Terri Chinn: For hospital CFOs, success comes from understanding payer expectations
Payers and providers don’t think alike, and it’s important for finance executives of hospitals and health systems to understand the differences, says Terri Chinn, CPA, a 37-year member of HFMA, and vice president, finance, at St. Mary’s Medical Center in Grand Junction, Colorado.
As a seasoned healthcare financial executive, who has been a C-suite leader in both payer and provider organizations, Chinn speaks from experience.
“It is easier to negotiate from the hospital side when you understand how the payer side works,” Chinn said.
For a hospital leader, that means being aware of payer processes and knowing where their actions might not meet a provider’s expectations — or even where they are most likely to make mistakes.
“It is imperative to check actual payments against the expected contracted payments, since payers have been known to make errors or change their policies in ways that may not make sense to the provider or patient,” Chinn said. “Differences in expectations between the providers and payers must be constantly monitored and followed up on to ensure alignment between what is actually happening and what was expected.”
Chinn’s perspective has evolved as she has moved through her career’s many phases. After starting work as an auditor for Arthur Andersen, she moved into healthcare finance as an accounting manager of Holy Cross Hospital of Salt Lake City. She moved to St. Mary’s in the early 2000 to serve as controller. In 2008, she moved to Albuquerque, New Mexico-based Lovelace Health System, where she was the CFO of the health system’s health plan and remained there until 2013, when she returned to St. Mary’s as its CFO. Her stint at Lovelace’s health plan gave her primary and useful insight into the ways insurance companies negotiate and implement their contracts with hospital and health systems.
The role of the finance executive
During her 37 years as a member of HFMA, Chinn has seen the industry evolve from single-facility hospitals to massive systems through mergers and acquisitions and witnessed the changes this evolution has wrought in caregiving and financial outcomes. This experience has reinforced for her the importance of a focus first and foremost on ensuring clinical excellence.
“I am a big believer that financial outcomes are a function of good clinical and operational outcomes,” Chinn said. “It is important that senior financial executives fully support efforts to improve the quality, safety and patient engagement outcomes through prioritized financial funding.”
Promoting cost effectiveness of health
In addition to underscoring the importance for St. Mary’s of achieving high quality and safety in clinical outcomes, Chinn said her organization recognized it had an important role to play in promoting health across its service area. St. Mary’s decided the best way to fulfill that obligation was through a partnership, so it decided to be part of a group in Western Colorado that developed a clinically integrated network (CIN), called Monument Health, designed to manage quality, access and cost to its beneficiaries. Over the past seven years, the CIN has grown to manage over 23,000 members and is the sixth largest CIN in Colorado.
Monument Health enjoys competitive rates with community providers that are committed to the concept of keeping care local and affordable. A portion of the Monument Health network fee is put at risk to give community providers an incentive to engage in care management, and standard quality metrics are tracked to measure and reward performance. On a quarterly basis, Monument Health meets with employer groups to provide status updates, share provider quality and trend information, and solve problems.
Chinn is proud of Monument Health’s success in the Colorado health insurance exchange, which was proclaimed in a recent article in the local paper, using publicly available information.a
”The work that has been done now allows Monument Health to offer insurance rates that are comparable, if not lower, than those on Colorado’s Front Range,” said Chinn. This amounts to significant savings for our local consumers.”
As a result, she said, several self-insured groups on the Western Slope have chosen to align with the Monument Health services since its inception.
“They have seen the benefits that Monument Health has brought to the table as they have compared previous quality and cost results to those of their peers,” Chinn said. “They would have left if they were not getting good results.”
Chinn’s best HFMA memory
Back in 1987, I was president of the HFMA Utah Chapter. That year, the Leadership Training Conference was held in Hawaii. One of the events was snorkeling out at Molokai. I had a great time, both learning and networking. I am still in touch with people I met at the conference 35 years ago. Getting actively involved in HFMA has been one of the highlights of my life.
a. Ashby, C., “Monument Health to offer comparable rates in 2022," The Daily Sentinel, Oct. 21, 2021.
Editor's note: With this series of columns, we recognize the dedication and insights of HFMA’s longest-standing members, healthcare finance executives with memberships of 25 years and longer. If you would like to share your perspectives, please feel free to contact the author.