As public trust declines and technology transforms decision-making, CFOs must lead with ethics, not just compliance.
Plato once said, "Good people do not need laws to tell them to act responsibly." In healthcare finance today, acting responsibly requires more than laws: it demands unwavering ethical leadership.
As trust in healthcare institutions continues to erode, finance executives are navigating murkier waters. Surveys show trust in government health agencies fell to 61% as of January 2025, while confidence in physicians and healthcare leaders declined 12% since 2023. Layer in the surge of misinformation and growing distrust in media, and the job of stewarding financial decisions that impact patient care becomes entrenched with ethical complexity.
A session at the recent HFMA Annual Conference tackled this challenge head-on, making the case that finance leaders must proactively engage with ethics and not shy away from it.
The Basics Still Matter
Led by former CFO and HFMA content director Rick Gundling, the session opened by grounding attendees in ten core ethical principles that serve as practical reminders amid healthcare's growing complexity. These include:
Screen and stabilize all patients who seek emergency treatment regardless of their ability to pay.
Provide high-quality patient care without asking for or taking anything of value for referrals.
Bill only for medically necessary services provided.
While some of these may seem obvious and foundational, Gundling emphasized how easy it can be for leaders to lose sight of these basics. Revisiting these principles is critical as finance teams weigh both routine decisions and high-stakes strategic pivots.
It's imperative to maintain an ethical tone at the top, in the C-suite, Gundling advised. Leaders at this level decide whether ethics count and must model not by what they say, but by what they do.
To help leaders systematize their approach, Gundling introduced a five-step framework to navigate ethical decisions with rigor and consistency:
Identify the ethical issues.
Get the facts.
Evaluate alternative actions through different lenses.
Choose an option for action and test it.
Implement your decision and reflect on the outcome.
AI and the Ethics of Innovation
As artificial intelligence becomes more integrated into clinical, administrative, and financial operations, CFOs will be called on to address new ethical frontiers, according to Gundling. There are both legal and ethical considerations that leaders must grapple with as AI grows across health systems.
Under the ethical umbrella, leaders will need to consider regulation, privacy, mitigation of bias, transparency and relevance. Meanwhile, under the legal umbrella, leaders will need to think about governance, confidentiality, liability, accuracy and decision making.
Emerging topics like robot rights, algorithmic inclusion, and machine-led cognitive services may seem distant, but Gundling stressed that forward-thinking CFOs should engage with these now rather than reacting later. Moreover, he posed a critical question: when does existing policy need to evolve to meet new ethical challenges?
The Ethical Bottom Line
Gundling left attendees with a powerful reminder: being ethical is about more than checking a compliance box. It's about judgment, intent, and clarity of values, especially with external pressures like Medicaid funding cuts and intense public scrutiny.
Gundling closed the session with three essential truths for finance leaders:
Morals are principles; ethics are the behaviors that reflect them.
No matter how robust the policy, ethical judgment is often a solo act.
Technology is reshaping what ethical decision-making looks like, so stay ready.
See how UW Health is handling operations barriers in its workforce transition.
For many health systems, workforce expenses are dominating operating costs, and reducing overreliance on contract labor is one of the most urgent financial to-dos for CFOs.
In this episode of HL Shorts UW Health’s Vp of finance Jodilynn Vitello discusses some of the biggest operational barriers when shifting from contract labor to sustainable staffing models.
For a deep dive into UW Health’s labor strategy checkout the accompanying article with Vitello's full interview.
At HFMA, Vanderbilt offered a guide for other systems looking to implement similar programs.
Vanderbilt University Medical Center is pioneering a bundled care program called MyHealth Bundles that has reportedly saved employers and their employees nearly $5 million in healthcare costs over three years.
The program is built around employers' biggest cost concerns. Each care bundle covers the full continuum of care offered at a single, transparent price with wide patient inclusion. Physician-designed models and real-time performance monitoring are driving better outcomes and fewer unnecessary surgeries.
This infographic provides a quick breakdown of Vanderbilt's strategy. The full article can be found here.
CFOs can get ahead with payers by using tech, leveraging data, and planning early.
Payers, unsurprisingly, were the subject 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.
Use tech, but don't wield it as a weapon.
Many health systems are experimenting with AI, particularly for AI generated appeal letters to quickly combat denials. After identifying the system's largest payer, CFOs can work with their teams to identify the service line that is best for automation. One session with Carle Health System Director of Patient Access
Jeana Sherry, lingered on the question "Where can we move the quickest?" when thinking about automation.
Keep in mind, automation isn't all or nothing, ; systems can always start small. While AI is a valuable tools for providers, executives urged each other to not stray too far from genuine, transparent collaboration.
Leverage Data
Providers typically have access to far more data than they use, and with new price transparency rules, payers are now required to display their pricing data. Ensure there is a team and cadence in place to review the massive payer datasets in order to leverage the data in negotiations.
In a session titled: ‘Data-Driven Denial Prevention,' executives from Colorado Children's Hospital outlined the system's initiative to use data-driven decision-making in a comprehensive denial prevention strategy. They urged providers to create a path for easy data visualization. To do this, finance teams can focus on identifying the root cause of denials, (focus on the cause, not the symptoms), analyze that cause, and then trial a solution.
