Vanderbilt's MyHealth Bundles are saving millions of dollars through employer-focused, transparent, and clinically led value-based care.
Vanderbilt University Medical Center is pioneering a bundled care program that has reportedly saved employers and their employees nearly $5 million in healthcare costs over three years.
The Nashville-based health system detailed the results of its MyHealth Bundles program during a session at this year's HFMA conference in Denver. Executives said the sustainable, patient-centered, value-based care model reduced costs to employers and employees, cut down on unnecessary procedures and boosted patient satisfaction rates between 2020 and 2022.
"We didn't impose value-based care—we listened," Ruchika Talwar, MD, Medical Director of the Office of Episodes of Care Population Health at Vanderbilt Health Employer Solutions, said at the HFMA conference. "Employers told us where the pain points were, like unpredictable maternity costs or avoidable NICU admissions, and we built clinical models around that."
Financial Woes
The push comes amid news that VUMC will lay off up to 650 employees as part of a broader effort to reduce expenses by $300 million. The job cuts come in response to significant changes in federal funding and reimbursement, particularly reductions in support for research and patient care programs. The layoffs represent about 2% of VUMC’s workforce and will primarily affect nonclinical roles in research, administration, and support areas.
The layoffs follow an earlier round of budget reductions implemented this spring to slash $250 million, which included hiring freezes and other cost-saving measures. Jeff Balser, president and CEO of VUMC, previously warned that deeper cuts could be necessary if federal funding levels continued to fall.
Customization to Clinical Excellence
VUMC's bundled care approach starts with employer-specific concerns, not generic healthcare templates. One early case involved Metro Nashville Public Schools, one of Vanderbilt's first partners in the endeavor, where maternity care was the biggest cost concern. In response, VUMC created a maternity bundle that ultimately cut $1 million in NICU spending, avoiding 50 unnecessary neonatal ICU admissions.
Unlike many bundled care programs that start on the day of surgery, Vanderbilt's bundles begin the moment a patient is seen, and can extend up to a year post-procedure, depending on the condition. This structure allows VUMC to take on bigger financial risk but also ensures better patient outcomes.
Transparent Pricing and Broad Inclusion
Each MyHealth Bundle is sold at a single, predictable price—, regardless of patient complexity, thanks to close collaboration with actuarial teams. This model allows employers to budget more accurately and patients to avoid surprise bills. In fact, for those not on high-deductible plans, cost-sharing is often waived, Talwar said, which further reduces financial barriers to care.
Notably, the bundles include most patients, thanks to a built-in outlier policy that accommodates rare complications without excluding participants.
Evidence-Based Outcomes and Risk Management
Clinical excellence is central to the model. Vanderbilt uses evidence-based guidelines and monitors real-time data dashboards to track trends and catch early warning signs of rising costs. Physicians, who helped design the bundles, are deeply intertwined in the outcomes, not just the billing codes.
In condition-based bundles, for example, the financial model assumes that only patients who truly need surgery will get it, an assumption backed by Vanderbilt's hard data. In 2024, just 13% of hip osteoarthritis patients underwent surgery, compared to 32% in the general market. Similar reductions were seen in knee and shoulder cases.
These outcomes also translated to quicker recoveries: 90% of spinal surgery patients returned to work within 90 days.
A Blueprint for Scalable Value-Based Care
VUMC executives say their model is replicable, but only with a full commitment to patient-centered care, meaningful employer collaboration, and deep clinical alignment.
"Healthcare systems can't take a one-size-fits-all approach," Talwar emphasized. "You have to understand your population, listen to your partners, and build around that. That's how we move the needle, not just tweak it."
As value-based care continues to evolve, she said Vanderbilt's MyHealthBundles serve as an example of what's possible when health systems are willing to take risks and responsibility for the full continuum of care.
Talwar shared a guide on how other health systems can get started with a model like VUMC's. Her guide offers these action steps:
Identify high-impact conditions with cost variability.
Engage clinical leaders to build evidence-based pathways.
Partner with actuaries to set universal pricing.
Design full episodes of care including wraparound services.
