AWS Health Innovation Podcast: AKASA’s Vision for Transforming the Revenue Cycle in Healthcare With Ben Beadle-Ryby

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Introduction

Welcome to another captivating episode of the AWS Health Innovation Podcast, where we delve into the cutting-edge advancements and transformative ideas shaping the healthcare industry. In today’s episode, we have the privilege of exploring AKASA’s groundbreaking vision for revolutionizing the revenue cycle in healthcare, as shared by the esteemed guest, Ben Beadle-Ryby.

The revenue cycle, a critical component of healthcare organizations’ financial operations, has long been plagued by complexities, inefficiencies, and manual processes. However, with the advent of AKASA, an emerging leader in revenue cycle management, a new era of streamlined operations and improved financial outcomes is on the horizon.

In this thought-provoking interview, Beadle-Ryby, a leading expert in healthcare technology and the co-founder of AKASA, sheds light on the innovative solutions his company has developed to tackle the long-standing challenges faced by healthcare providers in managing their revenue cycles effectively.

Throughout the podcast, Beadle-Ryby shares his deep insights into the transformative power of artificial intelligence (AI) and machine learning (ML) in automating revenue cycle processes, reducing administrative burdens, and enhancing overall financial performance for healthcare organizations of all sizes.

Join us as we dive deeper into the visionary concepts, groundbreaking technologies, and real-world examples that demonstrate AKASA’s commitment to empowering healthcare providers to optimize their revenue cycles, improve patient care, and thrive in today’s rapidly evolving landscape.

Whether you are a healthcare professional, an industry enthusiast, or someone eager to learn about the latest breakthroughs in healthcare technology, this episode will provide you with invaluable insights and inspire you to explore the limitless possibilities of revenue cycle management innovation.

So, get ready to embark on a journey that unveils the transformative potential of AKASA’s vision for revolutionizing the revenue cycle in healthcare. Let’s dive into this remarkable conversation with Ben Beadle-Ryby, a visionary leader who is reshaping the future of financial operations in the healthcare industry.

Alex

Welcome to the AWS Health Innovation Podcast, where you can learn from entrepreneurs and investors who are driving progress in healthcare and life science around the globe. I’m Alex Merwin, head of growth healthcare and life science startups at AWS. And in today’s episode, Amanda Goltz from AWS guides us through a fascinating conversation with Ben Beadle-Ryby, co-founder of AKASA, a leading AI-based company focused on driving step-change improvements in revenue cycle operations. Ben walks us through his vision of harnessing the power of AI to reduce administrative waste and improve the patient care experience.

My favorite part of today’s conversation highlights how bill shock — otherwise known as financial toxicity — impacts patients at best negatively impacting their impression of the care experience, and at worst, actually worsening health outcomes. All right, that’s enough from me handing it over to my colleague, Amanda. Enjoy.

Amanda

Hello everybody. I’m Amanda Goltz at Amazon Web Services. I am happy to be guest hosting this edition of the podcast I have as my guest, Ben Beetle Rey from Acasa. Ben, tell us about yourself and tell us all about AKASA.

Ben

Thanks so much, Amanda. It is a pleasure to be here. Great to meet you. I will start with AKASA. AKASA is a company dedicated to healthcare automation for hospitals and health systems based out of Silicon Valley. We apply modern machine learning and AI to back-office operations for hospitals and health systems in order to drive efficiency. We have a specific focus on the revenue cycle.

For me personally, I have spent my career in healthcare working with hospitals and health systems focused on revenue cycle and finance operations. Some of the less sexy sides of healthcare. I have always been attached to this mission and certainly observed a lot of the administrative waste that occurs in this area. And what AKASA’s mission is to really ensure that a greater percentage of every dollar spent in healthcare is spent on delivering high-quality care to patients. And so that is where we deploy automation in order to do that.

Amanda

That sounds like a much-needed solution in healthcare today. In fact, many of the health systems and AWS enterprise customers in healthcare that I work with tell me they are looking for exactly that kind of help on the back end. Tell me a little bit more about it and how you came to this particular type of solution to devote your life to as a startup founder. What’s your background and what brought you to the idea that a casa was the way to accomplish this?

Ben

I really appreciate you asking. I have now been in the world of healthcare for 15-plus years, and the earliest days were spent in hospitals and health systems working through process redesign and transformation. And when you really roll up your sleeves and you’re working side-by-side with frontline staff in hospitals, you immediately notice how much paperwork there is, how much back and forth there is that in some regards seems senseless.