Another session, titled ‘Prescriptive Partnerships: Strategies to Reduce Payer-Provider Abrasion,' with revenue cycle executives from OhioHealth and Baptist Health, urged providers to explore how they can work to co-develop claims editing criteria with payers. Consistent, structured collaboration with payers is key here to building a sustainable formula for managing claims.
Evaluate coding practices
Don't overlook coding practices when managing denials, especially when entering value-based care agreements. One session found that the impacts of Z codes for SDoH data are especially useful, although often overlooked by providers.
As value-based care agreements are increasing throughout the industry, health plans want SDoH data to bolster these agreements. The session discussed how providers need to compile SDoH data better to include in claims. To get a jump on this, CFOs can work with their revenue cycle teams to implement SDoH screening tools.
Start Early, Build a Strategy
Negotiations often fall apart when providers do not work as a synergistic team from the beginning. Identify and define a strategy early on so all leadership is on the same page to avoid later fumbles in payer negotiations.
Start by bringing together a cross-functional team (revenue cycle leaders, contracting managers, clinical leadership, and data analysts) well in advance of any negotiation window. Align this team on key goals: whether it's narrowing down top pain points with a specific payer, identifying problematic denial codes, or highlighting underpaid services that need attention.
Don't wait for contract expiration to begin preparing. CFOs can lead the plan by setting calendar milestones at least six to 12 months in advance to build a layered strategy that incorporates analytics, clinical insights, and regulatory changes.
CFOs are under pressure, with legal probes, cyber threats, and workforce challenges reshaping priorities. Here are the most popular stories for CFOs on HealthLeaders through the first half of the year.
: Key themes in healthcare finance this year so far? Turbulence and transformation.
This year is a pivotal one for healthcare finance, molded by high-stakes legal scrutiny, operational realignment, cybersecurity exposure, proactive clinical stewardship, labor and retention crises, and mounting technical debt. Together, these issues reflect a sector under pressure to balance fiscal responsibility, compliance, and innovation.
Here are the top six finance stories of 2025 (so far):
UnitedHealth Group is facing escalating pressure as multiple Department of Justice (DOJ) investigations—both civil and criminal—focus on alleged Medicare Advantage up‑coding and kickback schemes. A new criminal probe targeting its Medicare Advantage billing practices began in summer 2024, while a civil case is following Wall Street Journal revelations of aggressive diagnosis practices . Publicly, UnitedHealth denies wrongdoing, but its stock has plunged more than 50% from its early-year highs.
The aftermath of the Change Healthcare breach and other cyberattacks has prompted CFOs to rethink disaster preparedness. Following one incident, Greater Baltimore Medical Center CFO Laurie Beyer led rapid, cross-functional incident response teams that pivoted operations and segmented networks to limit fallout The lesson is clear: Outdated systems are not only operational liabilities, but financial catastrophes in waiting.
Technical debt is a stealthy cost driver. HealthLeaders reports show that deferred IT upgrades — from aging ERP systems to fragmented EHRs — increase security vulnerabilities, operational inefficiencies, and compliance risks . CFOs are now tasked with establishing continual benchmarking, prioritizing ROI-driven refresh cycles, and collaborating closely with CIOs to reduce future costs.
Healthcare bankruptcies persisted at elevated levels in 2024 with 57 Chapter 11 filings, the second-highest in six years. Rural, senior care, and pharmaceutical sectors were hit hardest. Notably, midsize provider bankruptcies (liabilities between $10M–$100M) remain a concern. CFOs serving vulnerable providers should proactively engage in community and payer coordination to preserve essential care access amid financial distress.
Northern Light Health’s CFO-led turnaround hinged on thoughtful retention and workforce development strategies. After deep losses in 2024 ($100M in operations, $620M in debt), leaders restructured administrative roles, doubled clinical staffing, modernized scheduling, and forged partnerships with nursing schools and local colleges. This model illustrates how targeted investment in people is critical to restoring revenue and quality.
MultiCare Health’s aligned intervention program highlights the financial upside of eliminating clinical waste. Through a collaboration with Epic and IllumiCare, MultiCare has achieved big savings by reducing clinical waste. CMO Arun Mathews shared how the system did it and how much work went into physician alignment with the new program. CFOs should not overlook the importance of collaboration with medical teams to uncover clinical and financial stewardship opportunities.
Strategic Imperatives for CFOs
Risk of Deferred Investment: Organizations that delay IT modernization, cybersecurity defenses, or workforce stability are increasingly vulnerable, not only to operational shocks but also to market and regulatory disruptions.
Need for Interdisciplinary Governance: CFOs are aware of their elevated role beyond finance: coordinating with legal, compliance, IT, clinical, and HR to mitigate threats and capture value, . Now is the time to act on the expanding duties.
Shift Toward Value-Driven Models: Waste reduction, retention strategies, and tech modernization are becoming core portfolio decisions. CFOs must view these as critical drivers of sustainability as the industry pushes forward.
Regulatory Reckoning: The DOJ’s intensified scrutiny of billing practices and MA models signals a new frontier of compliance risk. Proactive audit protocols, tighter coding oversight, and external benchmarking are non-negotiables.
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.
