Covid, what we saw is patient self service became really important. When I talk about patient self-service is that pre-check in, so Phreesia is a company we hear a lot that’s in this space. So you get a link and you can fill out your information before you walk into the hospital or the provider’s office. That’s a big area.
John Farkas:
I did it last week
Trish Rivard:
And it’s a great patient experience when it’s done well, especially when they have your information that’s pretty populated versus when you walk into the hospital, their physician’s office and you get a clipboard and you’re refilling the information they have on file for you that they’ve had for the past 20 years. So yeah, the patient self-service and another component of patient self-service is self-scheduling, that’s an area that patients want very much. We actually had done another study on the consumer side of self-scheduling and even the baby boomers want self-scheduling, which is fun to see. So patient self-service is definitely a category that we’re seeing a lot of traction and really we saw it take off during Covid.
And a lot of the health system executives really in that registration patient access area wanted to move forward with this patient self-service, but they weren’t getting the budget. But when Covid hit and became a patient safety issue, that’s where we really started to see this take off. Other areas of revenue cycle that there’s a lot of interest in is in that mid cycle, the mid revenue cycle. So coding, coding automation. So we asked about computer assisted coding, which we saw a strong demand for, and then a slightly higher demand. So about 26% of the market is looking for autonomous coding versus 23% said computer assisted coding. I think that really tells you that coding function. And we’ve seen the demographics on coding, a lot of coders are retiring. When we transitioned from ICD-9 to ICD-10, we saw a lot of coders retired at that time.
So we all know about the nursing shortage, but there’s also a coder shortage out there as well. So that’s a really important area of demand in the revenue cycle. And then also what’s called CDI, so clinical documentation improvement, so we saw 28% of the market is interested in CDI solutions. So clinical documentation improvement. Really it’s when you look at the medical record and you say, is all the information that should be there? Is it properly documented? Did the physician potentially go through this a little too quickly and not document some things that we could actually get reimbursed on? So that’s another area. There’s a lot of focus and some really interesting solutions out there.
John Farkas:
Gotcha. Was any of that surprising to you? Anything there that was a standout?
Trish Rivard:
No, actually, I guess I was surprised that in maybe the nuances of the order that patient self-service came above clinical documentation improvement. But no, I mean those are the solutions that we were actually expecting to see bubble to the top.
How Automation Will Affect the Revenue Cycle
John Farkas:
So I know that there’s a lot in there, and you just mentioned some, a lot in there about automation. What is the adoption for automation? What types of things are really catching traction right now? What do you see in there?
Trish Rivard:
So in healthcare, healthcare technology, revenue cycle, there’s a lot of AI out there and whatnot, and a lot of it is actually robotic process automation. And that’s fitting, right? Because when you think about revenue cycle and what revenue cycle is, revenue cycle is really just a lot of manual blocking and tackling to get claims paid by the payers. So we’ve seen a lot of RPA in things like backend follow up. So in that business office function, you get a denial. The payer’s not denying the claim because they’re requesting the medical record first. So you have to go, you pull the medical record and then you use the RPA to go pull the medical record, upload it to the payer website and really get that claim to the next status within the workflow.
Also prior auth. So prior auth is another good application of robotic process automation. Other areas of true AI we’re seeing in coding. So autonomous coding is using AI and machine learning, natural language processing to be able to code a claim. And then clinical documentation also, we’re seeing natural language processing. So fair bit of natural language processing in that mid rev cycle, which makes sense because you have this unstructured medical record that having that machine learning, that NLP machine learning come in can really help make things much more effective and efficient for the human.
The Pros and Cons of Full Outsourcing
John Farkas:
Yeah, there’s definitely a strong current, I’m catching nearly everywhere around the whole automation of documentation that I think we’re better situated to do now than we’ve ever been. And it’s going to be interesting to see how that plays itself out in the compliance realms and how we’re able to really watch AI replace a lot of the stuff that’s driving people crazy right now. So I hope we see some good movement there. What are you seeing happening with full outsourcing? I know you previously worked at R1. Is that a high area of growth right now?
Trish Rivard:
So interesting. So we’ve done a fair bit of work on looking at the market, trying to understand full outsourcing, and from our study, what we found is that 9% of the market currently is fully outsourced, and we say full outsourced, that’s-
John Farkas:
What percent of the market, did you say?
Trish Rivard:
9%. (% Of the market is fully outsourced. It’s really tough because the CFO is-
John Farkas:
It’s a lot of interface that needs to find its way to done in that.
Trish Rivard:
Yeah. And the CFO is used to being responsible for revenue cycle. So now taking that entire function, which is an operational function within the health system and having the entire thing managed by a third party is, it can be very intimidating.
John Farkas:
It feels a little unnatural.
