From the evolving role of Medicare Advantage and value-based care to the growing influence of AI and private equity in healthcare, several CFOs recently joined the “Becker’s CFO and Revenue Cycle Podcast” to discuss the trends they’re watching most closely — and the strategies they’re deploying to stay ahead.
CFOs or revenue cycle leaders who would like to be featured on the “Becker’s CFO and Revenue Cycle Podcast“ can email Alan Condon at acondon@beckershealthcare.com.
Editor’s note: Responses were lightly edited for length and clarity.
Daniel Isacksen Jr., Executive Vice President and CFO, Trinity Health (Livonia, Mich.): One of the most significant trends is the shift of care and resources into the ambulatory setting. While this shift has been going on for a long time, what’s notable now is the substantial allocation of capital and assets in this space. We’re seeing major investments in comprehensive ambulatory centers, medical group facilities, ambulatory surgery centers, retail imaging and infusion centers These changes are significantly influencing capital investment strategies and will continue to do so. The key to success in this area is developing expertise and aligning cost structures with the segment’s revenue base. Ambulatory care facilities aren’t hospitals; they need to be managed, operated and supported differently.
Another major focus, of course, is AI and the broader use of technology to support operations and service functions. The key here is distinguishing between shiny, new technologies and practical applications that genuinely existing problems or enhance a particular area. For instance, ambient listening is enhancing physician documentation in clinics, technology-enhanced virtual nursing tools to support care teams and help address staffing shortages, and automation and machine learning are improving revenue cycle management and supply chain operations. Our Epic-based platform, TogetherCare, continues to evolve with enhanced applications that make access and care easier for patients, clinicians, and administrative teams.
Lastly, physician partnerships continue to evolve into deeper, more meaningful collaborations. Increasingly, physicians are not just participants but true partners — often with ownership stakes and governance roles in clinical programs and care delivery. We’ve found that these partnerships drive performance and create a win-win situation for health systems, physicians and patients, who we call our members. The key is ensuring meaningful participation and ownership — not just small pieces of equity or ride-along situations, but real, engaged partnerships.
Brian Devine, CFO, Allegheny Health Network (Pittsburgh): One of the biggest trends we’re focused on is the shift from fee for service to value-based care. As part of Highmark Health, we have a close relationship with Highmark Inc., our health plan partner. Recently, we entered into a full-risk arrangement with Highmark — our first iteration of managing a population based on quality metrics and loss ratios. In this model we share both in the upside and downside of value-based care. Our goal is to ensure that we’re financially rewarded for our investments in quality, access and population health management while also collaborating closely with the health plan side to manage patient populations effectively. Beyond Highmark, we’re working to expand these quality and care models with other payers, moving further away from fee-for-service. We believe this shift will drive better outcomes for both our patients and health plan members, making it a key focus in our long-term strategy.
Another major trend we’re addressing is labor — particularly clinical labor. Coming out of COVID-19, every provider faced challenges with nursing shortages, agency staffing, and workforce stability. We’ve worked hard to reduce reliance on agency staffing, especially in nursing. However, we’re still experiencing challenges in recruiting and retaining talent in highly technical roles, such as surgical techs and CRNAs. Anesthesia staffing, in particular, remains highly competitive. Given our extensive network of access points, including both hospital ORs and ambulatory surgery centers, workforce stability in these areas is critical. To address this, we’re investing in talent development programs and forging partnerships with community education programs and local schools.
Lastly, a tough but important issue we’re facing is the rise in malpractice litigation trends. While we haven’t necessarily seen an increase in case volume, the severity of settlements has grown significantly in Western Pennsylvania. This is something we’ve typically seen in large metro areas, where plaintiff demands and settlements can be substantial. However, we’re now seeing out-of-state attorneys filing high-demand cases in our region, which is a growing concern for providers. The financial impact of these cases can be considerable, making it a trend we are actively monitoring as we move into 2025.
Steve Aleman, CFO, Prime Healthcare (Ontario, Calif.): One key trend is the growing prevalence of Medicare Advantage programs, which now cover more than half of all Medicare beneficiaries. While many believe MA ultimately lowers costs, the fact is that it poses serious challenges to hospitals. Prior authorization denial rates are unquestionably high, which causes providers to absorb additional costs to refile a claim and adds uncertainty around how much we will be paid or, for that matter, if we’re paid at all.
These denials increase costs, create uncertainty around reimbursement and add complexity to defining expected net reimbursement. We must engage actively with plans, ensuring state-of-the-art information and processes to close the gap between care costs and reimbursement. It is imperative to be extremely active in engaging with MA plans to ensure we have state-of-the-art information and processes in those discussions to close the gap between care costs and reimbursement.
Jenni Alvey, CFO, IU Health (Indianapolis): If you polled CFOs, I think many would highlight the same key trends. First, the healthcare labor shortage. Post-pandemic, patient demands have surged as the aging population requires more care. The competition for clinical talent is intense, so we’re partnering with institutions like IU and Ivy Tech to build pipelines for healthcare professionals.
