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David Henderson: Hey everybody. Welcome back to another episode of Time Out for Anesthesia. We are welcoming a guest that I'm actually really excited to have on for a couple of reasons: Number one, Graphium does some work with Imagine, and so we're super excited. But I'm also excited because Courtney, who we have on today is just a really cool person. [chuckle] So I'm excited for you guys to meet her. Courtney, welcome to the show. Take a second and tell us a little bit about yourself. How long have you been with Imagine and what's your role? 

Courtney Franco: Yeah. Hey. Courtney Franco, or if you want, Franco, whichever you prefer, right? 

DH: Moi bien.

CF: No, I've been with Imagine for nine and a half years, so I can't believe it's coming up on a decade. VP of sales, so I oversee our outside sales team. So we're targeting the four hospital-based specialties that the platform performs really well with, as well as third-party billing company clients.

DH: Fantastic. So almost a decade.

CF: I don't look that old, right? 

DH: Well, I was gonna say, did you start when you were like 15? How did you... That's illegal. No. [chuckle] You do look fantastic.

CF: Only in some countries. Yeah, I'm just kidding.

DH: And thank you for gracing our show with your presence. So before that, what... Take us back a little bit. So nine and a half years. What were you doing before Imagine? 

CF: Oh my goodness. Well, some various experiences in my life kind of brought me right to this moment. So I had my insurance licenses. So I was selling health and life. And then I also worked for a TPA, a third party administrator for self-funded health and welfare plans.

DH: Okay.

CF: They're the ones doing the adjudication of the claims for private plans. And then I also worked for a pathologist and worked in the billings and collections department in a former life. So all of those experiences kinda came together to put me here at Imagine, and it was a great fit. I was one of the producers for many many years, and then kind of moved more into a role where I was being mentored by our VP of sales to take over the team, and did that about three years ago.

DH: Awesome.

CF: Yeah.

DH: That's an awesome career. So lots of sales, and it seems, from what I can tell anyway, it seems like you are just the perfect fit. So congratulations on a good career. Tell us...

CF: Keep going. I've got time.

[laughter]

DH: The episode just got a little bit longer.

CF: That sounded like a retirement party.

[laughter]

DH: And I wish you a long and illustrious continued career with Imagine. And speaking of, tell us a little bit more about Imagine. Imagine works in healthcare billing and revenue cycle management. Tell us a little bit more about what Imagine does.

CF: Yeah, so I think an important distinction for Imagine in the marketplace is the fact that we do not provide any billing services. So...

DH: Okay.

CF: We are solely a software provider. We support the hospital-based specialties, so anesthesia, radiology, pathology and emergency medicine. Imagine performs really well in high volume, complex situations. So not necessarily the right platform for maybe a primary care physician, but definitely for anesthesia, which I think is the most complex of all. And then we also serve as the enterprise backbone for third-party billing services. So we have many clients that are third-party billing companies that provide that service of billing to those hospital-based specialties, and so we support them. Overall, like I said, my team will go out and directly pursue those four specialties plus the billing companies, but the platform through our third-party billing companies is used for 26 different specialties. So...

DH: Okay.

CF: Really scalable, allows for a lot of flexibility, especially for those billing company clients who are trying to... They can't be so singularly-focused anymore. They really have to diversify their own business.

DH: Got it. That's... You're singing a lot of our tune. I think what we experience a lot of times is that there is no such thing as a typical anesthesia group. And when we...

CF: That's true. [chuckle]

DH: When we dive into the way any given group runs their business, it's all they... They all seem to be very good solutions that are all working for them, but they're all very, very different. And inside of those variations though, you have them governed by the same rules and regulations and CMS and MACRA and whatever other alphabets that is out there.

CF: All the acronyms.

DH: And so I would imagine that you guys have a lot of insight into the regulations that start to enter into the equation when we think about revenue cycle management inside of the healthcare world. And specifically, I wanted to bring up this topic today, and we've talked about it before, and that is kind of the importance of accuracy and clarity and efficiency, and especially, of course precious to our hearts is reporting, when we talk about revenue cycle, and kind of from Imagine and your own personal perspectives, how important are those things? 

CF: Yeah, I mean there are two areas in which we give clients a lot of options in Imagine. One is payment posting, right? Because everybody wants to get paid. It's kind of what makes the world go round. [chuckle] So we give them every different opportunity to try to post payments to the system. But then secondly, is also reporting. So in the box with Imagine come four different reporting packages and that's just included in the product suite. And then we also have two product offerings for reporting that sit outside of the product suite; one is a true business analytics tool that they can build their own reports and really get into that data mining that a data analyst would be interested in, or secondly, our dashboarding product which is really an executive style dashboard that allows for super specific drill-throughs and able to get into some of that data behind the scenes.