Trish Rivard:
Yeah. But having worked at R1, I have colleagues who are at Ensemble right now, it can work very well. It can work very well because the outsource vendor brings in technology, it brings in people, it brings in experts and some best practices. So I’ve seen it work really well, and I actually think that over the next 10 years we’re going to see more of this full outsourcing. What we found is we found that 4% of the market who is not doing a full outsource, so 4% of the market has active plans to do a full outsource.
When we interviewed CFOs to start the project, we actually had several of the CFOs say “A way for us to improve our margins that we’re seriously considering is doing a full outsource of the RCM.” Then we had another CFO that said “If we weren’t actively looking to be inquired,” because that’s actually one of the ways that CFOs and health systems are looking to alleviate their margin pressure is if they have negative margins, they’re actually looking for an acquirer. “But if we weren’t in this position looking for an acquirer, then we would be actively pursuing full outsourcing.”
John Farkas:
Gotcha. What else would be good for us to know about this report, Trish? How are you seeing it being used currently?
Trish Rivard:
Yeah, great question. So we’ve gotten some really good feedback from the HFMA peer review vendors that it provides some really good information. Our hope is that it’ll be used by the strategy teams at the various vendors and the product teams for roadmap planning. So my background in product, and these are the data points I always wished I had. So those are some of the things that we’re hopeful. We have heard from one of our clients that does the strategic planning, that the information was exactly what they were looking for and needed. So excited about that. And then we’re hopeful that the private equity community that’s looking to invest in revenue cycle is aware of this report and gets a chance to take a look at the numbers and see where the investment areas are.
Why Trish Created Eliciting Insights
John Farkas:
Gotcha. Talk a little bit more, pull us into Eliciting Insights a little bit more and talk about what you all do, because obviously this report isn’t everything you do. It is a sample of what you do, but knowing that we’re talking to healthcare technology marketing professionals here, what would you want them to know about the kind of services that you can provide and the questions that you can answer?
Trish Rivard:
So I was actually at this small business event earlier this week and I said I had the greatest job in the world. So I get to interview health system CFOs, recently interview chief medical officers. We just get to be on the phone with various revenue cycle and other hospital executives, even sometimes the provider executives, we really get to ask them about what their challenges are, what they would like to see as a new solution in the market or how they think about various problems. So that’s really the core of what we do is we interview and we survey the market to understand what their challenges or pain points are. And the whole reason that I started Eliciting Insights back in 2015 is as a product executive managing up portfolio of healthcare technology, you have your investors, you have various executives, everybody’s got an opinion on what product we should build, but you don’t have the market data to say-
John Farkas:
We have opinions? Really?
Trish Rivard:
You don’t have the market data to say, we should really build a denials management solution because that fits with what we do, and oh by the way, the market will buy it, we build it. So you wind up building some solution that somebody champions or because it’s easier for the development team to spin up and then you spend a lot of time, or at least my experience, maybe this is very unusual, but my experience has been then a lot of time scratching your head saying, huh, I wonder why nobody’s buying our solution. So really that’s the genesis of Eliciting Insights.
So we have a proprietary panel. We have over 3000 panelists that we tap for surveys and interviews. Primarily health system, we do have some provider facing panelists. And really if you think about the core of what we do the foundation is the qualitative and the quantitative market research. Then the services we provide are really leveraging that qualitative, quantitative, this very robust panel we have. And so things like buyer personas or something that we do for clients, or we’ll do win-loss interviews, we’ll do NPS was really popular a couple of years ago. We’ll do roadmap planning, help our clients really which product should they be building, which they’re more of a market appetite, what feature functionality, competitive analysis. That’s something we had asked a lot.
Recently, pricing studies are something that we’ve been asked a lot to do. We also do content development. So we have health clients that want to create white papers or some unique content. They’ll say, “Hey, can we do some interviews and surveys so that we can come out with some nice citable market data?” That’s another area we focus. Strategic planning, love doing strategic planning type work. That’s really fun. And then M&A work, where an investor or strategic is looking to buy a company and add it to its portfolio.
John Farkas:
Yeah, I’m a big fan of the pragmatic marketing school. For those of you who are not aware of pragmatic marketing, especially those of you who are touching product marketing, you got to go check out pragmatic marketing, but one of their famous maxims is that your opinion, while interesting is irrelevant. I’m amazed at how many decisions get made in healthcare technology, any technology organizations around roadmap and stuff like that that are based on guesses really, or a very thin sample of experiences that people project out or multiply out to make major roadmap decisions. And there are ways to actually learn what the market is prone to do. And it’s not a cheap endeavor. It costs something, but it’s a lot less expensive than developing the wrong product or a product that is not going to get the kind of a market adoption that you are hoping because you pointed it in the wrong direction.
