When Retail Expertise Meets Healthcare
By Catherine LoPresti
VP, Professional Revenue Cycle Operations, Hackensack Meridian Health
When Catherine LoPresti was at Walmart Connect, the omnichannel media business of America’s largest retailer, she leveraged her extensive expertise in strategic client services, revenue management, and billing operations to improve operations and drive revenue collection. Now, as VP Professional Revenue Cycle Operations at Hackensack Meridian Health, a leading, 18-hospital system in New Jersey that generates around $8 billion a year in revenue, she’s replicating her retail success in the healthcare industry.
An increasing number of healthcare systems need support, stat. Coding errors, documentation issues, payer-specific rules and other issues mean that nationally, providers spend nearly $20 billion a year just to adjudicate with payers, according to a report issued last year. “Healthcare, particularly in revenue operations, has traditionally struggled with siloed operations,” she observes. “This has helped to inhibit the ability of healthcare, especially in the revenue cycle operations space, to use real-time data to make decisions, test ideas, and quickly implement changes as needed. I look forward to bringing the same speed and agility we enjoyed at Walmart Connect to Hackensack Meridian Health.”
During her time at Walmart Connect, LoPresti helped optimize revenue by partnering with the engineering team to identify, automate and fix system breaks that impacted $500 million of manual billing for advertising transactions. “I led strategic automation initiatives aimed at mitigating operational risks,” she explains.
“Our teams collaborated to align data, technology and customer experience at scale, using real-time insights to make decisions, test ideas and quickly pivot when needed.” The result: “At Walmart Connect, we increased the automation rate from 37% to 71%,” she says. “We also sharpened digital engagement, enhancing lifecycle analytics and revenue design while elevating financial engagement and streamlining operations.”
She’s been working on a variety of projects aimed at enhancing revenue collection while strengthening ties between HMH and its patients. “I envision an ecosystem where data, technology, and customer experience converge to benefit both patients and providers,” she explains. “I do not see these objectives as separate silos. Like retail, patients are healthcare consumers. So if we can use data analysis and other initiatives to improve their experience, it will rebound to our benefit, too.”
A Blueprint for Smarter Revenue Cycle Management
We asked LoPresti for some details about her digital transformation plans, and she obliged. One of her goals is to utilize artificial intelligence to improve data segmentation as a way to not only reduce denials, “which are often tied to documentation gaps” but to also bring physicians into the loop “by giving them real time financial information and performance insights,” she says. “It’s a matter of eliminating silos and moving from a reactive model to a data-informed proactive and collaborative one that ties front-end personnel like physicians, nurses and clinical leadership together with other team members. We’ll work closely with the IT and clinical teams to build individual physician dashboards and integrate tools for predictive analysis and AI to get a 360-degree view.”
During her time at Walmart Connect, “we focused on the customer experience,” LoPresti says. “And at Hackensack Meridian Health, patients are our customers, so we’re focused on the patient journey and on reducing denial rates. By integrating tools for predictive analysis and AI, we can create a personalized financial experience for patients that only improves their satisfaction but also enhances revenue cycle performance.”
The revenue cycle “needs to evolve,” LoPresti added. “Margins are thin, and our teams are stretched. Automation, including AI-powered ‘bots’ that can handle repetitive tasks, will take a lot of the load off team members, so they can concentrate on higher-level activities.” The organization has already made significant strides in improving patient financial engagement through innovative technologies. In 2022, HMH collaborated with TD Bank and Nordis Technologies to deliver a fully integrated patient billing and payments solution. Since that launch, the hospital network has converted more than 180,000 payments to electronic methods through self-service online or intelligent voice systems.
LoPresti plans to build on this and other wins by assessing and consolidating legacy assets to ensure scalability and cost-effectiveness. “There are lots of legacy platforms and technologies,” she observes. “For example, we have multiple vendors for tasks like coding, and we will engage in some rounds of business analyses to see if there is an opportunity for consolidation. I think we can gain a great deal of efficiency but first we have to gain a deep understanding of what we currently have.”
Of course, as any Finance executive can testify, attempts to implement new systems frequently run into the roadblock of inertia, or resistance to change. LoPresti has been through this before, and says she recognizes the need for team support during and following the transition.
“Across industries, you see this kind of silo-driven headwind,” she explains. “But we will use data to support goals on personal and organizational level. At Walmart Connect we coached leaders and created a roadmap so team members can see what and why we’re trying to accomplish. It’s important to stay curious, open and bold.”
