Collaborative Innovation: INSIDE UHS's SUCCESS

Innovating is hard – but it doesn’t have to be. Join us in a conversation with Chief Revenue Officer Ken Hogue as he explains how UHS uses collaboration to catalyze patient￾centered change.

The phrase “New York innovators” typically conjures images of the Big Apple, its hustle and bustle serving as visible indicators of human ingenuity and progress. But just three hours to the northwest, nestled within the Southern Tier of New York, United Health Services (UHS) is breaking the mold on what it means to be a healthcare system.

UHS is locally owned, not-for-profit, and provides care to nearly two-thirds of the residents in the Greater Binghamton area. They are not only  New York Southern Tier’s largest comprehensive provider, but the region’s largest employer. Suffice it to say, they serve their community on multiple fronts, making them an invaluable resource for the families that call the region home.

Ken Hogue joined the organization in April of 2020 – a harrowing time to say the least – and was originally tasked with overseeing the entirety of the system’s revenue cycle operations. He would move into his current role as Chief Revenue Officer four years later, but not before playing a critical role in the success of UHS’s virtual implementation of Epic. Beyond that, Ken has helped the organization redefine what it means to financially interact with  and support patients.

Ken’s spiritedness is palpable from the moment you sit down with him. Elements of his leadership style were refined during his previous military career, but many of those seeds were planted much earlier, back during his adolescence as he helped around his grandfather’s primary care practice. It was there that he first came to truly understand the impact supportive care delivery has on the community, and he came away from the experience feeling that there had to be a way to take that further. He knew the industry needed to innovate and decided that bringing forth that vision would be his own personal labor of love. 

Ken, to start us off, I think it would be helpful to learn about your personal approach to change. You’ve had a majorly successful virtual Epic implementation, you regularly trial new features as one of their beta test sites, and you’re always finding new ways to optimize your RCM strategy. Whenever you’re navigating changes like that, what is your secret for seeing your organization through to the other side?

I think it’s important to first recognize that while change always involves unknowns, the process of bringing about innovation is nothing new. If you look at the early applications of automation to census reporting or enlistment tracking in the 1950s or 1960s, for example, you notice that today’s advancements like AI are really pursuing the same goals. We’ve built upon those early parameters and advanced at warp speed, but we’ve jumped by leaps and bounds before. Every time we have, we’ve rediscovered that the whole process centers on people. 

We prioritize that human element at UHS whenever we start planning and testing something new. We examine our past projects to see what we did well and where we struggled, with an emphasis on how it impacted the entire system – how did those changes impact the various arms of UHS and what did we learn elevates or hinders their efficacy as a care delivery ecosystem for our community. That examination requires constant, honest communication, and we find that when initiatives do go astray, it’s typically because that communication wasn’t there.

We’ve worked hard to build communication into the culture of our organization. That way, when we do introduce something new like RPA or AI￾assisted tools, we already have a mechanism in place to learn how these changes affect our staff and can iterate accordingly. They’re empowered to bring attention to patterns or variances they see as counterproductive to our goals, keeping us on the right track toward true concierge care delivery. Technology is a tool, but it’s the culture of communication that keeps it focused and effective.

It sounds obvious when phrased that succinctly, but as many healthcare leaders will know, it can be extremely difficult to actually bring that culture to life. Oh, absolutely. It’s often a mountain to climb – Mount Everest, no less, and you’re often having to scale it in a 1995 Jeep Grand Cherokee without the latest and greatest. But I think that uphill battle is where real leaders are made, and it becomes a question of how you armor up and adapt with the limited tools and resources you have.

When I look at my organization, for example, there were times where uncertainties like AI made people apprehensive. Change is often uncomfortable, but as I learned being in a military family and moving from place to place growing up, you need to shed the notion that you can’t adapt to whatever life throws your way. Likewise, as a leader you need to understand that not everyone is going to be as comfortable as you are in uncertainty, and that’s where the conversation wraps back again to communication at every step: creating space for piloting ideas and candid feedback; breaking the process down so it’s digestible; allowing stakeholders to become part of the decision-making process so that they don’t feel like change is being forced upon them; et cetera. 

