Using Machine Learning in Your RCM with Eric Nilsson, CTO at The SSI Group, LLC. was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best audio automated transcription service in 2020. Our automated transcription algorithms works with many of the popular audio file formats.
Saul Marquez:
Welcome back to the Outcomes Rocket, Saul Marquez is here and today I have the privilege of being with Erick Nilsson. He’s a Chief Technology Officer at the SSI group. Erick joined the SSI group as the Chief Technology Officer to lead the SSI’s long term technology vision. He brings nearly 30 years of experience in the software industry with the last 10 in health care technology. Prior to joining SSI, he served as the Chief Technology Officer at Next Tech and Surgical Information Systems, where he focused on SAAS, on Premise EMR and Practice Management Solutions, as well as inpatient and ambulatory surgery providers from large hospital networks to surgery centers. Erick graduated from the University of Toledo with a Bachelor’s degree in Business Administration and Computer Systems. Today we’re going to be talking about revenue cycle and optimizing business operations to achieve success even in the most challenging times. And so, Erick, I’m privileged to have you here join us on the podcast. Thank you so much for being here.
Erick Nilsson:
Well, thank you Saul. Happy to be here.
Saul Marquez:
Absolutely. So the SSI group, certainly a dynamic business, you guys. I mean, the results there that right. over one point two trillion dollars in claims process. One hundred and seventy thousand providers. There’s an opportunity here for all of us to learn. But before we dive into what you guys do and how you do it, I’d love to learn more about you and what inspires your work in health care.
Erick Nilsson:
A couple of things, actually. So one of my passions is analytics and understanding the data and unlocking the value of the data for our users and our customers in the health care setting.
Saul Marquez:
And so you talk about data and that data is oftentimes not scrubbed right. or it’s not structured right.. It’s interesting to hear from you, the company CTL, about your philosophy around that. And is that something you guys do in-house versus something that you work with companies outside of your own to do it?
Erick Nilsson:
I would say both. In this case, I’ve worked in other industries, whether it’s logistics, banking, insurance, etc. but I’ve been in the healthcare space for the last 15 years and it’s clear that the level of data interoperability in the health care industry is, I would say, a little behind some of the other industries. The ability to exchange records is also been a challenge. So that’s outside of organizations. Inside being able to exchange data can sometimes also be problematic and understanding what the data is, the legal and medical aspects of the data, the privacy aspects of the data. So all that is a little bit more dynamic nature to being able to interoperate, whether you’re exchanging data between two companies or even within a company and doing that successfully at the volumes that you just described, where we process six hundred and eighty million claims at one point two dollars billion.
Saul Marquez:
Yeah, it’s a big business. Right. And so as we explore how exactly SSI is adding value to the health care ecosystem, I love to hear from you. What do you think that is? What’s that core offering that differentiates you guys?
Erick Nilsson:
Well, exchanging claims typically coming from hospitals with some 1200 hospitals today that some claims to us when we aggregate them and then send them out to a thousand plus insurance payers and then we send the remittances back. I mean, that’s rather simplified view of it, but we do that millions of times a day. And one of the things that we do at SSI is we believe we have the highest claim of acceptance in the industry. What does that mean? That when a claim comes from a hospital, it passes our edits, our edits being the editor of the payer of what they’ll accept. So we get the claim to the cleanest state before we ever send it on to the insurance payers. And that is truly one of our secret sauces. We’ve been in business for over 30 years and we believe we have a you know, that’s really one of our differentiators.
Saul Marquez:
And so what exactly happens? Right. And what does a dirty one look like versus a clean one?
Erick Nilsson:
I wouldn’t say they’re necessarily dirty. They’re just impossibly incorrect. So, yeah, typically we have a library of some sixty thousand edits and there’s hair edits, there’s even hospital edits. So we have the ability to basically say, what is this insurance company looking for in a medical claim before they’ll accept it. And knowing that before you go through the process of setting the claim, then they analyze it and then potentially come back a denial. If we do that up front and get that right the first time, then that reduces friction in the entire revenue cycle. Market space hospitals get paid faster at a higher rate too.
Saul Marquez:
And cash flow is key, especially today with some of the elective procedures being put on hold due to COVID, what types of things has SSI done during this period of challenge for providers to help them bridge this time that we’re all faced with?
Erick Nilsson:
We process roughly about twenty three percent of all the hospital medical claims in the United States. And as such, we did an extensive study of the effect of COVID. We found that medical claims fell off some forty eight percent over a four to six week period of the low watermark being the week of April 17th. The good news is, is that those medical claims have now come back up probably in excess of twenty eight percent to thirty five percent, and we measure it every day. So while we’re not back to normal that we have seen the low watermark and the industry, health care industry as a whole is getting back to whether it’s elective procedures or emergent procedures and that’s beginning to improve.
Saul Marquez:
Well, that’s good news and it’s good to hear that it’s heading in that direction. And, you know, during the time frame that we’ve been dealing with this, has there been anything that you guys have helped with or advised on that has helped the systems bridge this gap?
Erick Nilsson:
Yeah, we’ve done a number of things with our customers. One of them is while the industry has seen less claims, hospitals are working older claims to get those paid. So typically a hospital runs a backlog of claims and they’ve been working those down, anything that’s been held for any particular reason. So we’ve been proactively doing outreach to our customers to help them in that area. The other thing we’ve done is we’ve been studying the downturn and the upturn in the data and working with our customers on how we can help facilitate anything in that particular area. And then finally, we’ve done a number of things on how do we improve the process to get those claims back. And one of the things that we’ve done is we’ve given them we’re using machine learning to create a predictive view of when they’ll get paid based on the claims they’ve submitted. We’ve actually had that in the industry, in the market for over a year. We’ve seen a bigger increase of usage of that over this particular time period.