LoPresti and her team will engage “in a variety of initiatives that should smooth the implementation, of new revenue cycle operations,” she adds. “Communication with team members is key, and we will be prioritizing smart wins, working to engage teams by including them in discussions and providing training. We will also track our progress, focusing on such key metrics as net revenue collection rate, first pass resolution rate, and denial rates, and we will keep team members informed to ensure continuous improvement. Ultimately, everyone will benefit.”
An increasing number of healthcare systems need support, stat. Coding errors, documentation issues, payer-specific rules and other issues mean that nationally, providers spend nearly $20 billion a year just to adjudicate with payers, according to a report issued last year. “Healthcare, particularly in revenue operations, has traditionally struggled with siloed operations,” she observes. “This has helped to inhibit the ability of healthcare, especially in the revenue cycle operations space, to use real-time data to make decisions, test ideas, and quickly implement changes as needed. I look forward to bringing the same speed and agility we enjoyed at Walmart Connect to Hackensack Meridian Health.”
During her time at Walmart Connect, LoPresti helped optimize revenue by partnering with the engineering team to identify, automate and fix system breaks that impacted $500 million of manual billing for advertising transactions. “I led strategic automation initiatives aimed at mitigating operational risks,” she explains.
“Our teams collaborated to align data, technology and customer experience at scale, using real-time insights to make decisions, test ideas and quickly pivot when needed.” The result: “At Walmart Connect, we increased the automation rate from 37% to 71%,” she says. “We also sharpened digital engagement, enhancing lifecycle analytics and revenue design while elevating financial engagement and streamlining operations.”
She’s been working on a variety of projects aimed at enhancing revenue collection while strengthening ties between HMH and its patients. “I envision an ecosystem where data, technology, and customer experience converge to benefit both patients and providers,” she explains. “I do not see these objectives as separate silos. Like retail, patients are healthcare consumers. So if we can use data analysis and other initiatives to improve their experience, it will rebound to our benefit, too.”
A Blueprint for Smarter Revenue Cycle Management
We asked LoPresti for some details about her digital transformation plans, and she obliged. One of her goals is to utilize artificial intelligence to improve data segmentation as a way to not only reduce denials, “which are often tied to documentation gaps” but to also bring physicians into the loop “by giving them real time financial information and performance insights,” she says. “It’s a matter of eliminating silos and moving from a reactive model to a data-informed proactive and collaborative one that ties front-end personnel like physicians, nurses and clinical leadership together with other team members. We’ll work closely with the IT and clinical teams to build individual physician dashboards and integrate tools for predictive analysis and AI to get a 360-degree view.”
During her time at Walmart Connect, “we focused on the customer experience,” LoPresti says. “And at Hackensack Meridian Health, patients are our customers, so we’re focused on the patient journey and on reducing denial rates. By integrating tools for predictive analysis and AI, we can create a personalized financial experience for patients that only improves their satisfaction but also enhances revenue cycle performance.”
The revenue cycle “needs to evolve,” LoPresti added. “Margins are thin, and our teams are stretched. Automation, including AI-powered ‘bots’ that can handle repetitive tasks, will take a lot of the load off team members, so they can concentrate on higher-level activities.” The organization has already made significant strides in improving patient financial engagement through innovative technologies. In 2022, HMH collaborated with TD Bank and Nordis Technologies to deliver a fully integrated patient billing and payments solution. Since that launch, the hospital network has converted more than 180,000 payments to electronic methods through self-service online or intelligent voice systems.
LoPresti plans to build on this and other wins by assessing and consolidating legacy assets to ensure scalability and cost-effectiveness. “There are lots of legacy platforms and technologies,” she observes. “For example, we have multiple vendors for tasks like coding, and we will engage in some rounds of business analyses to see if there is an opportunity for consolidation. I think we can gain a great deal of efficiency but first we have to gain a deep understanding of what we currently have.”
Of course, as any Finance executive can testify, attempts to implement new systems frequently run into the roadblock of inertia, or resistance to change. LoPresti has been through this before, and says she recognizes the need for team support during and following the transition.
“Across industries, you see this kind of silo-driven headwind,” she explains. “But we will use data to support goals on personal and organizational level. At Walmart Connect we coached leaders and created a roadmap so team members can see what and why we’re trying to accomplish. It’s important to stay curious, open and bold.”
LoPresti and her team will engage “in a variety of initiatives that should smooth the implementation, of new revenue cycle operations,” she adds. “Communication with team members is key, and we will be prioritizing smart wins, working to engage teams by including them in discussions and providing training. We will also track our progress, focusing on such key metrics as net revenue collection rate, first pass resolution rate, and denial rates, and we will keep team members informed to ensure continuous improvement. Ultimately, everyone will benefit.”
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