If you pull up and look at the macro-level metrics, we as a country spend 6 trillion on healthcare a year. The Journal of American Medical Association found that nearly 25% of that was classified as administrative waste. So time spent on coding, on billing, on physician administrative areas.

The opportunity to drive efficiency, it ultimately seems quite obvious. But the process for doing that in this system that we have with patients, third-party payers, and providers altogether, is actually incredibly complex.

What we at AKASA did is we started examining processes across the revenue cycle (which we can talk about in more depth) and really started identifying areas where we could apply artificial intelligence and machine learning in order to take repetitive mundane tasks off of the plates of staff. And, eventually, that morphed into being able to take incredibly complex tasks off of their plates in order to help back office staff operate at top of license and drive better efficiency for health systems.

Amanda

Awesome. Yes, absolutely. I’m even more committed and it resonates even more with what I hear from my hospital partners and friends. I think for people like us who’ve been in healthcare for a while and are very familiar with these enormous numbers, the national healthcare expenditure, the percentage that’s spent on non-clinical tasks, administrative tasks that may or may not add value or may well be a complete and utter waste, I think most people have a basic familiarity that perhaps we don’t deliver care in the most efficient way. But they’re not familiar with why that is.

And I have a secret theory, which, you know, I’m joking here, and I don’t actually think that anybody is a bad actor, but that a lot of it is deliberately confusing and complex. Yeah. Just to sort of like frustrate anybody who’s really trying to fix it.

Help those of our listeners who are unfamiliar with revenue cycle management. I’m thinking the basic principle is understandable. Hospital does a lot of very expensive things for patients and it has to jump through a lot of hoops in order to get the appropriate reimbursement from a bewildering array of insurance companies — both of course on the private side and public entities like Medicare and Medicaid. Do you have sort of basic run-through? Can you walk us through how the claims process works very, very high level? And how that ties into revenue cycle operations?

In other words, help us understand. We think of hospitals as entities and clinics that provide care to patients, but I would argue that a huge chunk of their business is also the business of making sure that they’re paid adequately for the care they provide. Help us understand that part of it.

Ben

Yeah, Amanda, I think you hit on so many important pieces there. I’m happy to give a high-level understanding. I think let’s start with, for the general consumer of healthcare, patients, families, communities, I do think that there is this really head-scratching moment when you examine healthcare and you think about the paradox of the dollars that are at stake, the smart people, the resources that are there, but then, as a country, we’re achieving middle-of-the-pack outcomes. They’re hit with surprise medical bills and that’s really confusing and frustrating for these organizations. And so I think to first understand the revenue cycle, it’s important to acknowledge the different players there.

There are three primary groups involved in almost every transaction in healthcare. There is the patient that’s going through their care. There is the provider that is the hospital or health system, or the physician practice that is delivering care and supporting that process. And then there is that third-party payer that is your insurance company. It is government coverage, so Medicare, Medicaid, and each and every one of them plays a role in supporting the ultimate reimbursement of care.

For the patient, if we think about their experience, they’re oftentimes scheduling care. They’re providing their insurance card and then they’re taking a physician’s guidance, “Hey, this is what you need, this is my diagnosis.” At the end of their care experience, they’re getting a bill. And so they don’t really have a concept of what happens in the background.

The revenue cycle is what happens in the background for a hospital and health system and how they intake information from the patient, how they productively engage with the insurance companies or Medicare or Medicaid, and how they are communicating all of the different steps and observations in terms of what they’ve seen in care that helps to determine if they are authorized to deliver care, if that care is deemed medically necessary by payers, how they code the care that was provided, and then ultimately how they bill and get reimbursed for them.

There are so many steps that happen in the background — each and every one of which requires communication back and forth on pre-agreed terms that patients aren’t always privy to. That means there is complexity. There’s confusion.

You talked about is this deliberately set up in a byzantine, complex way. And I would argue that it’s not that each and every one of these players has things that they are guarding against.

For insurance companies, they’re trying to guard against fraud, abuse, and improper utilization of care. For the provider, they’re looking to provide the highest quality care possible, but make sure that they get reimbursed appropriately for it. For the patient, they’re looking to get healthy and hopefully do so in a way that doesn’t catch them off guard financially at the end.

And so what we focus on is supporting hospitals and health systems through that process in order to capture that information cleanly and get reimbursed appropriately. Historically, they have deployed armies of people to the problem. So it is very manual in nature.

