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Payer-Provider Software: 5 Strategies for Smooth Sailing

For many revenue cycle leaders, 2025 is all about the tech.

Time and again, execs have said they're investing big in AI and advanced analytics to improve team efficiency, payer relations, and patient access. But all too often, shiny new tools that promise to help are doing more harm than good.

"If you've been in the industry long enough, [you've seen] criteria sets in the market that have a tendency to create friction," says Debbie Schardt, DSL, MBA-HCA, RN, assistant vice president of revenue cycl...

From Stability to Strategy: Rev Cycle Leaders Gear for Growth in 2025

After years of margin pressure, workforce strife, and pandemic recovery, things are looking up for revenue cycle leaders, according to two new trend reports.

"2025 could mark a turnaround period for the health care sector, driven by innovation, resilience, and strategic growth," write the researchers of Deloitte's 2025 US Health Care Outlook for large systems and plans.

Of the 80 C-suite executives the firm surveyed, 59% are optimistic about their prospects in 2025, up from 52% just a year ago...

2025 Dental Salary Survey Report

Flexibility, freedom, and autonomy came up repeatedly as wins among dentists of all stripes, with circumstances like private-practice ownership and 4-day work weeks enabling control over clinical and administrative decisions, as well as work-life balance.

Many said their people — both patients and colleagues — are the best part of the job. They derive great meaning from using deft hands and hard-won skills to perform complex and varied procedures, help newer professionals progress in their careers, and restore smiles throughout their communities.

Let's Get Digital: How 2 RCM Leaders Are Tapping Tech to Improve Patient Access

RCM leaders are losing patience with barriers to patient access. 

When it comes to complex, expensive procedures, "medical necessity from a payer perspective is not always in alignment with what the physician necessarily says," says Shana Tate, chief revenue officer at Ballad Health, a 20-hospital system serving four states in the Appalachian Highlands (Tennessee, Virginia, North Carolina, and Kentucky).

It "creates a lot of angst" for everyone involved. Often, "the patient really doesn't know...

Payer Practices are Top Health System RCM Stressors. Here's What to Do

Payer practices, which have gripped public consciousness for much of December, are also the leading revenue cycle stressor for healthcare providers, according to recent research from HFMA and Guidehouse.

Among more than 130 system financial executives surveyed, nearly nine in 10 (85.8%) cite health plan patterns like denials and underpayments as one of their top three challenges; more than half (51.5%) finger a related pain point: prior authorization.

It's something RCM leaders have said time and...

(Robotic) Hand in Glove? How Nascent Tech Stands to Shape RCM Outsourcing

Within the past few months alone, Mary Washington Healthcare; Hancock Health; and Brookwood Baptist Health, now part of Orlando Health, have made moves to outsource some or all their revenue cycle operations to external vendors.

They're in good company: According to Kaufman Hall's 2023 State of Healthcare Performance Improvement Report, nearly one-third of respondent organizations were pursuing outsourced revenue cycle solutions, up from 27% in the 2022 report.

Whether outsourcing revenue cycle ma...

Spark Joy, Vanquish Vapor: How Mass General Brigham Uses Tech to Rev Up RCM

Let's face it: We're not getting any younger.

"Our population [is] getting older, more complex, more challenging, so there's always going to be more volume than we can keep up with," says Michael Mercurio, vice president of revenue cycle operations at Mass General Brigham, a 12-hospital system headquartered in Boston.

For revenue cycle teams, it means the pressure is on "to not only perform well and bring in as much cash as we can as effectively, compliantly, and quickly as we can, but [to] do it...

Stuck in denial

HealthLeaders christened 2023 the year of managing denials, but a spate of recent reports suggests revenue cycle leaders could be in for more of an era.

Payer denial activity was chief among the contributors to Community Health Systems' (CHS) net loss of $391 million in the third quarter, according to the Franklin, Tennessee–headquartered organization's report for the fiscal period ending September 30.

"We are seeing some payers aggressively deny payment for medically necessary services that have...

6 future-focused applications of green building technology

When it comes to experience, green building practitioners are far from green. 

The global green buildings market surpassed $0.5T last year, and could more than double—topping $1T—in the coming decade, fueled by the worldwide sprint to achieve net zero by 2050. 

The industry’s propulsive growth is a necessary step: Globally, the built environment is responsible for roughly 42% of energy consumption, according to Architecture 2030. It’s also a major culprit of environmental degradation, energy u...

Death becomes you, darling

Kill your darlings.

It’s a common adage in writing. Variants will have you murdering kittens or even babies — basically anything precious that you’ve been nurturing on the page to the detriment of your overarching story. It’s about getting cold-blooded and clear-eyed: sacrificing the saccharine for your prose’s higher purpose.

