Renton, Wash.-based Providence is owed $1 billion by Medicare Advantage plans. About $600 million of it is from this year alone, according to President and CEO Erik Wexler, and he wants Congress to make payers pay faster.
Mr. Wexler is a leading voice behind the Medicare Advantage Prompt Pay Act. The bill would require MA plans to pay 95% of clean in-network claims within 14 days and out-of-network claims within 30 days. Speaking Nov. 2 at Becker’s CEO + CFO Roundtable, he said the bill now has 25 bipartisan co-sponsors and is starting to move through committee.
The idea took shape during his first weeks as CEO, when he went to Washington, D.C., as Congress weighed the cuts that became HR 1. Before meeting with a senator, he told Providence’s chief advocacy officer, “I don’t want to be the CEO of ‘no to everything.’ I want to give some ideas.”
His pitch was that MA plans are a federal vendor, paid per member per month to cover Medicare beneficiaries. Meanwhile, the money owed to Providence is “sitting on their books, and they’re arbitraging it. Those are our taxpayer dollars,” Mr. Wexler said. He asked lawmakers to hold that vendor accountable so providers get paid on time, which would help them absorb federal cuts.
“I saw something I’d never seen,” he said. “I saw the member writing it down, and I saw the staff writing it down.”
Mr. Wexler made the same pitch in 18 meetings over about two weeks, then he helped draft the bill with the American Hospital Association.
“This will save rural healthcare in the United States,” he said. “It’s not just about my organization; it’s about all those little hospitals and others that are desperate to get paid on time by these payers.”
Here are four more takeaways from Mr. Wexler:
1. A sixth consecutive positive quarter is coming.
Providence will report another quarter of positive operating margin next week, its sixth in a row, Mr. Wexler said. He did not share the figure. He said the system expects a strong fourth quarter, which will position it for 2027, when HR 1’s cuts take effect.
The streak follows six straight years of operating losses that “bled away billions of dollars in liquidity,” Mr. Wexler said. Caregivers he met on a four-month listening tour, about 4,000 people, told him to “pull the Band-Aid off. Have courage.”
Providence began scenario planning and acting before HR 1 passed. Halving its 36 subsidiaries, a move central to its roughly $400 million operating swing through the first half of 2026, put $1 billion of liquidity back on the books, Mr. Wexler said. The system also cut duplicative, low-utilization services; is moving a couple of hospitals “outside of Providence, but into thriving hands”; and reduced turnover and agency spending.
Quality has held up, he said. For the first time in 10 years, Providence’s systemwide metrics across all four areas of the quadruple aim are at the “outstanding” level.
2. AI’s first job is removing administrative burden.
Rather than “trying to do everything and boil the ocean,” Providence pointed AI first at administrative work, so clinicians can spend more time with patients — and their own families, Mr. Wexler said.
The clearest example is the in-basket. A clinician might wake up to 100 messages and get through 20 before treating patients that day. In a theoretical example he described, if message No. 67 describes jaw pain, arm pain and indigestion — possible signs of a heart attack — it may not get read until later in the day. Providence’s homegrown tool, ProvARIA, triages that queue: prescription requests go to medical assistants or advanced practice providers, appointment requests are routed out and gratitude notes land in their own folder.
Among 267 clinics, the tool has removed about 57% of in-basket messages, or 300,000 messages, Mr. Wexler said. Across the system, Providence has removed 1.6 million tasks from physicians. Because a handful fewer messages a day can go unnoticed outside those clinics, the system is raising its target from 3 million tasks to roughly 15 million, he said.
Providence is also using an agentic tool, Empathy AI, developed through its Institute for Human Caring, to help clinicians rehearse hard conversations, such as delivering a bad outcome, without feeling judged.
3. Rural access runs through research and medication.
“I’m worried — I know you all are, too — about rural healthcare, and we should be,” he said.
One gap is clinical trials. Without access to them, rural patients miss the most advanced research, he said. Through Longitude Health — the collaborative Providence formed with Dallas-based Baylor Scott & White Health, Houston-based Memorial Hermann Health System and Winston-Salem, N.C.-based Novant Health, and which Ann Arbor-based Michigan Medicine later joined — members are pooling their clinical research programs and taking them to biotech companies to extend trial access to rural communities, among other places.
Another gap is medication. Providence seeks out patients who say they cannot get their prescriptions and enrolls them in financial counseling. More than 1,000 people have received medications they need this year, but Mr. Wexler said that is not enough.
“It needs to be tens of thousands of people for us,” he said. “We all need to double down on that.”
4. A $1.1 billion gift will build Oregon’s first dedicated women’s hospital.
When Daniel Oseran, MD, executive medical director of Providence Heart Institute, called, Mr. Wexler braced for bad news. Instead, Dr. Oseran told him Phil and Penny Knight were about to make a contribution: $1.1 billion.
Mr. Wexler assumed he meant $1.1 million. “He said, ‘No — a billion,'” he recalled. “I literally stood up, I think, and just gasped.”
Providence had wanted to rebuild part of its St. Vincent campus in Portland, Ore., and add a dedicated women’s hospital for a decade but could not afford it. Half of the gift will fund that hospital, Mr. Wexler said. It will focus on cardiovascular care and other major conditions affecting women, including menopause, which he called “endemic in this country and improperly treated.”
“So much of research and care delivery over the years has been focused on men, and there have been so many mistakes,” he said.
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