Do any examples come to mind of initiatives that bettered UHS by leveraging those strategies?

Plenty, including one that I’m most proud of, which is our tech-assisted patient concierge service that’s expediting referrals, appointments, and care continuity. Starting in Fall of 2022, we foresaw no longer being able to report patient medical debt to credit agencies, which of course worried plenty of providers. Having medical debt impact credit scores has historically helped drive collections, but rather than find new ways to recreate that pressure, we wanted to go in a more patient￾friendly direction. As it turns out, when you deliver exceptional care, most patients want to pay their bills. The challenge is often that they’re facing obstacles and hardships preventing them from doing so. Maybe they just lost their job, or they’ve had major family hardships for the last six months. 

Instead of emphasizing fear of consequences, my team and I created something really innovative that we call “self-pay and patient forensics.” We chose the phrase to be bold and evocative, while also having it ring true to what our actual goals were. Basically, it’s a process of working with patients to understand their environment, their home life, their financial situation, and all the other social determinants and barriers that prevent them from achieving their care and financial goals.

We analyzed referral patterns on the backend to find new ways to expedite care in a manner that aligned with patient needs, and on the front end, we used EPIC’s referral tools to revamp scheduling and intake processes for our specialties. Those feed into a centralized escalation model, whereby a concierge team uses all the referral, scheduling, and financial data available to give patients tailored, white-glove assistance. We often refer to UHS as our “house” and modeled this with a hospitality slant – when you need to make a “reservation” with us, our dedicated teams will do all they can to maximize the convenience of your “stay”. This extends to the revenue cycle, as we’re working with patients to understand and overcome the barriers that stop them from fulfilling their financial obligations. 

The entire revenue cycle process is complex, which is why RCM professionals often act as patient financial counselors to their loved ones. At UHS, we’ve embedded that idea of intimate assistance into our self-pay process directly. You don’t just receive a quick 5-minute phone call saying, “here’s how much you owe” and “here are the payment plan options”. You’re going to have a respectful, forensics-like conversation about how we can help you navigate around or through the financial barriers in your path.

Often, that requires us fighting alongside patients to secure the coverage they’re entitled to. Maybe you’re a veteran and not receiving the VA benefits you’re supposed to, or maybe your health was directly impacted by the events of 9/11 and there are state funds you should be receiving. Rather than telling you to go and make all these phone calls yourself, we’re going to directly connect you to community resources, help you apply for Medicaid, and tap you into other programs you might be eligible for. When you’re in our house, we’re going to do everything we can to help guide you through all the overwhelming and confusing nuances of healthcare in this country. 

I love that. Is this something you’re delivering through a third party?

No, this is something we do ourselves. We work with a handful of vendor partners for certain instances of overflow, but even then, we’ve structured the program so that anyone needing bespoke assistance is referred back to our teams.

That’s remarkable. Was this initiative your idea? 
It was. It started out as a pilot with six of our most experienced revenue cycle professionals. The team had an average of 20 years of experience between them, which ensured they deeply understood all the nuances of insurance regulations, billing, denials, and the ways those complexities can be impacted by patient hardships. We then expanded that team’s repertoire of customer service skills. That included what you might expect, such as learning how to speak softly with upset patients, but even more importantly it included how to listen. 

Talking is rarely enough to deescalate a situation, typically because that conversation we’re having with them is the first time they’re actually being 
heard. People are used to being referred through one system, and then being told to play phone tag with several other departments, and it was  important to us that we break that pattern. We wanted to minimize the touches that a patient has with us before their needs and concerns are truly  heard and addressed, that way they know UHS has their best interests at heart. Those friction points can be so exhausting for patients, especially when navigating them alone.

Those friction points can be so exhausting for patients, especially when navigating them alone.