Saul Marquez:
That’s great. And as we look for ways to use some of this downtime to optimize operations, I think that forward looking technologies like machine learning or I could definitely help get ahead of the game. When you think of any particular instances and doesn’t even have to be with COVID of how you guys have helped improve business operations for your customers.
Erick Nilsson:
Well, a couple of different areas. One is we’ve prior to this machine learning application, we introduced a new analytics platform and that’s allowed our hospitals to get greater insight into the data and to be able to understand where they might be seeing friction in their revenue cycle. Based on top of that, we’ve added the predictive cash flow we’re working on predicting denial’s. So if you can predict the denial prior to ever happening, you can then take action on that. So that’s one of the things we have actually in the development lab currently.
Saul Marquez:
You know, you put together all these pieces and you start to develop a smooth engine that tackles a lot of the challenges up front. And so we’d love to hear from you, Eric, as you’ve developed these and your team has pitched in with customer feedback. Any particular setbacks that you’ve had that have made you guys even better?
Erick Nilsson:
Yeah, that’s a great question. Being CTO is all about people, process and technology. And some days I don’t ever get off people and not quite make it through the process of technology. That being said, building software is a highly collaborative experience. Analytics that we’ve built it in SSI represent the third time in my career where we’ve built an analytic platform from the ground up, a little bit of a Goldilocks situation because it’s not too hot, not too cold, it’s just Right.. So having that experience and having done different platforms in the past has allowed us to really build something that’s on target for our customers here. So that’s been one of the exciting things. And working through how we bring that to market has also been one of the exciting things as well.
Saul Marquez:
Yeah. What would you say is one of the key factors that has helped you build that Right.? Because to build it from the ground up is never easy.
Erick Nilsson:
Yeah, no. The number of the hospitals that we have across the country process between 20 and 30 million claims in a given year. And so being able to have a solution that scales where you can see in a single pane of glass all those claims and what the impact is on your business is key to that solution as well as to providing value to our customers.
Saul Marquez:
I love it. And it’s about understanding the dashboard too, right.. I, I’ve, I don’t know if you ever seen like a cricket scoreboard, but have you ever seen one, Erick?
Erick Nilsson:
I have, yes.
Saul Marquez:
You’re just like what in the world is happening there right now and just having clarity and just knowing what you’re looking at is key. Can you point to how the analytics system you guys offer is clear and offers clarity and informing actions and insights.
Erick Nilsson:
One of the first things we did is we looked at the key performance indicators that the revenue cycle managers used in their day to day business, and we baked that into the solution. And then also at the same time, we were putting that in there. So we wanted to make sure that the persona of the user, we understood exactly what they wanted. One of the things in this happens across the industry is that they try to put too many features in that are for too many different types of users. What happens is you don’t actually get something that works very well for any particular user. So when you focus on, OK, who’s our target audience, what are they going to do? How are they going to use this every day? How are we going to make this an integral part of their daily experience? That’s what we focused on.
Saul Marquez:
I love it. Drove the dashboard directly from their KPIs and built it. And was there any reason that you didn’t actually, like, use different technology stacks and just kind of built something based off of what was already out there instead of building your own?
Erick Nilsson:
Well, so we have those claims that are going through our system of the six hundred and eighty million claims a year, we have access to that. So we put those essentially into a large enterprise data warehouse and then we can actually look at a particular hospitals data and benchmark that to another hospital’s data. So it was something we felt we needed to do from the ground up. We’re using all commercial software, Microsoft and a few other vendors to build this. So we wanted to have scale and we wanted to have something that really hit the mark for the customer.
Saul Marquez:
Well, it sounds like you guys are definitely doing just that, Eric, as you think about today. And we turn the corner on some of the challenges we’ve had. What are you most excited about?
Erick Nilsson:
Well, we talked about we just released our first machine learning capability. We have four other projects in the pipeline currently that’s going to represent a change across the entire industry for across all of health care. And that’s really going to be exciting to see how that unfolds over the next couple of years.
Saul Marquez:
Yeah, for sure. And how we handle that will make a big difference. If you’re listening to this and thinking about how to best look around the corner or how else you could optimize the way that you do your claims management certainly consider the SSI group and if you want to learn more about them there at the SSI group Dotcom. So as we wrap this one up, Eric, I love to just get a closing thought from you and the best place where the listeners can reach out to you or someone on your team to request a demo or to continue the conversation.
Erick Nilsson:
Clearly, they can go to the SSI website. Also available email Erick Nilsson at the SSI group Dot com, also available on LinkedIn.
Saul Marquez:
Beautiful. And what closing thought would you leave us with there?
Erick Nilsson:
Well, you know, it’s an interesting time. We’re in in our country with COVID and the effect it’s had on our health care industry. One of the things that I’ve seen is how resilient we are. Back in April, at its low watermark, we wondered when will we be able to return back to something that’s normal? Well, we’ve come halfway back at this point, and I think it will probably take the rest of this year, probably in the next year before we get back to normal again, pre COVID levels of health care, whether it’s elective or emergent procedures. But they are coming back and it’s we’re a resilient industry.
Saul Marquez:
Yeah, that’s a good thing to call out, because when you’re in the middle of it, it’s hard to appreciate. But when you have the numbers, you have the data just like you guys do, at SSI it’s easier to make the decisions and to see those kinds of things. I appreciate that vote of confidence for all of us, Eric, and certainly appreciate the work you and the team are doing at the SSI group.
Erick Nilsson:
Thank you.
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