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.

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:

1. Identify high-impact conditions with cost variability.
2. Engage clinical leaders to build evidence-based pathways.
3. Partner with actuaries to set universal pricing.
4. Design full episodes of care including wraparound services.
5. Develop communication and navigation plans.
6. Launch with performance monitoring and iterative refinement.

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."

For a deep dive into our interview with Schinittger, check out the accompanying article here.

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.

Use Time Blocks by Marie DeFreitas