Building resiliency and driving growth in a challenging financial environment

Health systems and hospitals are grappling with unprecedented levels of uncertainty. Reimbursement challenges, rapidly shifting regulatory requirements, and rising costs are driving innovation at many healthcare organizations in the name of financial sustainability.

During an April 2025 roundtable with the Healthcare Financial Management Association (HFMA), leaders from Guidehouse and four health systems shared insights on how healthcare organizations can build resiliency and drive growth in the current financial environment. The conversation highlighted several key strategies and initiatives that their organizations are implementing to navigate financial and operational challenges.

Participants included:

• Stephen Forney, MBA, FHFMA, CPA, FACHE, Senior Vice President and CFO, Covenant Health, Tewksbury, Mass.
• Tim Kinney, Partner and Payer/Provider Leader, Guidehouse
• Harold Mueller, MHA, MBA, Senior Vice President and Chief Revenue Officer, BJC Health System, St. Louis
• Mary Beth Remorenko, Vice President, Revenue Cycle Operations, Mass General Brigham, Somerville, Mass.
• Katie Willis, Senior Director, Patient Access, Maine Health, Scarsborough, Maine

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Sevent-five percent of healthcare providers have increased their digital and IT budgets over the past few years, with 1 in 5 citing increases of more than 30%, according to a Guidehouse analysis of an HFMA survey. Many of these investments are aimed at enhancing patient and provider experiences while reducing costs.

Doubling down on outsourcing

Some organizations have initiated new or expanded relationships with outsourcing partners—a strategic move to improve efficiency and manage costs.

“Our revenue cycle improvements have driven about $20 million a year in net revenue lift against an initial base of around $580 million, without increasing costs,” said Stephen Forney, Senior Vice President and CFO at Covenant Health. “We doubled down on outsourcing and outsourced our entire IT function, and we’re projecting it’s going to save us about $70 million over 10 years. Our quality levels, first-call pickups, first-call resolutions, and the ability to respond to crisis went through the roof.”

Optimizing technology investments

Several of the executives featured in the roundtable spoke to the importance of and optimizing their EHR implementations to increase efficiency, improve the patient experience, and cut down on denials by improving data accuracy.

“From a patient access perspective, we have spent a great deal of time enhancing the patient’s digital experience,” said Katie Willis, Senior Director of Patient Access at MaineHealth. “We’ve been optimizing MyChart® eCheck-In. Over the last several years, we rolled out several enhancements — really reviewing the data elements that we collect during this process, the way in which that flows into Epic® [and] collecting consents…as well as turning on copay collections in MyChart.”

Improving clinical documentation

Similarly, participants in the roundtable pointed to clinical documentation improvement (CDI) as an area where improvements drove additional revenue or expanded margins.

“CDI has been an area of major focus over the last few years, and it was a project that involved several different areas,” said Mary Beth Remorenko, Vice President, Revenue Cycle Operations at Mass General Bigham. “Part of it was structural. A theme for us at MGB is operating more like a system rather than a group of individual organizations or hospitals. We also have three different tools that we’re using for decision support [that are] facilitating and augmenting what the providers are doing.”

“We went down the CDI route as well,” said Harold Mueller, Senior Vice President and Chief Revenue Officer at BJC Health System in St. Louis. “We had put in some technologies, centralized a CDI team, and saw a significant increase in our major complication or comorbidity and comorbid complicating conditions capture rates driving higher DRGs. We saw about a $20 million dollar lift the first 18 months in revenue, which was great.”

Bolstering success in Medicare Advantage

Looking toward the future, leaders pointed to Medicare Advantage plans as a key area where providers need to scrutinize the risks and advantages, working closely with payers and other partners to make the margins work.

“We need to crack the Medicare Advantage nut and we’re seeing some organizations go on the offensive,” said Tim Kinney, Guidehouse Partner and Payer/Provider Practice Leader. “We know we have to be very calculated when we do a termination, but can that termination drive some concessions?”