And that’s the kind of work that Trish and her team are ready to do. They are as well connected as any I know in this market and ready to help get the kind of insights that organizations need to make the kind of meaning and the impact that you’re wanting to make in the market. It is a critical tool because understanding product market fit, understanding who’s getting ready to buy what and what they’re actually looking for, and what’s critical in there, it’s not something best left a chance. Why guess when you can know or at least know better. Nothing’s ever certain, the world moves quickly, but what stuff like this report is demonstrating and showing is some really strong foundations to base decisions on. And I am just consistently surprised at how organizations are willing to go forward on conjuncture, not necessary, you can build a better foundation.
Trish Rivard:
And I mean, I think we’ve all had the experience, right? We’re in a room, we’re shopping with other people, and there’s a niceness factor and there’s a hierarchy. So if somebody at a higher level wants something to move forward, you just naturally give that higher weight and depending if you do a formal rating or not because that person is higher level or you don’t want to shoot down anybody else’s ideas in front of them. So in the absence of-
John Farkas:
We call it RCB, recent conversation bias, it’s very strong.
Trish Rivard:
So in the absence of good market data, there’s a lot of bad decisions that are made to be nice or because of biases. So I love what we do. I love the work that we do. It’s been fun. I just wish that Eliciting Insights existed when I was a product executive years ago because I had trouble finding a market research company to help us with our roadmap. It’s funny because in order to do good B2B market research, you have to know your space. So if you put me in the oil and gas industry and had me interview executives in oil and gas, I wouldn’t understand the nuances of what they were saying. I wouldn’t be able to speak the language. So good B2B market research is really contingent upon having interviewers or having survey designers or people doing the analysis really know their market and be able to interpret or expand upon what the market is saying.
Closing Thoughts
John Farkas:
Yeah, definitely. Good word. And really encourage folks, if you haven’t already, check out elicitinginsights.com. Trish, if people are hearing about this report and going, “Gosh, I need to get me some of that.” What’s their path? Where would you direct them?
Trish Rivard:
Sure, yeah. If you go to the elicitinginsights.com homepage, there’s a button on there that will take you to information about the report or there’s also a market studies page within the Eliciting Insights website that has our various reports out there. We also have, if anybody’s interested in the consumer study, we did the self scheduling that’s available for download as well on our website.
John Farkas:
Awesome. And we’ll be linking out to that too in the context of the Healthcare Market Matrix show notes, so you can access it there. If you’re already tuned into that channel, just follow the stream down the page and you’ll see the links to get those reports as well. Trish, anything else that would be good for folks to know? Anything else that you’re seeing in the market right now that has you interested and intrigued?
Trish Rivard:
I think automation, AI, it’s going to be really fun to see where this takes us. I think we’re all trying to get our heads around ChatGPT and what that means. It’s going to be really fun to watch how this plays out. In two or three years, are we going to have providers using appeal letters to payers and then payers using ChatGPT to create the denial letter, and we have ChatGPT arguing with one another back and forth. I think it’s going to be really exciting to see where automation will take us. I think we’re finally going to start to see the real payoff in the revenue cycle from investments in AI and machine learning.
John Farkas:
Yeah, I think it’s going to happen remarkably quickly. I think that the market is extremely ready for it and very incentivized right now. We can’t have clinicians spending time the way they’re spending it, and we can’t have administrators bogged down so deep that they can’t see their way straight. And some things have to change in order for our system to survive. And the incentives are extremely aligned to see automation come through. From a market perspective, we have to be very careful to understand what people are willing to do and spend on right now that is in their critical path. That’s where Eliciting Insights comes in. This is a great report that you can access right now to help in that world. It’ll give you a great picture. So follow the links here. We’re going to give you clear access to that.
Trish, thank you so much for spending some time with us today. And thank you too for your investment with the Ratio advisory board. We’re glad to have you there and looking forward to watching that relationship continue to grow as we work together.
Trish Rivard:
Awesome. And thanks for the opportunity to be on your podcast.
About Trish Rivard
Trish Rivard, an accomplished ROI-driven leader and consultant specializing in Health Care technology companies, boasts an impressive 15+-year cumulative track record of success. Her expertise lies in steering EBIDTA improvement and fostering market share growth within the healthcare and payment industries. Trish is widely trusted for her exceptional consultative skills, which she employs to prioritize IT projects, enforce ROI accountability, and streamline resource allocation to meet ambitious timelines.
Drawing upon her extensive experience as a Healthcare Revenue Cycle Executive, Trish excels in helping companies position themselves for growth. She excels at guiding them through the process of clarifying their vision, validating market receptiveness for their goals, charting a strategic roadmap, and optimizing resources for optimal outcomes in the ever-evolving healthcare marketplace. Her profound insights and dedication make her an invaluable asset to any organization seeking to thrive in this competitive industry.