Develop communication and navigation plans.
Launch with performance monitoring and iterative refinement.
Three topics dominated conversations at this year's conference. Here's what you need to know.
HFMA 2025 discussions were laser-focused on deep-rooted financial issues in healthcare. Three of the most pressing topics for finance leaders at last week's conference were: leading operational transformation, keeping pace with payers, and making the most of health system investments in today's heated economics / regulatory climate.
To keep up with payers, finance leaders are pushing for more streamlined, tech-enabled payer-provider partnerships that prioritize patient-centric outcomes. CFOs are also being called upon to go beyond budgets, taking the lead on system-wide performance improvement and fostering financially aligned, cross-functional teams.
Lastly, CFOs are exploring nuanced strategies for improving their systems' investments. With economic pressures mounting, CFOs are exploring private markets, liquidity balancing, and peer benchmarking to reshape their investment approaches.
This infographic details the best advice from HFMA on these three stress points. Also, the accompanying article can be accessed here.
UVA Health's new CFO shares her view on advocacy efforts.
In this episode of HL Shorts UVA Health's incoming CFO Stephanie Schnittger answers how she views the role of the CFO in influencing policy and advocating for the financial sustainability of hospitals both at the Federal and the state level.
She approaches financial leadership with a cautious eye on federal and state reimbursement models, especially Medicaid, warning against over-reliance on current structures.
"I think it's fair to say there's a heightened degree of uncertainty at the federal level," she said. "Don't get too comfortable with this reimbursement structure because it could change."
See how UW Health is cutting contract labor costs with some key strategies.
When workforce expenses dominate operating costs, reducing overreliance on contract labor is one of the most urgent financial to-dos for health systems.
In this episode of HL Shorts UW Health’s VP of Finance Jodilynn Vitello explains how her health system balances short-term labor cost containment with long-term workforce sustainability.
For a deep dive into UW Health’s labor strategy checkout the accompanying article with Vitello full interview.
Here's how CFOs can keep pace with, or even get ahead of, payers.
Payers, unsurprisingly, were at the center of much of the talk at HFMA this year. Several sessions focused on the best strategies to keep pace with, or get ahead of, payers, including using technology, leveraging transparency data, and reevaluating coding practices to combat denials.
Check out this breakdown of four tips from executives and speakers at HFMA on how to get a handle on payer strategies.
At HFMA, themes of payer collaboration, operational leadership, and smarter investments are dominating the conversation.
HFMA attendees are settling in on day two of the annual conference, discussing key issues that are focused on the deep-rooted finance issues in healthcare.
Three of the most pressing topics for finance leaders in the sessions so far are:
Working better with payers (and what that really means);
Stepping into the role of operational transformation leaders, and
Making the most of health system investments in today’s heated economical and regulatory climate.
Pacing Payers
Payers and prior authorization are on everyone’s agenda, with sessions focusing on denial prevention, simplifying claims creation and prior authorizations, and strategies for taking the friction out of payer-provider relationships.
Providers are rapidly embracing AI and automation in claims processing, but they’re also aware that payers are using the same technology, and more often than not, they’re faster and more efficient. So instead of sinking into a battle of the bots, both parties should be working together to create a claims/prior authorization process that revolves around the patient.
From aligning managed care and revenue cycle, to uncovering better claims processes, to digging into more comprehensive (but more efficient) coding practices, providers are searching for new ways and new perspectives to approach their relationships with payers.
Overall, it’s clear the industry wants a faster, standardized method for processing claims. The tone is overall hopeful: if both parties can save time, both parties can reduce costs and provide better patient-centric care.
Operational Leaders
CFOs are realizing there is a cost to inaction. With the threat of small financial missteps turning into big operational pitfalls, CFOs must be involved at every operational step. On the flip side, both clinician and administrative teams also must understand how misaligned workflows can negatively impact finances.
The first step is defining performance improvement and what it means to a particular health system. CFOs need a proactive approach to tying financial outcomes with performance, one that involves strategic alignment, especially for the long-term.
Discussion on operational improvement should also include training and culture, and it’s clear to finance leaders that performance improvement is imperative in today’s market.
