Getting there will take smart tech investments and relentless focus on the patient experience, according to two new trend reports.
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. Additionally, 69% expect to see a rise in revenue, and 71% anticipate improved profitability.
To get there, RCM leaders must shift focus from stability to strategy, the researchers say. It's a sentiment echoed in a 2025 report from Kaufman Hall and parent company Vizient aptly titled Strategy is (Finally) Back in the Driver's Seat. Chief among investment priorities: greenlighting AI and advanced analytics projects to automate revenue cycle management, which nearly two-thirds of leaders say is a top goal over the next three years.
Balance growth with affordability and access
Growth and affordability are twin themes for 2025.
Nearly a third (65%) of executives surveyed by Deloitte say developing growth strategies is a top priority. In terms of patient experience, more than half (52.8%) of leaders polled by Kaufman Hall see access, throughput, and capacity as their top focus for 2025. Deloitte's report reinforces this finding, noting that 55% of system leaders say they need to improve consumer experience, engagement, and trust; 46% say affordability is a top industry consideration.
Of course, growing margins and profitability while containing costs and rebuilding trust is a balancing act. But it's one that's mutually beneficial. "A loyal patient generates more than three times the revenue of an uncommitted one," Kaufman Hall researchers write.
Some ways RCM leaders say they're finding success on affordability and access fronts include:
Get to the heart of what patients want, says Shana Tate, chief revenue officer at Ballad Health, a 20-hospital system serving four states in the Appalachian Highlands. "If you don't really understand what the community is asking for, what they need, or what's going to make you successful, and you just throw spaghetti on the wall and hopefully something sticks, that's going to make your job much harder," Tate previously told HealthLeaders.
To truly understand "the different pockets" of Ballad Health's population, which spans rural and urban locations, Tate's team started prioritizing referral reports and other EMR outputs that offer valuable insight into the patient experience but were previously flying under the radar. It's helped them answer vital questions about leakage, such as: "Where were our patients going? Why are they going elsewhere? What do we need to do better?" Tate explained. "How do we make sure that we're reaching out to the entire population — not just one section of it?"
Be transparent. As patients become responsible for more of their healthcare costs, systems are putting more emphasis on their financial experience as consumers. When adjusting its pricing structure, Illinois-based Carle Health is mindful of how it will impact their patient population financially. "I think price transparency is an obligation of the health system," Aron Klein, vice president finance operations and supply chain, previously told HealthLeaders. "Quite honestly, I think it's a benefit to our patients to make sure they're fully informed in advance of services."
Break out the white gloves. MemorialCare Health System, a four-hospital organization serving California's Orange and Los Angeles counties, has earned industry recognition for their concierge program. The service features "a team of trained individuals who identify patients in need of financial counseling to ensure they are aware of their out-of-pocket liabilities prior to the service date," Steve McNamara, vice president of revenue cycle, previously shared.
Get smart on tech investments
When it comes to advanced analytics and AI, 65% of health system leaders surveyed by Kaufman Hall called revenue cycle automation a leading focus over the next three years, making it second only to clinical decision support in terms of priority.
Top ways health systems are investing in tech, according to Deloitte, include bolstering core infrastructure (43%); prioritizing virtual health, digital tools, and alternative sites of care (33%); and investing in platforms for digital tools and services (30%).
"All technology and operational investments and implementation projects at health systems should help ensure equitable access, experience, and impact for all users," the Deloitte researchers write. "Understanding the needs and impacts of different populations from a technology or operational change and intentionally designing to meet those needs or mitigate those impacts can help ensure broader adoption."
It's easier said than done.
"Vendors that say they can do what we're looking for are a dime a dozen," Brian Ice, vice president of clinical revenue cycle for the Allegheny Health Network, previously told HealthLeaders. But actually finding one "that's a good fit for your organization, that integrates well with your electronic health record, that has the right price tag associated with it" is an elusive goal.
To sniff out potential snake oil, consider connecting with a peer organization already using a prospective solution to discuss how implementation went, Michael Mercurio, vice president of revenue cycle operations at Mass General Brigham, previously advised. "There's a very big difference between selling and installing," he noted.
Other ways RCM leaders are getting real ROI on their investments include:
Go robo. MemorialCare Health System has adopted robotic process automation (RPA) that allows their revenue cycle team to "notify the health plans of hospital admissions, on average, within 14 minutes," McNamara said. His team is also using the technology to identify any coverage alternatives to those presented at admission. Given the benefits they've seen from these early use cases, they plan to explore additional RPA opportunities in 2025.
Remove friction. "We're all trying to remove touches from the claims process," Ice said. The key, he noted, is to have AI do the number-crunching and analysis and give RCM and finance executives the data they need to make those collaborations meaningful, whether it's in plotting the right pathway for patients to pay their bills or working with health plans to align care management with coverage.
Look for big numbers. Mass General Brigham's rev cycle team is automating more than 80% of their radiology-related coding activity with a commercial computer-assisted coding solution developed by the system's physician organization billing office.
"We've seen a reduction in denials and therefore a reduction in cost on the backend, which we've been able to pass on to our practices or reinvest in ourselves by redeploying staff to areas [that] need it," Mercurio said. When considering automation, he recommends starting with higher-volume service lines where notes typically follow a standard template or format, such as radiology or pathology. "There's significant volumes of those, so the machines can learn very well on past history and do a really good job predicting the future."
Delaney Rebernik is a freelance editor for HealthLeaders.
KEY TAKEAWAYS
Strategic growth is back on the table for RCM execs after years in stability mode, according to new reports from Kaufman Hall and Deloitte.
To bring promises of healthier revenue and profitability to fruition, leaders should center patient access and affordability while finding tech-enabled efficiencies, according to the research.