CF: We, at Imagine, hosted a series of panels, expert panels, I guess through COVID, as we were all kind of desperate for interaction with our peers and yet still sitting behind these monitors. But I moderated some of those or all of them and one of the most interesting topics I thought that came out of that is that our clients could no longer... I'm trying to think of how they said this. They could no longer kind of sit on their laurels and just look back at the month before them of reporting. Now, in COVID, so many of our clients are tied to that reimbursement, well, radiology, pathology, anesthesia, all of those kind of elective procedures that dropped off during that time, when the procedure stopped, the receivable stopped, right? So...

DH: Right.

CF: Their cash flow was severely impacted and no longer was looking at reporting at month end like, "Okay," right? So now we're looking at daily reports, what should we be expecting to come in from a revenue standpoint? When is that going to hit? Reconciling that with the bank. So the call for more in-depth and specialized reporting really was kind of birthed during that COVID period where clients just needed more real-time analytics on what to expect and where their production should be and what they could expect to get reimbursed.

DH: And that is such... That's such a valuable thought that I hadn't even... I don't know why, maybe I'm a little slow on the uptake sometimes, but I hadn't even processed the importance of taking data from back beyond COVID because the months where COVID is spiking, especially when elective surgeries are shut down, does not represent an accurate... Doesn't give an accurate depiction of what the practice actually does on a normal basis, right? And the longer COVID went on, the more important that became. That's a fantastic point. I'm gonna have to think about that a lot.

[chuckle]

DH: But I also think... One thing that, from our perspective that anesthesia providers and anesthesia groups deal with, is the idea of remaining competitive and going out and winning contracts, winning bids at new facilities or in new organizations, things like that. And if all they have to rely on is last month's data when there were no elective surgeries, how would they remain competitive? And I would imagine that Imagine has a lot to offer as far as, "Hey, here's some insights that you could use to go and win contracts to... "

CF: Yeah, absolutely, not only that, but also, yes, contracts are important, and yes, having the data in order to undergo meaningful payer negotiations are important, but also some of the reporting that we have that revolves around how things should be staffed based on how busy the ORs are, or the surgery centers that they're working in. So a lot of that reporting, especially in conjunction with y'all and our two platforms just really gives the practice a holistic view and gives them the data in order to make decisions. So the challenge with reporting, being in the software space, everyone says... Shoots their hand up and they're like, "Wait, when do we get trained on reporting, when do we get trained on reporting?" and the real question is, and I've heard our implementation team say it time and time again is, "What questions are you trying to answer?" Because training reporting is only as good as identifying the questions that you're trying to answer, right? 

DH: Right.

CF: And then what... Which one of the many reporting platforms that we have is going to best illustrate that answer for you? And then what do you wanna do with that data? What... It's kind of like taking a COVID test. If you're not feeling well, maybe you're like a shut-in to begin with, or you're one of my sales guys and you're remote and you're just hanging out at home anyways, and you start not feeling well, and you're like, "Gosh, I wonder if I have COVID." Well, what are you gonna do with that information? Right? So the answer is, yeah, you should probably find out, but then how you act on it is also just as important.

DH: Yeah, fantastic. And I think to borrow an adage from our chief medical officer, Dr. Zavaleta, who will be around shortly, probably in an episode with you in the future, but one of the things he talks about when he talks about data is when you look through the room, if you pull the room of doctors and ask, "Who in here is above average," all of them would raise their hands. "Yeah, yeah, I definitely, I'm above average." Well, that can't be true, right? And unfortunately, when we bring data into the conversation like you're talking about, somebody's gonna find out that they're below average and that could cause friction unless we've already developed a really good mindset like you're talking about. "No, there's something we're gonna do with this data," and maybe my start times are a little bit late. Maybe when I'm doing first cases, I do need to get to the OR a little bit more promptly, no big deal. Now I have actual data to act on it. The nice thing about data is it doesn't lie, and it's not biased. It's not trying to hurt your feelings. It doesn't have that ability, right? And so... And that's one of the most powerful things about the data that you guys are providing, is the ability to see things, have a source of truth, and then be able to make it actionable, and trust that the steps that you're taking are actually data-driven, and that's usually valuable.