The message to CFOs: Don’t just improve the budget. Lead the system improvement.
Imperative Investments
To set their health systems up for clearing the (seemingly never-ending) industry hurdles, finance executives are taking a close look at, and in some cases overhauling, their investment portfolios. But finding liquidity is easier said than done.
To help, CFOs are turning to private market investments for returns, and leveraging peer comparisons to reassess risk exposure. Looking at the organization through an enterprise lens is vital; one session advised CFOs to ask their finance team: "Are we taking the right risk through an enterprise perspective?"
For CFOs looking to leverage their health system’s portfolio as much as possible, some tips from the sessions were: try to align liquidity while limiting cash drag, grow and diversify sheet assets with private markets, and utilize peer group data for comparison.
At HFMA 2025, finance executives are confronting a turbulent investment landscape, and exploring new strategies to optimize portfolios and manage risk.
The first day of HFMA 2025 is off to a fiery start.
Healthcare finance executives convened in Denver to discuss strategy in an industry fraught with financial hurdles across areas like payers, federal reimbursement, and labor costs.
To set their health systems up for clearing these hurdles, finance executives are turning towards nuanced strategies and even overhauls in their investment portfolios. But, execs are also acutely aware that navigating risks and finding liquidity in their portfolios is easier said than done and new strategies are needed.
One thing here is certain: The market is volatile, and has been for some time.
In a session titled "Observations on Health Systems Investing in the Current Landscape," Adventist Health Senior Finance Officer Brandon Seibold and Sarah Siwinski, director at BlackRock investment management, discussed how health systems across the country are performing operationally, (especially in examining expense growth, days cash on hand and cash to long term debt), how they're allocating their investment pools to achieve strategic growth goals, and how investment portfolios will continue to evolve.
Zooming out to an industry point-of-view, a few key enterprise themes in healthcare cited by BlackRock were continued operational pressure on health systems, persistent market volatility, structural industry, demographic and policy shifts, continued M&A activity, and a growing focus on strategic and venture initiatives.
Seibold dove into how Adventist revamped its investment portfolio, saying that the biggest challenges are getting Adventist's investments to reflect its core goals and deploying new strategies to achieve extremely efficient asset allocation.
Two of Adventist Health's top challenges are Medicaid and labor costs, according to Seibold. With more than 30% of its patient base using Medicaid, and a $25/hr healthcare worker minimum wage mandate in California, he says navigating the shifting headwinds is particularly difficult and called for new strategies to find liquidity and efficiency within the system's portfolio.
Seibold says faith-based Adventist Health began with a very conservative portfolio with investment restrictions, and he sees substantial room for improvement staring back at him from the balance sheet.
The session advised CFOs to ask their finance team: "Are we taking the right risk through an enterprise perspective?"
One strategy that helped put investments in perspective for Seibold's team was a cone chart to visualize volatility and risks. When finance teams examine these types of charts together it's easier to collectively examine positive and negative deviations. These charts became a great communication tool across the finance committee, Seibold says.
If returns are within the standard deviation, Seibold says leave them alone. Strategy only changes when there is a big change in the business. CFOs should keep in mind that market volatility doesn't always mandate a strategy change.
BlackRock research suggests that health systems are moving toward investments in private markets that have provided notable returns.
The session urged finance leaders to use peer groups for investment comparison. Through this, CFOs can examine how their system compares to peer groups and the risks they are taking.
Seibold shared that he realized, after looking at this data, Adventist Health owns more real estate compared to its peer groups, translating to lower risks due to no renewals. This data enables the finance team to move forward and feel more comfortable taking more risks.
Two additional tips from Seibold were to involve stakeholders and ensure consistent, clear communication on investment strategies, and set expectations around what volatility means for the finance team and stakeholders.
The CFO To Do List
The session closed with a little homework for CFOs as they navigate their portfolios in today's volatile market. While every organization will differ in its goals, resources, and strategy, CFOs can consider these steps:
* Fine tune governance and risk management;
* Redefine portfolio buckets and optimize strategic asset allocation;
* Align liquidity while limiting cash drag;
* Grow and diversify sheet assets with private markets;
* Adopt innovative structures to maximize returns.