Second, inflationary pressures. Labor, supplies and drug costs have risen sharply, and health systems are caught in the middle — facing higher costs while striving to keep care affordable. We’ve managed well but have more work ahead.
Third, which is probably no surprise, is AI, a game-changer, poised to transform patient care, efficiency and innovation. The challenge is leveraging it wisely while navigating financial and operational complexities.
Terry Metzger, CFO, ProMedica (Toledo, Ohio): The three key areas we’re prioritizing from a financial perspective are volume trends, labor and staffing costs, and reimbursements.
We saw strong volume growth across 2024, which has been a positive bounce-back for our system. However, like many health systems, we’re seeing a shift from inpatient to outpatient care, and we’re closely analyzing how this trend impacts different service lines. Specifically, we’re looking at volume changes in northwest Ohio and southeast Michigan, benchmarking ourselves against competitors, and comparing industry-wide trends at a macro level to inform our 2025 strategy.
On the labor side, we made significant progress in 2024 by building up our internal teams and reducing reliance on agency staffing. That effort was highly successful, and for 2025, we’re refining it further—analyzing staffing at a granular level, shift by shift and location by location, to identify areas for improvement.
Finally, reimbursement is a major focus. With changes in the political landscape, we’re closely evaluating shifts in Medicare Advantage versus traditional Medicare, as well as continued growth in Medicare managed care. On the commercial side, we’re monitoring reimbursement trends relative to inflation. While inflation has come down significantly, there’s still a lag in reimbursement from payers, and we’re working to optimize this as we move forward.
Michael Gleason, CFO of Franciscan Missionaries of Our Lady Health System (Baton Rouge, La.): First, ongoing labor dynamics. And I’m not just talking about the competition for RNs — we’re also seeing challenges in hiring techs, administrators, operators and physician leaders. Across the board, there simply isn’t enough talent to fill all the roles we need. Our focus is on attracting and retaining the best talent possible.
In addition, we’re seeing an uptick in union activity. I’ve worked in unionized environments before, and they certainly come with challenges. As we continue rebounding from the pandemic, dealing with labor unions is another layer of complexity we’d prefer to avoid right now. So, we’re keeping a close eye on labor trends and workforce dynamics.
The second major category is regulatory trends, which encompass several critical issues. One that we’re monitoring closely is the ongoing pressure from big pharma on the 340B program. This program is a significant revenue stream for us, helping offset the costs of providing care to underinsured patients in our markets.
We’re also concerned about site neutrality threats, which remain a major issue. Additionally, with the change in administrations, there’s renewed focus on the subsidies for exchange products, set to expire in 2026 unless renewed. The potential impact is significant—recent projections show that in Louisiana, up to 32% of those insured through the exchange could lose coverage, while in Mississippi, it could be as high as 43%. If those individuals move into the uninsured population, the financial impact on health systems would be substantial.
Another key regulatory issue is Medicaid supplemental funding programs. CMS has recently encouraged states to move toward supplemental funding that approaches average commercial rates, which has been incredibly important for supporting health systems — especially in states like Louisiana, Mississippi and Florida, where I’ve spent much of my career. While this is a positive development, as with all government programs, policy changes can happen quickly and unexpectedly.
The third category is what we call disruptors — the involvement of private equity and other nontraditional players in healthcare. These entities continue to target profit centers outside the hospital walls, acquiring specialty surgical groups and ASCs. While this trend is growing in some areas, we’re also seeing some physician groups express dissatisfaction with these new arrangements, which could lead to shifts in the market.
That said, not every disruptor succeeds. We’ve seen notable examples of large corporations struggling in healthcare, such as Walmart abandoning its primary care initiative and Optum stepping away from telehealth. These moves highlight how difficult it is to navigate this industry. But overall, we’re keeping a close eye on private equity and other nontraditional players, particularly in areas where there’s potential for strong margins.
George Wiley, CFO, Lovelace Medical Center and Heart Hospital of New Mexico (Albuquerque): One of the biggest challenges we’re focused on is payer relations, particularly denials and pre-authorizations. We’re closely analyzing whether we’re getting reimbursed correctly, and as Becker’s has covered, denials have increased significantly in recent years. Looking back 20 or 30 years, denials were an issue, but nothing compared to what we face today. Our focus is on ensuring all necessary documentation is submitted accurately and on time to reduce preventable denials.
Pre-authorizations are also a major concern, especially for our heart hospital. We frequently receive calls from surrounding rural facilities requesting specialized procedures, and each case requires us to verify not only the patient’s insurance coverage but also whether the insurer will reimburse us for the procedure. This dynamic makes payer relationships a top priority, not just for us but for many of our peers in the hospital community.
Another major area of focus is federal and state regulations. With the recent election of President Trump, there’s uncertainty around potential policy changes. There’s also been discussion about Dr. Oz’s involvement and his support for managed Medicare, which has already contributed to a significant rise in denials. At the state level, we’re tracking multiple regulatory issues, including changes to malpractice costs, potential mandatory staffing ratios, and policies impacting average length of stay.