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Tracy Berry considers all aspects of healthcare management to be an opportunity to improve the lives of patients. And as the vice president and chief revenue officer at BJC HealthCare, she’s made it a priority for her work to affect patients in the most positive way possible, starting from when they arrive at the hospital for treatment. “We want to have a conversation with a patient so that we can say what a test is going to cost and understand in advance what their out-of-pocket expenses will be,” Berry explains. “By improving our pre-arrival process, we can provide better service to our patients.”
The chance to do so is what drew her to BJC in 2010, after having worked for nearly twenty years in revenue cycle and financial service roles at companies such as CSC Healthcare Group, Tenet Healthcare, and Centura Health. When BJC contacted her with the opportunity to come in as a leader to consolidate its then-decentralized revenue cycle, Berry was immediately in—and ready to move with her family, dog, and horse from Denver to St. Louis for the role. “It was an opportunity to build a department from the ground up for a health system with a wonderful reputation for world-class care,” Berry says. “It seemed like a once-in-a-lifetime experience.”
When she started in the position, BJC’s hospitals used four different revenue cycle systems. Because of Berry’s earlier experience with large-scale project management, particularly her experience implementing Meditech information systems for Centura, it was a task that she was ready to take on for BJC. Since starting the project, her team implemented standard technology across its hospitals.
When that project was finalized in 2016, it brought Berry to her most recent initiative: improving denial management. “Like most health systems, we were not collecting the total expected payments from insurers,” Berry says. “While it’s a small percentage of our net revenue, that adds up to be a lot of money.” One of the biggest areas, she explains, was ensuring timely processing of all work from securing an authorization to billing to timely appeal of denials.
In her early stages of researching how to address those issues, Berry’s biggest focus was on communication. “We first had to better understand what was driving the denials in order to focus on the root causes and engage stakeholders across BJC to make changes,” she explains. “Collaboration between the financial leaders at these individual hospitals and my team was key, especially in thinking through change management.”
As she worked to collect information and understand the root issues that could be addressed for financial improvement, Berry was able to pinpoint four major areas: creating more timely workflow processes, building a centralized clinical denials team, expanding pre-arrivals teams, and bringing in more help for areas where BJC didn’t have the resources or expertise. For the first, she began revisiting their revenue cycle technology to improve and streamline work queue management. These queues make sure that each account is being sequenced into the correct work list as soon as it arrives in order to take immediate action and get denials overturned.
“Tracy’s vast knowledge and experience of the hospital revenue cycle, more specifically the importance of charge strategy in a complex healthcare system, are unparalleled,” says Denise Buonopane, managing member and president of the Buonopane Group. “Her quick decision-making skills and strong leadership have contributed greatly to the success of our projects at BJC over the past seven years.”
When she also identified that BJC’s previous process of sending denials to clinical teams at individual hospitals was creating delays, she focused next on creating a specialized clinical denials team by hiring nurses and other specialists to handle those appeals directly. Then, she began working to expand the pre-arrivals team. “For most scheduled outpatient appointments, the team makes sure we have everything we need including a physician order, insurance authorization, and verification of the patient’s insurance,” Berry says. “We strive to provide an estimate so that the patient is aware of their out-of-pocket cost and we can discuss payment options.”
“We first had to better understand what was driving the denials in order to focus on the root causes and engage stakeholders across BJC to make changes.”
Last, she began looking into other areas where BJC needed to bring in more outside help. One of the key issues she noticed was in working small balances. While her team was rightly prioritizing the more expensive claims that came in, many of the small claims were getting lost in the shuffle. In addition to hiring a firm to help with those small balances, she also hired firms to help in other specialized areas, such as worker’s compensation and clinical appeals.
“We are proud to partner with Tracy to create a seamless process, influencing financial viability and acting as an extension of her team to ensure there are no gaps in the patient experience,” said Shannon Dauchot, CEO of the revenue cycle point solutions division at Parallon. “Every patient call, every transaction, and every decision we make on our end has a trickle down impact to BJC HealthCare’s patients, and because Tracy instills that patient-focused mind-set in the forefront of everything she does, she without a doubt will continue to establish standards of excellence as a healthcare leader.”
Berry implemented most of the changes between mid-2017 through 2018. In its first year, the initiative had already had a major financial impact, with a $13 million improvement from the previous year. BJC is now on track to have an additional $15 million improvement in 2019 as the changes take hold.
And it’s had other benefits, some of which Berry is most personally proud of. “It’s a great patient benefit to understand in advance what their out-of-pocket expenses will be,” Berry points out. “If we know that we have the right information before a procedure is scheduled, the patient isn’t brought into the middle of a very confusing billing process.”
It’s also had a positive impact in showing the value of centralization. Berry has since turned her attention to other areas, such as creating revenue cycle liaison roles to improve the collaboration between the revenue cycle and hospital operations, and will next be working to consolidate revenue cycle functions of BJC further in order to bring patient access and health information management solutions under one umbrella, beginning later this year.
She takes personal pride in knowing that part of the initiative’s success has been the team that is running it. “By creating this cohesive team that works well together, we’ve also raised our level of employee engagement,” Berry says, noting that its scores in that area have been at some of their highest levels in this past year.
“I love making a difference,” she adds, “and I love being able to have an impact on its delivery of care by the work we do in the revenue cycle.”
