At Valleywise Health, the public safety net system for Maricopa County in Phoenix, technology decisions don’t get made without a financial case attached. That discipline predates the current funding environment, but it has grown sharper as Medicaid reductions take hold and the system prepares for what follows.
“With what we’re facing, particularly financially, we’ve got the pressure of doing more with less,” said Stephanie Hines, senior vice president and CIO at Valleywise. “So when we make those decisions on what we invest in and what we move forward, we have to think about that with the financial lens.”
Valleywise sits at a particularly exposed position with around half of the system’s revenue flowing from Medicaid or supplemental funding that supports its teaching program and care for uninsured and underinsured patients. The coverage reductions under the One Big Beautiful Bill Act are expected to shift more patients from insured to uninsured, increasing demand at exactly the moment funding contracts.
“In a safety net organization, as Medicaid coverage changes and people potentially lose that coverage and become uninsured, that’s going to mean more people gracing our doors,” Ms. Hines said during a recent “Becker’s Healthcare Podcast” interview.
That anticipation drives two investment priorities. The first is reducing administrative burden on clinicians — less a quality-of-life initiative than an operational one. In a system expecting higher patient volumes, every hour a clinician spends on documentation is an hour not spent on care.
“For us, that’s really translating to focusing on areas where we can reduce friction, and things that are going to have a strong financial return, whether it’s automating things that we previously had people doing, and ensuring that we are delivering on technology and functionality that helps retain the staff that we need to retain so that we’re not needing to backfill or continue recruitment in those areas,” she said.
Reduced administrative work frees capacity, freed capacity absorbs more patients without adding headcount, and staff who can do the work they trained for are more likely to stay.
“Removing some of that opens capacity and reduces the cognitive load that we struggle with in this work,” Ms. Hines said. “Our teammates and their time is one of our most precious resources.”
Ray Lowe, senior vice president and CIO of AltaMed Health Services in Los Angeles, is making a similar calculation. AltaMed is the nation’s largest federally qualified health center treating more than 500,000 patients across 80-plus sites. Many of the patients are non-English speaking and concentrated at 200% or below the federal poverty level. California’s Medicaid expansion had extended coverage to patients with undetermined immigration status in the past but new federal requirements are establishing eligibility thresholds many won’t be able to meet, but as a community health center AltaMed is still chartered to provide healthcare to everyone.
“How do we still enable care? We don’t want to go backwards,” Mr. Lowe told Becker’s. “How do we wrap our patients in technology? How do we improve the productivity so that we can have a net reduction, improvement of cost and cost savings without reducing quality or engagement?”
AltaMed is relying on Epic as its EHR platform to drive transformation. Mr. Lowe is deploying a suite of AI-enabled tools on that infrastructure including ambient documentation platforms and note-summarization capabilities that absorb administrative work from clinicians and redirect that time to direct care. The goal is to extend what the existing workforce can do.
“I’m really excited about note summarizations, helping our docs get a summary of a number of encounters versus before they have to read it,” he said. “There’s text assistance, level of service and coding happening, drafting patient instructions. So a lot of things to help our providers.”
The discipline around what gets deployed matters as much as the tools themselves. Mr. Lowe measures every proposed investment against a documented, measurable use case tied to the organization’s quadruple aim of quality, cost, patient experience and provider experience, before any technology moves forward.
“I think the time of shining coins is really moving away,” he said. “When we look at the discipline required, especially from a governance perspective, we have use cases that are tied to discrete outcomes that can be measurable.”
AltaMed has driven measurable improvements in colorectal and breast cancer screening rates, using Epic’s analytics and outreach infrastructure to identify and reach patients who need those services. The organization has also prioritized closing health literacy gaps for a patient base that is predominantly non-English-speaking, using technology-enabled outreach to connect patients to care in their primary languages.
A key priority for Valleywise is also the consumer digital layer. The health system is investing in tools that allow patients to self-schedule, navigate wait lists and access care more efficiently. But the population the system serves makes this more complex than a standard digital front door deployment. Language barriers and connectivity gaps specific to the safety net population mean the wrong tool, deployed without sufficient context, can widen the inequities it was meant to close.
“The problem that we’re looking to solve is, how can we affect that access? How can we improve health equity?” Ms. Hines said. “How can we make sure that when we deploy technology, we are closing gaps and we’re not widening them for this particular population?”
Whether the conversation is about AI, EHR optimization or access tools, every decision is made around people, the clinicians delivering care and the patients receiving it. That guidepost shapes how she views the AI opportunity at Valleywise. Ms. Hines is not skeptical of AI’s potential, but she is wary of a pattern she has seen across the industry that is particularly harmful for health systems with few financial resources.
“In the past with some tools, it’s been kind of a layering on of new technology on the old process,” she said. “We’ve gotten stale in a couple of areas, I think. But with the capabilities of AI, it is a completely new frontier. We’re able to do some things that we’ve not been able to do before.”
How well the healthcare industry structures the environment around that frontier in coverage policy, legal frameworks and legislation will shape how far the technology can actually go.
“I’m super interested in how we are going to not evolve what we’ve done, but really revolutionize how we are delivering care,” Ms. Hines said.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.