How UW Medicine’s CFO Is Navigating Regulatory Pressure While Driving Strategic Growth

Facing Medicaid cuts, reimbursement shifts, and rising costs, Jon Alford is balancing aggressive cost control with targeted growth to protect margins and expand access.

: Jon Alford isn’t approaching UW Medicine’s financial challenges as a tradeoff between cutting costs and growing the business.

Instead, the Seattle-based academic health system’s new CFO and vice president of medical affairs at the University of Washington is focused on doing both simultaneously against a backdrop of Medicaid funding pressure and reimbursement volatility.

With over a decade of experience, Alford brings a steady hand and an approach that starts broad before quickly moving into operational detail.

Prioritizing Policy Changes

Alford outlines three main priorities for his first year, starting with managing major external funding pressures. The top focus is responding to policy changes, especially reductions in Medicaid eligibility and cuts to intergovernmental transfer funding.

Second, he emphasizes improving internal operations, particularly in revenue cycle and back-office systems. Third, he highlights the importance of strengthening strategic partnerships. This includes collaborating more closely with organizations like the Children’s Hospital and Fred Hutch Cancer Center.

“That will be about working with them again on policy changes, and the impacts that we're going to have from changes in reimbursement, but also just talk with them about how we can find efficiencies and streamline our clinical services together,” Alford says.

Harborview Medical Center, as a safety-net hospital, naturally serves more Medicaid patients, since it is the safety net for Seattle and King County, and the state’s only Level I trauma center. Additionally, the broader academic system attracts complex cases requiring specialized care, which also increases Medicaid volume, further amplified by a multi-state partnership.

“It’s not just the Washington Medicaid, it’s also potentially Medicaid from all of those other states,” he explains.

The Constant Balance

Alford frames the balance between growth and cost containment as a need to aggressively reduce administrative expenses while being strategic about where and how to grow.

With pressures from shrinking reimbursement and rising costs, the priority is cutting inefficiencies, especially since, as he puts it, “roughly 20 cents of every dollar in healthcare ends up going to administrative and general tasks, so the focus needs to be on how we reduce that portion.”

A major lever is technology and automation. He points to adopting AI beyond clinical care, particularly in back-office functions like revenue cycle, where costs can be high. By automating repetitive tasks, organizations can lower the cost to collect and reduce reliance on labor-intensive processes, sometimes limiting human involvement to less than 1% of transactions.

“We have to adopt some different approaches to be able to move faster and at a lower cost,” Alford says. “For example, pulling in agentic AI to do repetitive functions in the revenue cycle like teaching it how to deal with initial denials. It's got to be about lowering the cost.”

On the growth side, his focus is not on expanding market share indiscriminately but on a targeted “right case, right space” strategy. This means delivering care in the most appropriate, cost-effective setting while preserving capacity for high-acuity patients. Growth, in this sense, comes from improving access, reducing bottlenecks, and investing in the right resources at the right locations and levels of care.

Assessing Access

Alford has learned a few key lessons around balancing cost control with access, especially from Medicaid expansion. One major insight was that real-world outcomes can differ significantly from projections.

“You can model something perfectly in theory, but when it goes into practice, you need to really observe what actually happened,” he says.

This includes unexpected shifts like patients moving from commercial coverage into Medicaid. That created financial strain, since Medicaid reimbursement was around 60% of cost, according to Alford, turning previously profitable patients into losses. As a result, a critical focus became maintaining system sustainability while expanding access.

He also underscores the importance of supporting rural and public hospitals, using targeted funding to keep them viable and ensure patients can receive care locally. The overarching priority from his time spent on the Colorado Healthcare Affordability and Sustainability Enterprise Board was ensuring access.

“How do we make sure that there's access to care while balancing limited resources and preserving financial stability across the system,” he says.

Approaching Partnerships

Alford emphasizes that partnerships are essential in modern healthcare.

“The days of each organization standing solely on their own island are pretty much gone,” he says.

As the regulatory environment becomes tougher to navigate, health systems may rely more on strong partnerships than ever before.

“A great example for us is the partnership with the Fred Hutch Cancer Center,” he says. “We're relying on a lot of their expertise around oncology specific programs and having a constant dialogue about what's working and what's not.”

He believes that successful deals must create true shared value, not just combine operations.

“One plus one can't equal two. It's got to equal three,” he says, explaining that partnerships should generate compounded benefits, whether through shared services, improved clinical outcomes, or accelerated research.

Ultimately, Alford’s strategy focuses on collaboration that enhances value across organizations and for patients, including pursuing more advanced models that improve outcomes while lowering costs.

“The question is, how do we create a better value equation by having better outcomes with lower utilization and lower cost?’” he says. “Whether it's the sharing of processes of back-office functions to reduce overall cost, or the sharing of knowledge, a lot of organizations aren't ready for that conversation.”