Health systems spent years decentralizing revenue cycle operations to give hospitals, physician groups and service lines greater autonomy.
Now, many of the country’s largest health systems are moving in the opposite direction.
Revenue cycle leaders recently interviewed by Becker’s pointed to enterprise-wide operating models as one of the most effective changes they have made in recent years, citing stronger financial performance, lower variation, greater accountability and a better patient financial experience.
While AI and automation continue to reshape revenue cycle operations, executives said those technologies provide the greatest value when built on standardized processes and centralized governance.
Here is how five health systems are approaching this transformation.
Texas Health Resources: Building ‘One Revenue Cycle’
Jeff Mincher, senior vice president and chief revenue cycle officer at Arlington-based Texas Health Resources, said the system’s “One Revenue Cycle” transformation has created a common operating model across the enterprise.
“The most impactful current initiative has been our One Revenue Cycle transformation, which aligns revenue cycle functions across the enterprise under a common strategy, governance structure, and operating model,” Mr. Mincher said. “By focusing on standardization, automation, and shared accountability, we are improving decision-making, reducing variation and creating a stronger foundation for scalable growth and innovation.”
Mount Sinai: From fragmented to enterprise
New York City-based Mount Sinai Health System also moved away from a decentralized model after years of individual hospitals and physician groups managing many revenue cycle functions independently.
Sal Brown, system vice president of revenue cycle, told Becker’s that structure limited Mount Sinai’s ability to consistently execute best practices.
“One of the most impactful initiatives we’ve undertaken at Mount Sinai has been transitioning from a decentralized revenue cycle structure to a centralized enterprise operating model,” Mr. Brown said. “Historically, many functions were managed independently across hospitals, physician groups and even departments, which created variation in workflows, productivity, payer strategies, performance and ultimately accountability. While local ownership has its advantages, it often limits our ability to scale best practices and respond consistently to industry challenges.”
By centralizing operations, Mount Sinai standardized governance, workflows and performance metrics across the system.
“The result is improved financial performance, greater operational resilience, a more consistent patient financial experience, and an organization that’s better positioned to adapt to the rapidly changing healthcare reimbursement landscape,” Mr. Brown said. “Centralization wasn’t simply an organizational redesign — it became the strategic enabler for sustainable transformation across the entire health system. That foundation also positioned us to accelerate innovation and enable an exception-based operating model.”
Novant Health: Breaking down silos
At Winston-Salem, N.C.-based Novant Health, the transformation centered on redesigning the revenue cycle around the patient’s financial journey rather than individual departments.
“The single biggest impact has been moving away from siloed departments and redesigning our revenue cycle into an integrated operating model with clear accountability across the entire patient financial journey,” said Heather Dunn, senior vice president and chief revenue officer.
Novant Health consolidated functions into centers of excellence, established a unified business office for hospital and professional billing, strengthened payer relationships and strategically deployed AI to eliminate manual work where it added value rather than simply shifting it elsewhere.
“The results have been significant. We’ve reduced AR days by nearly 6%, reduced our aging by 16%, exceeded our goals, improved operational efficiency and lowered costs through a thoughtful sourcing strategy,” Ms. Dunn said. “We’ve also reinforced our internal relationships, particularly partnerships with both our IT and managed care teams. More importantly, we’ve created a foundation that allows us to scale innovation while improving the patient experience. Sustainable revenue cycle transformation isn’t about one technology — it’s about aligning people, processes and technology around a common strategy.”
VCU Health: Aligning the front end
Richmond, Va.-based VCU Health focused its transformation on consolidating front-end revenue cycle operations under common leadership.
“The most impactful initiative to our overall revenue cycle performance over the past 36 months has been foundational and functional alignment of historically disparate front-end revenue cycle functions into a consolidated team of access professionals under common revenue cycle leadership,” said Brett McMillan, vice president of revenue cycle operations.
Mr. McMillan said securing organizational buy-in required clearly demonstrating improvements through measurable results.
“This is a multi-year journey at a complex academic multi-hospital system, but just as Rome wasn’t built in a day we have found success in clearly articulating our vision for the revenue cycle operating model and maintaining milestone-level work plans and regularly tracking progress through data,” he said.
The strategy has translated into measurable gains. VCU Health said it has consistently exceeded its cash targets for more than three years, reduced accounts receivable days to a five-year low and lowered its revenue cycle cost to collect — all while maintaining a stable revenue cycle workforce despite a high-single-digit organizational CAGR.
Grady Health: One revenue cycle, one patient experience
Atlanta-based Grady Health System took centralization a step further by bringing employed physicians together with Morehouse School of Medicine and Emory University School of Medicine onto a single professional billing platform.
Monica Richey, interim vice president of revenue cycle, summarized the effort in four words: “One Revenue Cycle. One Patient Experience. One Grady.”
“While technology enabled the work, the true transformation came from aligning people, processes, and a shared vision,” Ms. Richey said. “Consolidating multiple physician enterprises into one revenue cycle operation eliminated unnecessary complexity, standardized workflows and created operational efficiencies that continue to benefit our providers, staff and patients every day.”
She said the unified operating model also created the foundation for robotic process automation and AI while delivering sustained double-digit revenue growth.
“Large scale transformation is never the result of technology alone,” Ms. Richey said. “It requires committed leadership, trusted partnerships and talented people willing to embrace change.”
A broader industry shift
Despite differences in size, geography and organizational structure, each health system described a similar strategy: reduce fragmentation, standardize operations and create enterprise accountability before layering on automation and AI.
While technology remains an important accelerator, many revenue cycle leaders increasingly view centralization as the foundation that makes broader transformation possible.
As reimbursement pressures intensify and health systems seek new efficiencies, enterprise operating models are regaining momentum as a strategy to improve financial performance, increase scalability and enhance the patient experience.
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