Valerie Barckhoff – Principal at Windham
Brannon, PC & Co-Founder at SHOAR
Valerie is a Revenue Cycle executive with over 20 years of experience in delivering revenue cycle transformation services, compliance support, leadership skills, and strategic plans focused on improving compliance, cash and net revenue positions for providers across the country. She is passionate about improving revenue cycle operations and adopts progressive strategies to achieve strategic goals.
In this interview, Valerie talks to me about her journey into the RCM domain, the things that excite her the most about this field, and her visions for the future of the industry.
Starting Out in the RCM Domain
Valerie recalls a trying time when she was 16 and fell severely ill. At the time, her parents took her to the closest hospital which did not have the clinical expertise that was required. Further, her parents were on HMO which was quite unheard of in 1986.
In the emergency room, Valerie was refused treatment till a surgeon arrived from Lexington, the nearest city. While waiting for the surgeon, things got further complicated when Valerie’s appendix ruptured while her parents were sent down a complicated maze through collections.
Even with coverage, the hospital was unable to create a smooth or pleasant experience for Valerie and her parents. When Valerie attended the University of Kentucky, she chose Bachelor’s in Healthcare Administration as her major to create better experiences for other patients.
‘Revenue cycle is the puzzle you will never solve because the picture is constantly changing. We are a pawn on the political chessboard, and the fun part is to try to solve the puzzle as fast as you can and catch up to the changing picture knowing that you will never get to the end.’
Current Business Structure and Organization
Valerie leads the Healthcare Advisory Practice for Windham Brannon. In 2016, when automation and artificial intelligence started gaining attention, Valerie recognized its value as a lot of work in the revenue cycle is predictable and repeatable.
They formed a joint venture with Deep Indigo AI which ultimately led to the creation of their new company – SHOAR Health. This company is dedicated to bringing robotic process automation and AI machine learning into the revenue cycle space.
‘We are focused on helping to transform the revenue cycle through automation which we are calling the fourth lever after people, process, and technology.’
With the great resignation and the workforce shrinking and driving up the salaries, Valerie believes the industry will have to find a way to become more efficient. Automating claims statuses, reconsiderations and prior authorizations, along with several other aspects are critical.
‘I do not care about the size of the organization, from critical access rural hospitals to large multi-hospital health systems, everybody should be embracing automation.’
Prior to founding SHOAR Health, Valerie worked for two different health systems in Atlanta. She worked for DeKalb Regional Health System as their Executive Director of Revenue Management and Managed Care Contracting. Next, she worked as the Vice President of the Revenue Cycle at Saint Joseph’s Hospital. Following this, she began consulting in 2009 after which she was recruited by Windham Brannon to head up their healthcare advisory practice because their partner was leaving.
Presently, SHOAR Health is working with some of the largest academic medical centers in the country. Getting academic medical experience is rare because it is very complex, and people need to know how to maneuver around. Valerie states that they work with large academic medical centers, some 15+hospital systems, and physician clinics of diverse sizes, while also having a passion for rural and critical access hospitals.
‘We have created a whole service offering because we believe the rural hospitals may be in need for the revenue cycle services more than some of the larger health systems and clients all over the country.’
At any one time, the company will have between five and seven clients that are going on at a single moment in time. The healthcare advisory practice has ten people along with partner firms to bring subject matter expertise to clients that may fall outside of their domain.
Windham Brannon has around 200 employees involved in tax, audit, advisory, and healthcare. Their advisory practice is the largest of the three and continues to grow with a range of services from litigation support and CFO advisory services to cyber security.
‘Our expertise is in diagnosing where your issues are, where your opportunities are, and helping you achieve those results. We have deep subject matter expertise in chargemaster, and coding and billing compliance, which are the core focus areas post-COVID.’
Standout Moments as a Business Leader in RCM
Over her years of experience in this field, Valerie observed that most of the revenue cycle issues are that hospitals don’t use the systems correctly, and consultants come behind flawed system installs all the time. Hospitals put a new system in but try to put it in on old processes, and consultants would come in and try to reconfigure the processes that work with the system.