As the HFMA annual conference kicks off in Denver, CFOs are preparing to tackle urgent financial, regulatory, and ethical challenges.
The Healthcare Financial Management Association (HFMA) is kicking off its annual conference in a few days in Denver.
The conference will host roughly 70 planned sessions with topics including leadership and innovation trends, AI and cybersecurity, strategic investments and alternative payment models, navigating the regulatory landscape and protecting rural health systems.
Navigating Federal Uncertainty
CFOs are deeply stressed about the federal regulatory climate, and for good reason; Congress is potentially on its way to cutting Medicaid even further than previously thought, which could result in an extra $200 billion in uncompensated care costs.
One of the more technically innovative sessions, "Protecting Revenue with AI Automation for Medicaid Enrollment," will highlight how two hospitals, Saint Peters University Hospital and AtlantiCare, are leveraging automation to streamline enrollment in Medicaid, charity care, and FQHC programs. The session will explore how AI is being used to bridge the gap between data collection and successful application submission, helping hospitals in low-income areas secure reimbursement and reduce labor costs. Speakers will include Garrick Stoldt, CFO of Saint Peters University Hospital, Sandra Gubbine, AVP of Revenue Cycle at AtlantiCare, and
Pedram Afshar, CEO of Escher Health.
As CFOs face mounting complexity in compliance, the session "Navigating the Changing Regulatory Landscape" will offer a comprehensive update on recent legislation affecting medical debt, credit reporting, and patient payments. Policy shifts at the federal, state, and local levels are dismantling the traditional approach to revenue cycle management (RCM). Panelists will outline actionable steps for maintaining compliance without compromising recovery rates or patient satisfaction. Speakers include Timothy Haag, board president/president & CEO of ACA International/State Collection Service, Mike Frost, partner at Frost Echols PLLC, and Leah Dempsey, shareholder at Brownstein Hyatt Farber Schreck, LLP.
Attendees will also learn about advocacy efforts by organizations like the American Collectors Association and explore how providers can align RCM strategy with evolving legal frameworks.
Protecting Rural Healthcare
Rural hospitals face distinct financial vulnerabilities, often exacerbated by limited resources and external shocks, and with federal dollars being pulled back, many are at risk of closure. The session "Building Back Stronger: A Roadmap for Rural Healthcare Resilience" will feature executives from Ballad Health's Unicoi County Hospital, which endured a temporary closure following Hurricane Helene. The discussion will focus on adaptive leadership, particularly the entrepreneurial mindset required to navigate operational disruptions in under-resourced settings.
CFOs of rural systems will gain insights into disaster recovery, risk mitigation strategies, and long-term sustainability planning, all essential for preserving care access in rural America. Speakers will include Pam Austin, CIO of Ballad Health, Laura Kreofsky, rural health director at Microsoft, and Jason Griffin, head of digital health strategy at Nordic.
Payer Relations: Turning Conflict into Leverage
When are payers not on the minds of CFOs? The conference will also tackle the evolving dynamics between providers and payers in the session "Turning Payor Challenges into Opportunities." In a time where contract disputes are increasingly public and politically charged, this session examines the business case behind terminating a major managed care agreement. Matt Stacell, chief administrative officer at Naples Comprehensive Health (NCH) will walk attendees through how their organization balanced board governance, donor relations, and public messaging to strengthen its negotiating position. Panelist Kevin Thilborger, chief revenue strategy officer/ chief managed care officer at Unlock will also speak at this session.
This session will include strategies for managing multi-pronged payer relationships, including fee-for-service, ACO, risk contracts, and value-based arrangements, along with best practices for using media to build stakeholder support.
Ethics in Healthcare Finance
Today's healthcare climate features deep financial strain and cultural reckoning, and ethics has become a top concern for CFOs. Rick Gundling, former CFO and HFMA content director, will lead the session "Ethics in Healthcare", which will examine how leaders can uphold transparency, integrity, and trust in financial decision-making.
