AI is often positioned as a strategic imperative for revenue cycle efficiency, accuracy and sustainability. But translating AI from buzzword to operational backbone remains a steep climb in revenue cycle management.
Beyond being complex, healthcare’s revenue cycle is notoriously fragmented. Essential functions like prior authorizations, coding and payment posting are often siloed and managed through a patchwork of manual workflows and disconnected vendors. This fragmentation results in data friction, duplicative work and lost insights.
“AI is proving what we’ve always known — managing the revenue cycle as a system, not silos, is the only way to unlock value and truly resolve the root cause of administrative friction,” said Judson Ivy, founder and CEO of Ensemble, which manages revenue cycle operations for more than 300 facilities across the country. “That’s why we’re taking an enterprise approach to AI and unifying the revenue cycle with a horizontally integrated agentic platform.”
Building for scale
An agentic AI network depends on connected, contextualized data. Fragmented infrastructure and data-readiness challenges make it difficult for many health systems to advance AI initiatives beyond pilot phases.
“Supporting AI at scale takes significant data storage capacity, processing power and engineering resources. Many healthcare organizations are quickly realizing they aren’t equipped to meet these data demands,” Grant Veazey, Ensemble’s chief technology officer, said.
Mr. Veazey added that once a data foundation is established, mapping relationships across models is an important but often tedious step due to the sheer volume of data points spanning EMRs, payer portals, clearinghouses and bank transactions.
“The idea of building and training AI agents to optimize revenue cycle operations ourselves was daunting,” Mark Nantz, president and CEO of Winchester, Va.-based Valley Health, said. “Ensemble has eliminated that burden for us entirely. Their system is trained on their proven processes and delivering results we know we can count on.”
Valley Health’s partnership with Ensemble to operate the system’s revenue cycle has enabled the organization to benefit from AI-powered performance without the complexity of model development and training.
AI in action
Ensemble recently announced a strategic partnership with Cohere, the leader in security-first enterprise AI. Together, they’re launching an integrated network of agentic AI capabilities to support end-to-end revenue cycle operations, marking healthcare’s first deployment of Cohere’s secure agentic platform, North.
The first network of agents is designed to manage one of the most complex and fragmented challenges in healthcare — insurance reimbursement. The agents autonomously reason through data patterns, evaluate context, make informed decisions and activate other AI solutions across Ensemble’s ecosystem to successfully resolve accounts.
“Working with Ensemble to bring secure AI into healthcare — where data privacy is a deeply personal issue — is an incredible opportunity. Their industry leadership, data foundation, and forward-thinking approach make them an ideal partner to enter the industry,” said Ivan Zhang, Co-Founder of Cohere. “By working together, we’re setting a new standard for tackling some of healthcare’s toughest administrative challenges, and showing how agentic AI makes a real-world difference.”
Ensemble’s agentic platform is designed to orchestrate its growing suite of AI-powered solutions, including clinically trained generative AI to enhance denial appeals, conversational AI to improve patient engagement, predictive models to prevent denials and agent assistants to support front-line staff.
Together, these solutions are already delivering significant results, including accelerating denial appeals by 40% and improving overturn rates by 15%. Ensemble has also deployed integrated AI solutions to improve patient communications and strengthen customer service, helping patients resolve inbound calls 35% faster than before and improving overall patient satisfaction.
Current pilots involve deploying integrated omni-agents to manage other complex processes, including authorization management, utilization management, coding and denial prevention. These efforts reflect Ensemble’s enterprise-scale approach to AI — with all solutions being designed to communicate and collaborate through Ensemble’s infrastructure. Its orchestrated AI agents embedded throughout the revenue cycle can connect fragmented workflows, streamline operations and enable data-informed decision-making.
“We’re looking at real gains in payment accuracy, reduced administrative burden and stronger financial outcomes — freeing our teams to focus more fully on patient care,” Billie Jean Mounts, chief revenue officer at Cincinnati-based Bon Secours Mercy Health, said. “This is what the future of revenue cycle looks like — smarter, faster and more connected.”