We, as a company at AKASA, saw a great opportunity to help them be more efficient in accomplishing those same goals so that they could ensure more and more of their resources were focused on the patient.

Amanda

I really love that it, it’s a very sophisticated and broad-minded view of one of the critical problems and challenges in healthcare today, which is this one of reimbursement. Revenue cycle management is a fairly dry business term that’s used across industries to talk about how you receive value for the goods and services provided. In healthcare, it means much more.

And I think you articulated that really well and I especially appreciate the comprehensiveness in which you’re appreciating everybody’s standpoint. This is a little bit of an iron triangle with the patient locked in the middle. And I, and you’re right, I’m the small-minded one. I’m accusing people of bad behavior, but it’s not bad behavior. Everybody is at this zero-sum game. One person’s dollar of savings is another person’s dollar of cost and they’re all operating in a system that’s governed by those economic rules and trying to survive and do the right thing given the constraints.

So I really appreciate that perspective. Another thing I want to mention that I appreciate as well, especially with you always bringing it back to the patients, which is near and dear to my heart,

There’s a new appreciation for the effect of what is sometimes called “financial toxicity” on patients. That the cost of their care is a component of the healthcare they receive — for good or for ill. And that there’s a role that players can take in protecting patients, helping patients pay for their care, and accessing payment for their care. It’s a new term I think we’re all trying to appreciate what it means.

But it’s not like really at the forefront of that. So tell us about the patient’s role in all of this and how you may or may not see that changing with some recent changes in healthcare.

Ben

When we think about the patient, they have two experiences. One is their care experience and the other is their financial experience. And, unfortunately for hospitals, health systems, and providers, a poor financial experience can entirely influence a patient’s perception of their care experience. Oftentimes it is the last thing that sticks with them. They go through a great care experience, they’re getting healthier, and then four to six weeks after that care experience, they’re hit with a surprise bill. We have seen over the last 5–10 years an increasing out-of-pocket responsibility for patients with the introduction and really leaning into high deductible health plans. So patients have a greater role in understanding how much their care may be that is structured so that they are not seeking unnecessary care. They’re really only there for care experience. But when they’re entering this care experience, they oftentimes don’t have visibility into what the cost of care is going to be and they’re hit with outrageous medical bills afterward.

That leads to that financial toxicity that you’re speaking to. And that is something we as an industry have to do a better job of in almost every consumer transaction that’s out there. You go in and you’re staying at a hotel, you know how much that hotel is going to be. You’re making a purchase, you know how much that’s going to be. When you’re going into care, particularly for urgent emergent, even certain care cases where you’re going to have numerous points of contact in the care delivery system, you are going to encounter numerous different bills, all of which pile up. And so it is on patients themselves, but it is on us as an entire industry — providers and payers — to do a better job of creating clear transparency and visibility for these patients, so that they have a better understanding of what their financial responsibility in the care process will be.

We at AKASA look at many of the different elements of the revenue cycle, including things like automating the prior authorization process, automating the back-end billing process, as mechanisms to help support patients in avoiding those surprise medical bills or those outbound communications from providers to say, “Hey, listen, this is what we believe you need, but your insurance company has not given us authorization to provide those services.”

Hopefully, that helps to illustrate I think how important the patient financial experience is in this whole equation.

Amanda

It really does and it’s also an inspiring message with some practical components of how we can help patients in this process. I often speak to folks and they talk about things that they’re going to do and then benefit to the patients is a side effect. But it really sounds like a good one. It sounds like you’ve really built that into the value proposition for AKASA in a way that I really appreciate. You’re singing to the choir. That’s very noble and I’m so grateful that you’re including that. But let’s talk about you. What is your ambition for the next few years? What goals do you have for yourself and for your team at AKASA and for what you’re able to accomplish?

Ben

Our ambition is to be able to drive down the cost-to-collect in healthcare. And, in order to do that, our ambition over the next few years is to be working with every hospital, health system, and physician practice in the country across the next couple of years in order to remove some of that administrative waste and those burdens that exist.

It’s interesting. As I look at the entrepreneurship and innovation that’s taken place in the healthcare ecosystem over the last several years, a lot of the AI application and the machine learning that’s taken place have been focused on some of those areas for clinical improvements. And, certainly, that is something we all aspire to. But you mentioned it earlier, some of the pieces we’re talking about may be the drier business elements. And in our world, I think that is maybe the less sexy side of healthcare, but that side of healthcare is incredibly important.