In horror, some creators take this directive literally, making quick work of a would-be final girl...

Optimizing Sourcing and Logistics: 6 Proven Strategies

For today’s healthcare procurement leader, a focus on the future is crucial to building an operation that stands the test of time.

Sourcing and logistics — the cornerstones of a thriving supply chain — are the right place to start, according to more than 170 leaders surveyed for HPN and SBA’s 2024 Healthcare Procurement and AI report.

“We need to enhance our ability for technological innovation to cope with the changes brought about by various developments,” one respondent notes.

Headwinds range...

Mastering the 3 ‘P’s of Post-Pandemic Procurement Efficiency: Price, Process, Product

As the healthcare industry recovers from the pandemic’s peak, procurement leaders continue to face uncertain economic conditions, stubborn supply shortages, and a proliferation of new settings in their purview, among other aftershocks.

To overcome these challenges, a relentless focus on efficiency is crucial. According to the 170+ leaders surveyed for HPN and SBA’s 2024 Healthcare Procurement and AI report, efficiency is one of the three key mandates shaping the future of procurement.

Guided attention: use your modern intranet to reduce digital friction and drive dexterity | Interact software

Despite its promises of faster, smoother workflows, digital transformation often breeds multitudinous platforms, logins, and complex navigation menus that squander your people’s productivity and satisfaction instead of enhancing their experience.

In practice, this “digital friction,” which Gartner defines as the “unnecessary effort an employee has to exer...

Optimizing Healthcare Procurement: Balancing Quality and Cost

Healthcare procurement has navigated a complex and volatile landscape in recent years. Confronted with tightening margins, rapid industry evolution, and geopolitical instability ranging from cybersecurity threats to climate change, procurement leaders have demonstrated exceptional resilience.

“We are facing challenges due to disruptions in the global supply chain, leading to delays in the delivery of essential medical supplies and equipment,” says one hospital supply chain executive in an April...

2024 Healthcare Procurement and AI: Your Playbook for Increased Efficiency, Cost Savings, and Cybersecurity

The past few years in healthcare have been marked by tightening margins, disrupted supply chains, escalating geopolitical tensions, and a surge in cyber threats. Yet, through it all, healthcare procurement leaders have emerged as resourceful heroes, continuously finding innovative solutions to keep their systems running.

New research from Healthcare Purchasing News and Staples Business Advantage (SBA) signals AI could help unlock solutions for top challenges that today’s procurement teams are facing, from bracing for cybersecurity disruption to controlling rogue spending.

But there’s room for improvement.

Marketing tricks to try in your internal communications

As today’s workforce grows ever-more purpose-driven and distributed, internal communications must sweep, soar, and sing to hit their mark and inspirit their recipients. Yet many efforts just wilt. In this article we explore how internal communicators can take cues from marketing to improve connection and engagement with their audiences.

According to Gallup, only 27% of U.S. employees strongly believe in their organization’s values, and less than half even know what those values are. Maybe tha...

Why do so many of us blame ourselves after a loved one’s death? | Psyche Ideas

My dad had a bad death.

The lead-up was long – a decade-old stroke had forced an early retirement from carpentry – but the end was abrupt, avoidable. Shocking.

A night out drinking with friends like he’d done countless times before, but that his body, now 68 and sustained by blood thinners, could no longer handle. A slip getting into bed that caused a brain bleed, invisible and irrevocable by the time his roommate found him the next day.

My sister and I, both in the thick of COVID-19 bouts, need...

4-Pillar Culture and 3-Legged Stool: Sanford's New CFO Gets Real on What it Takes to Build a 'Premier Rural Health System'

For all the ground they cover, rural health providers sometimes get short shrift when it comes to coverage of healthcare innovation.

"We have over 250,000 square miles of geography that our footprint covers," says Nick Olson, executive vice president and chief financial officer at Sanford Health, a nonprofit organization based in Sioux Falls, South Dakota.

Sanford is the largest rural health system in the U.S., with 48 medical centers across South Dakota, North Dakota, and Minnesota, and h...

Employee activation: the evolution of employee engagement

Employee activation will set top-performing organizations apart. It’s not quite listening, or empowerment, or advocacy, but a propulsive combination that puts workers at the helm of company culture, strategy, and reputation.

Today, just 22% of companies consider employee experience at all when designing work—even though it’s a force multiplier for customer and worker happiness as well as financial performance—and a paltry 10% involve their employees in organization and work design, according to recent research from the Josh Bersin Company.

Given this gap, setting your employee activation strategy now can put you ahead in an ever-tighter talent market.
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