Gundling will explore a practical framework for ethical leadership, including real-world dilemmas faced by finance executives. Attendees can reflect on how to build ethical cultures from the top down, with a focus on character-driven leadership in times of uncertainty.
As Senate Republicans push forward with the 'Big Beautiful Bill' CFOs across the country are sounding alarms about the potential effects.
The Senate GOP's "Big Beautiful Bill" now proposes more severe Medicaid cuts than the House version, including capping provider taxes and reducing supplemental payments to hospitals.
The phased reduction of the maximum allowable provider tax rate is one of the most contentious components in the bill; the Senate draft proposes a provider tax rate drop from 6% to 3.5% in Medicaid expansion states. This is a huge drop off from the House bill, which would only freeze provider tax rates at current levels, according to Politico. Although nursing and intermediate care facilities would be exempt, the Senate plan would start phasing in the cap in 2027 and fully enact it by 2031.
While moderate Republicans express concern that the bill's Medicaid changes could harm rural hospitals, (which rely heavily on Medicaid funding), more conservative senators argue that the bill doesn't go far enough in reducing the national debt. With a slim majority, Senate Republicans can only afford to lose three votes, and disagreements over Medicaid provisions and the debt ceiling could further complicate matters.
The bill, which includes more than $200 billion in federal spending cuts to Medicaid over the next decade, has triggered alarm bells in health systems already operating on razor-thin margins and serving large Medicaid populations.
Ongoing negotiations and revisions indicate that the final version of the bill may differ significantly from both the House and Senate proposals.
The CFO POV
Following HealthLeaders’ prior coverage on the looming crisis of uncompensated care, CFOs are now preparing their organizations for the potential financial fallout. For one major Arizona health system, the stakes couldn’t be higher.
“With more than 25% of our patients covered by Medicaid, we are watching the federal debate very closely and have engaged with our delegation,” said Brad Hipp, CFO of Tucson Medical Center (TMC).
Arizona’s situation is particularly complex. The state already has a Medicaid work requirement on the books, set to take effect next year, pending federal approval. That policy may be accelerated—or constrained—depending on the final decisions in the reconciliation bill.
Hipp emphasized the importance of state flexibility.
“We are concerned that any federal requirement has the flexibility to be customized by states to meet their unique challenges,” he said.
Advocacy in Full Force
Unlike the behind-the-scenes maneuvering that so often typifies budget season in Washington, this time hospitals are going public with their concerns. Hipp said his organization’s multi-tiered advocacy effort includes lobbying and grassroots engagement with the local business community.
“Our team has been very proactive in lobbying both as an individual health system and through our associations,” he said. “We have brought our business community together so they understand the impact cuts to hospitals have on the broader communities and businesses—and they have stood with us.”
This broader messaging strategy reflects a shift among healthcare finance leaders: Medicaid is no longer seen solely as a safety-net program, it’s a critical pillar of state and economic stability.
Operational Efficiency In The Spotlight
Even as they lobby to prevent cuts, health systems are bracing for impact.
“We are actively advocating but also continuing to focus on operational efficiency and cost savings so we can weather any changes in reimbursement,” Hipp said.
This includes everything from re-evaluating vendor contracts and staffing models, to expanding care partnerships that offer more predictable revenue streams.
The Real Cost of Medicaid Cuts
For CFOs, the potential effects of the bill extend far beyond their balance sheets.
“It’s important for lawmakers to understand that cuts to Medicaid don’t just impact the individual who loses coverage—it impacts all of us,” Hipp said. “We know from experience that when you cut Medicaid, emergency rooms get more crowded and wait times grow, hospitals reduce staff, and in some cases close.”
See the strategies UW Health is using to reduce contract labor.
As workforce costs continue to pressure health system margins, healthcare CFOs are urgently rethinking how to reduce dependence on contract labor. At UW Health, a multi-pronged approach led by Vice President of Finance Jodilynn Vitello offers valuable lessons in balancing financial stewardship with workforce sustainability. Here are three strategies CFOs can take away.
Also see the accompanying article on how UW Health is reducing its contract labor here.
