The revenue cycle has always been complex, but 2026 is testing leaders in entirely new ways.
Tightening margins, relentless payer friction, a flood of AI vendor pitches, and a workforce reshaped by automation have forced revenue cycle executives to throw out the old playbook, and fast.
Our new report, The New Revenue Cycle Blueprint: Actionable AI, Clinical Collaboration, and Workforce Evolution, pulls back the curtain on how some of the country's leading health systems are navigating this volatile landscape.
Produced in partnership with Smarter Technologies, the report draws on candid conversations from HealthLeaders' Spring 2026 Revenue Cycle Mastermind program, featuring executives from Baptist Health Jacksonville, UF Health, Piedmont Healthcare, Beth Israel Lahey Health, UNC Health, UW Health, WVU Medicine, and others.
The AI Hype Problem
One of the report's sharpest tensions: the AI market is saturated, and health system leaders are over it. Executives across the Mastermind program were blunt: an "AI" label means nothing without proof.
Beth Israel Lahey Health's VP of Mid-Revenue Cycle put it plainly: she runs native EHR tools through the same vetting process she'd apply to an outside startup. Baptist Health Jacksonville went further, standing up a formal AI Institute that requires vendors to hit specific pilot metrics before any contract is signed.
Tom Dougherty, SVP of Smarter Clinicals at Smarter Technologies, challenged the crowd on something even more fundamental: health systems need AI that delivers attributable ROI from day one, not just someday after a massive upfront investment. His take cuts right to the core of the frustration in the room: stop paying for promises.
The Payer-Provider Cold War
The report doesn't sugarcoat the state of payer relationships.
Leaders described the dynamic as "possibly more adversarial than ever before," with shifting policies, excessive records requests, and Medicare Advantage reimbursement gaps creating constant headaches.
The response? Revenue cycle teams are getting proactive by partnering with managed care contracting teams to build data-driven denial trend narratives they can actually use at the negotiating table.
Clinicians in the Back Office
Perhaps the most dramatic structural shift explored in the report is the push to embed clinical professionals directly into revenue cycle operations.
At Confluence Health, adding a pharmacist to review drug reimbursements uncovered a six-figure payer shortfall almost immediately. Registered nurses writing appeals are dramatically improving overturn rates. As one VP put it: these roles pay for themselves.
A Workforce in Transition
With bots handling routine eligibility checks and status updates, the humans left in the revenue cycle are doing far more complex work which means traditional productivity metrics no longer apply.
Leaders are wrestling with how to redefine performance standards, build real career ladders, and develop the next generation of managers who can lead through technological change, not just master the tools.
The HealthLeaders report, sponsored by Smarter Technologies, is essential reading for anyone steering a health system's financial operations right now. Read the full report here.
Amanda Norris is the Director of Content for HealthLeaders.