HFMA 2025 Recap, Part 3: Holistic Transformation in Healthcare Finance & Revenue Operations
Post by
Seth Pfaltzgraff
A common theme across each day and session of the HFMA 2025 Annual Conference was bringing attention to long-term sustainability through integrated financial and operational transformation. The message was clear for revenue cycle management experts—tactical improvements are no longer enough. The future belongs to systems that redesign how they work.
This is the third and final part of my HFMA 2025 Recap series, where I explore critical themes that were addressed during the conference, as well as the advice I am passing on to my Healthcare Provider Revenue Cycle Management clients. Did you miss the first two articles? Check them out here:
Want to continue the discussion? Schedule a chat with Seth.
Finance as a Driver of Strategic Change
Jonathan Ma (CFO, Sutter Health) and Mike Nugent (Guidehouse) outlined how finance teams are moving beyond traditional budgeting to enable strategic decision-making. At Sutter Health’s session Finance’s Role in Strategic, Financial & Operational Transformation, Ma expressed the need to link operations and finance; applying Generative AI to identify cost-saving opportunities, forecasting demand to improve resource planning, and rethinking core processes like staffing, scheduling, and supply management.
These efforts are tied to real results: reduced write-offs, improved net revenue, and a more agile approach to managing labor and capital in a volatile environment.
The RCMTAM: A Technology Adoption Roadmap
At UC San Diego Health’s session, Connecting RCM Technology Adoption and Modernization Patterns to Financial Performance, they shared their experience implementing the Revenue Cycle Management Technology Adoption Model (RCMTAM) The takeaway: digital maturity is highly correlated with better financial performance.
Organizations at the highest adoption levels saw substantial improvements across KPIs:
- 21% reduction in denial rates
- 31% reduction in cost to collect
- 8% drop in AR days
- 48% decrease in accounts over 90 days
By adopting the model, UCSD Health improved their clean claim rate from 93% to 97.6% and increased POS collections by over $2 million in one year. For other systems, RCMTAM offers a structured path forward, prioritizing technologies that deliver impact and guiding investment decisions.
Denials Prevention Requires Cross-Functional Change
During Proactive Denials Management: Breaking Down Silos and Enhancing Revenue Cycle Performance, Kearstin Jorgenson and Sathya Vijayakumar at Intermountain Health provided a clear example of denial volume growth, from 36,000 to over 180,000 denials in just five years. Their solution: a custom Financial Impact Tracker that unifies multiple stakeholders, automates key workflows, and tracks appeal activity across physician advisors, coding, and case management.
The goal wasn’t just workflow visibility; it was performance visibility. By measuring the financial value of interventions, Intermountain was able to scale peer-to-peer reviews, reduce manual tracking time, and improve recovery.
Their experience reinforced a consistent theme: denials prevention isn’t a billing function but instead, it is a collaborative, system-wide initiative that benefits from real-time data, well-defined processes, and targeted automation.
My Takeaways: Transform for Sustainability, Not Just Efficiency
- Position Finance as a Strategic Partner: Finance should be embedded in transformation—not just reporting on it. Equip operational leaders with timely, actionable data to drive smarter resource use and strategic planning.
- Use Technology Frameworks to Guide Adoption: Tools like RCMTAM help avoid fragmented solutions by providing a roadmap based on peer benchmarks and proven outcomes. Use them to focus tech investments where ROI is highest.
- Break Silos to Manage Denials Upstream: Build cross-functional teams that include clinicians, coders, and revenue leaders to target the true root causes of denials. Automate tracking but keep humans in the loop for high-impact appeals.
- Embed Intelligence Into Core Workflows: Predictive models can surface issues before they cause revenue loss—such as likely denials or payer-specific flags. Use AI to prioritize work queues and provide actionable insights.
- Invest in Change Management and Upskilling: As automation expands, workforce development must keep pace. Equip employees for the transition with training and communicate clearly about the evolving roles technology will support - not replace.
True transformation requires more than isolated technology wins; it demands an integrated approach across finance, operations, and revenue cycle. Organizations that elevate finance to a strategic partner, follow structured roadmaps like RCMTAM, and embed intelligence across the revenue cycle are showing measurable gains. The providers who succeed over the next decade will be those that treat transformation as a continuous, organization-wide commitment instead of a one-time initiative.
Want to continue the discussion? Schedule a chat with Seth.