In the newly created role of VP of Mid-Revenue Cycle at Beth Israel Lahey Health, Keisha Downes is prioritizing systemwide standardization, an 'informed consumer' approach to vendor selection, and a human-focused view of AI.
Keisha Downes is taking a pragmatic approach to a saturated revenue cycle technology market that’s filled with hype.
In 2025, Downes was appointed Vice President of Mid-Revenue Cycle, a brand new role at Beth Israel Lahey Health (BILH), a 14-hospital, Massachusetts-based health system. With no predecessor to follow and no existing blueprint, her goal was to bring cohesion to a complex environment.
"There was no blueprint,” Downes, a HealthLeaders Exchange member, says. “There was just a lot of opportunity."
As a participant in this year’s HealthLeaders Revenue Cycle Mastermind program, Downes has taken a pragmatic approach to a saturated revenue cycle technology market that’s filled with hype. Her strategy focuses on foundational standardization and being an "informed consumer" of technology, ensuring that innovation solves actual business problems rather than just adding noise.
The Informed Consumer Approach to Vendor Selection
Downes takes a measured, vendor-neutral approach to AI evaluation to ensure that any solution, regardless of vendor, meets BILH standards for clinical effectiveness, operational fit, and responsible use. Like many large health systems, BILH leans toward an Epic-first technology strategy. However, Downes maintains a healthy skepticism regarding new features, particularly in the burgeoning AI space.
Operating under a philosophy of strict due diligence, Downes evaluates native EHR functionality alongside third-party vendors, assessing each based on merit, accuracy, and maturity. A feature’s availability does not automatically equate to readiness for deployment, according to Downes.
"I need to treat them just like I would any other startup company that has this new technology for me to be considering," she explains.
This means asking the hard questions, like requesting specific automation and accuracy rates, to establish where each solution stands in its maturity. If a specialized vendor offers a more accurate, proven solution in areas like autonomous coding, it may represent the best path forward as the broader market continues to evolve.
"The pace of innovation is exciting, but I need to make sure we’re adopting solutions that are truly ready, not just available,” Downes says.
I can't be a beta for these technologies that they're coming out with rapid-fire," Downes says. "I need to do my due diligence".
Human-Centered AI
BILH is taking a human-centered approach to AI, according to Downes. These tools are intended to support, not replace, the human workforce.
This approach targets "low-hanging fruit” first. If bots can handle simple, monotonous tasks, revenue cycle staff can focus on the complex, ambiguous cases that require human judgment.
"I want you to be focusing on the more complex things that require your critical thinking," Downes tells her team. "I need you to navigate through those gray spaces that AI just doesn't do very well in.”
There have been some unexpected challenges associated with introducing AI-based tools to the BILH mid-revenue cycle staff.
In some implementations, Downes observed staff members questioning their own expertise because it conflicted with an AI suggestion. "The prompts that were coming from the AI solution had them questioning their own skill set," she says.
Her response has been to reinforce that AI is "just math.” It is, at least for now, a probability engine, not an infallible authority. “It's not 100%," she reminds her team, encouraging them to trust their training over the algorithm when necessary.
Standardization Before Optimization
Before deploying advanced automation at scale, Downes is focused on the unglamorous but essential work of standardization. Within a health system that includes sites ranging from major academic centers to community hospitals, establishing a baseline is critical.
"We can get into optimization, technology, all those types of things," she says. "But first, we have to make sure we're all doing things across the system the same way.”
This involves aligning productivity expectations, standardizing workflows, and ensuring that existing vendor relationships are being utilized to their full potential before adding new layers of complexity.
The Bottom Line
Keisha Downes approaches the revenue cycle with the mindset of a builder. By prioritizing accurate data, demanding accountability from vendors, and carefully managing the cultural impact of automation, she is creating a resilient revenue cycle infrastructure capable of adapting to rapid change.
"We're in the space where we need to be informed consumers because there's so many sparkly, razzle-dazzle type of technology out there," she says. "If you don't have the right folks who are going to be committed to driving this home, then it's going to fall short.”
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
To find out more about the HealthLeaders Exchange program, visit the program’s webpage and LinkedIn page. To inquire about attending a HealthLeaders Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
Downes subjects native EHR tools to the same rigorous scrutiny as any third-party vendor, judging them based on merit, accuracy, and maturity.
AI is being used to address simple, monotonous tasks first, freeing up revenue cycle staff for more complex work that requires critical thinking.
It is critical to align workflows across the diverse 14-hospital system before adding new layers of technological complexity.