CF: That's so powerful, right? And so since I lead the sales team, most of the time I'm the one facilitating demos for prospective clients, or at least sitting in on them just so I can spy on my team and see how they're doing. I promise, I'm maybe not that much of a control freak at any rate. We had a demo just this last Friday, so it's Tuesday, just this last Friday, and I was shocked. Number one, anesthesia is a very paper-driven specialty, and I know that you all are trying to change that, and we're like all for the change, and we're there trying to help kinda push the product out and get folks kind of up-to-speed, and just up-to-speed with all the other hospital-based specialties. But they... They had... To say that they had no level of confidence in the data that their platform was producing is an understatement.

CF: Like they... The questions... So if I spend an hour and a half on a traditional demo, I typically save the last 15 minutes, 20 minutes for reporting. They wanted me to just breeze through the platform and get right to the reporting because the level of... They had zero confidence in their reporting that they were able to make meaningful decisions around their financials, around their staff productivity, around their doctor's productivity, just around claim volume. Like they weren't even... They weren't even confident in the reports that the system was producing that shows their claims because they know what they get from the hospital versus what they're inputting, which is terrifying to think there might be some black hole out there where that delta is going, and like... It's just... To your point earlier, when you've seen one anesthesia practice, you've seen one anesthesia practice...

DH: Right.

CF: And all wholly different from one another.

DH: But on the positive side about all of that is there's a place to put that data where...

CF: Absolutely, yeah.

DH: All of a sudden you can get some confidence in it and you can figure out good answers.

CF: Yeah.

DH: Imagine...

CF: That's... Productivity is a huge piece...

DH: Seems like such a great player in that space.

CF: Right now, right? Like, yes, you wanna know about the provider productivity, but let's talk about the fact that in this post-COVID environment, I know we're in kind of a hybrid model here where our team spends three days in the office, two days at home, and you can kind of juggle those around however it best fits your work-life balance for that week. Imagine, actually, measures staff productivity in three areas: Charge posting, payment posting and AR follow-up. And it does so not only on a summary basis, so you could see what their input into the application is, but it also measures it on a time basis, so that... Let's think about... I'll just... A single mom at home and maybe their child had COVID, so now they're at home for two weeks, and they're trying to play that homeschooling, like bridge...

DH: Right.

CF: Which so many of us were challenged with over the last two and a half years. And thank goodness, my kids are in pre-school and I'm not responsible for any more than ABCs and numbers. That would be really tough. But you can actually see when that employee has logged onto the system, so that maybe that single mom is getting up bright and early, 5 o'clock, working until 8:00 PM or 9:00 PM, then putting the time in with the child, taking the lunch, working then, and then coming back after 5:00 PM and working. It's just a really good opportunity to see how hard your staff is working, because I promise you, if they're still in the space, they're working really hard for your practice, and they love what they do. So Imagine is just... We're there to capture all of that data and empower people with it.

DH: That's great. I think I would love to talk to you on a future episode about the positive things that data can do for the individual healthcare provider, 'cause I think a lot of people approach data and they're like, "Oh great, another thing that's gonna be my tattletale, and another thing that's gonna be watching me," and things like that. But if we can change the perspective into, "No, you're a wonderful healthcare provider, this is your chance to prove it," I think we change the story to something better. And I think that's the direction that data has been moving. I think that comes from... Previously, it was used that way as some kind of big brother thing. But now that we have more data points and we can get them into these sophisticated systems, but extremely usable systems, all of a sudden we can paint better pictures, I think, and I think that's... I think we're telling a more compelling story. What do you think? 

CF: Absolutely, yeah. Data, I... People are data hungry. I mean, I don't know if you have an Apple Watch. I have an Oura Ring. I'm a data junkie. I wanna know how well I slept that night, I wanna know how many steps I did, how many calories I burned. And the practice is no different, especially as it comes down to being competitive in the landscape, knowing where you are against national and local benchmarks is super meaningful, knowing... And being able to provide the facilities that you service with metrics around your service to just solidify your value to them and the relationship that you have, and then to use some of that data to assist in payer negotiations and contracts and all that good stuff. It all benefits the patient when the entire ecosystem works well together.

DH: Right.

CF: And so as the billing application, we're kind of the hub for all of that. We try to ingest as much data as we can, and then turn that back around and make it usable and applicable in all those various scenarios.

DH: Right. Awesome. Well, Courtney, thank you so much for being on the show. I'm hoping to have you back really soon. So, hopefully, you're up for that. [chuckle]

CF: For sure.

DH: But I really appreciate your time. We love working with Imagine. So hope to talk you soon. Thank you so much.

CF: My pleasure. Thanks, David.

DH: Take care.

CF: Bye.

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