Valerie realized that working on system implementation, change management, or lack of change management, leads to a lot of these issues that exist in the revenue system. The systems are designed differently, and it is important to understand how they work and then design the processes to work with them. A lot of times, the process and the technology are fighting against each other.
A source of pride for Valerie is that her firm is one of the oldest and largest professional services firms in the South. As the company is neither too big nor too small, they are able to design their revenue cycle services that meet the clients’ needs.
‘Some of my proudest moments are when the CFOs tell us that this is the best consulting experience they have ever had and that we are willing to jump in and help their team members when they are not making progress. We are partners in this, and we want to see clients succeed at the end of the day.’
Business Plans for the Future
Valerie claims that the firm is succeeding in the traditional healthcare advisory side. They are also focused on automation becoming a dominant force in the future and are recruiting data scientists as well as working with many health systems to do proofs of concepts around automation.
‘Our growth plan is going to be two-thirds focused on the automation side of the house and then one-third focused on the traditional revenue cycle so that we can help these organizations transform over the next 10, 15 years and become fully automated.’
Talking about the marketing methods that have worked over the years, Valerie states that healthcare is a relationship-oriented business. The company is focused on building those relationships in a grassroots campaign and arise involved in local organizations like HFMA.
They also serve on committees and focus on building those relationships to build trust which is crucial in an advisory role. The firm works with and sponsors local organizations.
Top Philosophies and Core Values in Business
Valerie believes that the revenue cycle is not necessarily as complex as it is rigorous, and it relies heavily on people to do the jobs. Often, they are some of the lowest-paid individuals within the health system. If someone is not doing well in the domain, Valerie states that it is often leaders that have not given them the tools, training, technology, or feedback they need to do their jobs well.
‘I do believe now and then you are going to have a bad egg that you have to get rid of, but for the most part, everybody is here to do a good job, and it’s on us as leaders and as management to make sure we have structured everything so they can be successful’.
Her business philosophy is that there are three levers in consulting – the people, the process, and the technology. She states that she would rather have good people every day of the week and have questionable technology and questionable processes because a motivated team can result in success every day of the week.
‘You can have the best systems money can buy, you have well-defined processes, but if your people are not inspired to work every day, that they are not there for the mission, you will not be successful.’
Advice for Newcomers Looking to Start a Career in the RCM Domain
Get experience. Valerie highly values gaining experience in different arenas while in college itself to get a true understanding of the field. Next, join HFMA, attend sessions and search for opportunities for certifications in the field.
‘It’s not about the pay, it’s about the experience and sitting in the shoes either being a registrar or working in the business office, I think those are all very valuable experiences because you need to know the details and the challenges that they are facing if you want to be able to try to put together solutions.’
Key Benefits of Services at Windham Brannon
A key benefit as per Valerie is the accessibility to seasoned people that are a lot less expensive than the big four. Further, their subject matter expertise in the field allows them to look at every problem in a new way rather than focus on a single solution for everyone. They take into consideration the technology, the culture, and the financial position of the organization when creating a solution for them.
Staying Successful in This Domain
No revenue cycle organization is perfect, and it is important to continually look for what is broken. Revenue cycle leakage occurs in every health system, regardless of the size. Valerie advises having manageable metrics such as between 20 and 30 high-level metrics for the revenue cycle.
The goal is not to be perfect all the time, it is to try to find those things that are not perfect. The focus needs to be on continually challenging oneself to ensure the right things are being monitored and corrective action is being taken at the right time.
Leadership Lessons Learned Over the Course of Life
‘The biggest leadership lesson that I have learned is that it’s not really about me being successful, it’s about helping the people who work with me be successful.’
Valerie views her role as helping people get obstacles out of their way to be successful. Instead of focusing on what she needs to do, she looks at what she can do to help the people around her be successful. Everybody has got different philosophies, but as a leader, it is important to develop the people in your team to grow and excel and become leaders themselves.