And so we aspire to touch every single patient’s care experience and improve their experience by working with every hospital and health system. Today we’re working with nearly 500 hospitals across the country. Those hospitals are representative of over a hundred billion in net patient revenue today. So we are touching nearly 10% of the healthcare ecosystem. We see there being a huge opportunity to deploy more of our automation with our existing groups and expand to other organizations so that each and every patient is having a better care experience and each and every health system is removing that administrative waste from their ecosystem.

Amanda

We’re completely supportive of those goals and that ambition here at AWS. We want to help you succeed. That is what we want too, as we deploy generative AI tools, which are really exciting, and machine learning on behalf of our healthcare enterprise customers in the cloud. And so we’re thrilled to be able to work with you and AKASA to help further that goal.

I have a little bit of a kind of split experience where I’m so lucky to work at Amazon, where we’re developing these amazing tools that can do things with data we never dreamed possible, and especially the promise of generative AI. But the other half of me, the healthcare institutionalist part of me, has the same thoughts that you do. It’s why I guess we go off to the clinical piece because it’s sexier. That’s what people understand about healthcare because it’s attention-grabbing to be able to say AI will replace doctors (and that’s a terrible idea!). What my idea is, what I think we should do, is AI should replace a claims denial. How about that? Right? I mean that’s not as exciting, but I think that’s what you’re trying to do.

Ben

Amanda, I think that you and I would have a lot of fun over some drinks together because we share that vision. When we think about the different really concrete and tangible areas that we are touching for hospitals and health systems, it spans the revenue cycle. It spans that claim management process.

And there are really three types of impacts that we’ve had. Number one is in generating kind of virtual staff and production for these organizations so that they can be more efficient. I’ll provide a very concrete example.

A large academic medical center that I was speaking with the other day has over 400 staff members devoted to their revenue cycle operations. Today they have 43 vacancies. Roles that they cannot fill. That’s over 10% of their needs. When we work with organizations on a particular workflow, we’ve been able to generate 20 FTEs worth of work. And that is alleviating those organizations of the need to backfill those roles. It’s addressing their staff and workforce shortage problems, which is plaguing the entire industry right now.

The second area where we’re having an impact is helping these organizations do their work more accurately. The reality of this work is that it is prone to human error and mistake. And by doing this through artificial intelligence and machine learning, we’ve actually reduced errors that are occurring, helping organizations to minimize their denials (you just talked about the denials process) to be able to capture more appropriate revenue. For one of the organizations we worked with, we have improved their overall revenue yield by 1%. That’s massive when you think about them being able to capture all that.

And then, lastly, we are accelerating their time to collect reimbursement. For one of the organizations we work with, we’ve reduced their accounts receivable days by 13%.

Each and every one of these is a key performance indicator, a key metric that is tracked by these groups. And so when you share that vision of “could AI replace the claims denial process,” we feel like we’re already on that path. Organizations can lean into machine learning in order to do things more accurately, more timely, and more efficiently.

Amanda

I love that perfect summary. I encourage all of our listeners, if they are looking for a solution like this, are looking to realize some of those amazing gains in KPIs that Ben just laid out. Reach out to us here at AWS. We can help you get connected.

And also, Ben, we’re happy to help you and your team here at AWS. However we can. I myself have about 10 hospitals that I want to make sure you’re working with that I talk to on a daily basis, so that’s awesome. I think unfortunately we could talk all day and even though it’s 7:30 a.m. here, I would love to get that drink with you. But I do think we have to close. So any closing thoughts before we wrap it up?

Ben

Amanda, I want to first just say thank you to you and the AWS team for hosting us. We have been incredibly privileged to do the work that we’re doing with some of the most prestigious health systems across the country. We are motivated by improving how we deliver healthcare today, the cost at which exists in healthcare today.

And so, in closing, we remain very excited about the potential to elevate care delivery and the financial experience that patients go through day in, day out by continuing to deploy machine learning in this space. So really appreciate the time and look forward to remaining in touch with you and your listeners.

Amanda

Awesome Ben. We’re thrilled to be on this journey with you.

Thanks for joining us today for the AWS Health Innovation Podcast. If you want to get in touch with AWS, please check out our show notes where you can find a link. If you enjoy the podcast, the best way to support us is to share it with your colleagues and friends. We also really appreciate your reviews and ratings wherever you listen to podcasts. We love hearing feedback from our listeners, so please don’t hesitate to get in touch. Again, you’ll find all the details in our show notes. See you next week.