Roseville, Calif.-based Adventist Health said it is seeing measurable gains from bringing revenue cycle operations in-house, according to its March 19 financial report.
The 27-hospital system said insourcing revenue cycle operations resulted in days in accounts receivable of 56 days in 2025 and cash collections of $5.2 billion, reaching 100% of the system’s goal.
Bringing revenue cycle operations in-house has also improved transparency and teamwork between the system’s finance, managed care and revenue cycle teams, according to the report. This has shortened the time for issues to be identified and has led to operating improvements.
“Results of this collaboration include the identification of managed governmental and commercial payers not paying according to contract and escalating for resolution,” Adventist Health said in the report.
Net patient revenue per case mix index-adjusted discharge grew 1.9% year over year in 2025, which exceeded Adventist’s expectations.
Overall, the system’s total operating revenue grew 6.9% year over year to $7.4 billion in 2025. Adventist cut its operating loss to $159 million (-2.2% operating margin) from $224 million (-3.2% margin) in 2024.
Another large system, Chicago-based CommonSpirit, will soon insource its revenue cycle operations, exiting its ownership stake in Conifer Health Solutions.
CommonSpirit CFO Michael Browning said on the system’s March 3 investor call that the decision to exit the Conifer joint venture aligns directly with the system’s unification strategies to drive greater operational integration, efficiency and patient experience.
“We also believe we can significantly improve revenue yield and overall collections,” he said, adding that CommonSpirit’s cost to collect is about double the industry average and that returning to the median benchmark data would materially reduce its overall costs.
Conifer will continue to provide revenue cycle services to CommonSpirit through the end of 2026.
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