Exactly. I had seen the toll of that first-hand. It took my grandfather 13 different touchpoints and the help of multiple family members to resolve an issue he was having with another health system. It was nauseating for us as a family, and so I knew when we started down this concierge path at UHS that I had to do what I could as a healthcare executive to make sure our patients never experienced that. Our team has dropped the number of touchpoints it takes to zero a self-pay account below 7, with each of those interactions being more respectful, supportive, and patient￾centric than they would be traditionally. 

Circling back to the idea of managing change, what role did communication play in seeing your organization through all the challenges that arose during and after this pilot? 

It played a central role. Overcoming barriers to success is all about building and maintaining the right relationships. We made sure that we had respectful conversations with every stakeholder as the pilot evolved. Sometimes that entailed sharing our success stories with the rest of the organization and the community. Other times, it took my team and I spending a month out in our practices to hear what physicians, support staff, and patients were struggling with. When resource or staffing shortages were making it difficult for the front desk to help patients in accordance with our new vision, we worked with them to find new ways to streamline intake tasks with RPA and AI. 

Later, when we moved from pilot to full implementation, we made sure to invest in our relationships with organizational, clinical, and 
communications leaders. We met with them monthly to give our recommendations based on the metrics we saw coming out of revenue cycle and made sure we never gave just one option. We always came to the table with a handful of vetted possibilities, that way our leaders weren’t forced into any one direction, and we could all work collaboratively to find a solution that worked for everyone. Open lines of communication make it possible to prioritize and address challenges as they come along, and that’s even true on the other side of the equation when dealing with payers. 

Payer relationships are always difficult to navigate, and I believe this is another area where UHS and your team are working hard to innovate, correct? 

Absolutely. This is yet another “labor of love” for me and the rest of UHS’s revenue cycle team because it’s just so important. It affects not only our financial health, but our patients, and our ability to support the community where and when they need it most. Payer relations at UHS is really a joint venture between revenue cycle and legal, and while it’s always been that way, we’ve worked hard the last few years to supercharge that collaboration. 

There’s a lot of data involved in today’s insurance landscape, and so when you’re trying to optimize how denials are managed, you can’t just look at metrics monthly or quarterly. You need to dig into that data week after week and make sure your guardrails are operating as expected. When they’re not, that’s your sign to reach out to all parties and bring them to the table to brainstorm a solution. We’re supporting that analysis internally through an AI-assisted payer scorecard, which we’ve built out with EPIC’s tools. It’s taking our claims adjudication and other metrics and making it possible to monitor them all throughout the week via a convenient dashboard, that way we can quickly course correct rather than playing catch-up with reports rated weeks after the fact. 

This approach shaved 6 weeks off the time it takes to action plan following a denial, which in turn allows revenue cycle to be a financial catalyst for advancing UHS’s other patient experience innovations. 

Thank you, Ken, for having this conversation with us today. As we bring it to a close, I’d love to pick your brain one last time. As your peers set out to advance their own innovation initiatives, what advice or words of wisdom do you think they should keep in mind? 

I think that most would benefit from centering the idea of servant leadership, which is something we stress at UHS. You are not and cannot be an expert on all things, and so the way that you adapt to changes brought about by innovation is to really listen to your people. Work with your teams. Get the input of those who are actually living the results of your changes day in and day out. It’s very likely that they’ve noticed something you haven’t. Additionally, I think it’s important for healthcare leaders to remind themselves that they cannot be afraid to test the waters, and that sometimes it’s not enough to just dip your toes in. Sometimes you need to plunge right in to have enough data to meaningfully analyze and explore it with your colleagues. 

The tie that binds both of those is, of course, collaboration. I like to give myself a daily grade on how well I worked through my list of priorities, that way when I see myself spending too much time on one action item, I know it’s time to reach out to my colleagues for help. They of course can reach  out in kind, and over time we’re strengthening our ability to support each other. I am so proud of how UHS has advanced in the last few years,  and it wouldn’t have been possible without our willingness to communicate.

Watch the full interview with Ken below: