Charting the Unknown: Reflections on the “Frontier of Health” from HFMA 2024

The term “frontier” is potent. For some, it inspires optimism. Envision an explorer on a mountain, looking at a brilliant sunrise, surrounded by crisp air, and feeling content. For others, it evokes fear—a dark, disorienting abyss. But regardless of the emotion it stirs, “frontier” compels movement, pushing us toward future adventures.

At the HFMA Annual Conference 2024 in sunny Las Vegas, “frontier” was this year’s passionate theme. HFMA described the healthcare finance industry as “a new frontier of health.” This mantra served as a catalyst for change and a call for action—blending manifest destiny with carpe diem for an industry ripe for transformation.

During Monday’s opening general session, Ann Jordan, J.D., President and CEO of HFMA, shared three essential qualities to become a healthcare frontierist. Jordan encouraged thousands of finance and revenue cycle professionals to celebrate, reflect, and aspire as they redefine what’s possible across the healthcare ecosystem.

AI, preventive care, health equity, financial sustainability, and modern learning experiences were all identified as new aspirations for attendees to pursue. Jordan’s presentation was followed by comments by Richard Pollak, President and CEO of the American Hospital Association (AHA), who received HFMA’s Richard L. Clark Board of Directors Award honoring his 40 years of executive leadership at the AHA.

For a first-time attendee, the conference left a profound impression. I navigated my own frontier, discovering innovations within this “uncharted territory” and learning about ambitious projects to address what reminded me of the fundamental levels of the healthcare “hierarchy of needs” pyramid.

Maslow’s Hierarchy of Needs highlights the foundational physiological needs: food, water, shelter, clothing, and sleep. These must be met before any higher-level experiences leading to self-actualization can occur. In healthcare, this underscores the importance of “social determinants of health,” factors that influence the best possible healthcare outcomes.

However, the financial side of healthcare has its own hierarchy of needs. Here are four new ways these needs were addressed by pioneers attending the HFMA Annual Conference 2024.

MRO is one of several companies working to build new bridges of trust between payers and providers through more secure and efficient data exchange. MRO hosted a private roundtable dedicated to the nascent trend of providers granting payer access to EHR data.

Amid rising rates of payer denials, the roundtable identified new opportunities to reduce administrative burdens and expedite revenue cycle processes through better payer connections. However, roundtable attendees agreed that risks remain and payers should provide commensurate benefits in return for EHR access.

Electronic exchange of health information with payers will also support providers as they address CMS’s new expedited prior authorization rule effective January 1, 2027. The sense of urgency for both payers and providers became clear in my conversation with Todd Doze, CEO, Janus Health.

Doze shared how AI is already helping revenue cycle teams navigate payer portals to check prior authorization status, expedite communications, and prevent denials. “Logging in and searching multiple payer portals is just one of the many time-consuming workflows still plaguing revenue cycle teams,” said Doze. According to Janus Health, some revenue cycle teams already save eight minutes per engagement and reclaim thousands of hours annually by automating the prior authorization process.

However, one question remains to be answered. Will revenue cycle automation address healthcare affordability?

Affordability is another step in the hierarchy of healthcare needs, one that extends beyond patients paying their bills on time. Achieving affordability calls for health systems to consistently provide necessary services, payers to continually afford reimbursements, and most important, patients to afford insurance for their care.

For health systems, the challenge of improving measures on administrative burden can begin by addressing administrative cost. According to KFF research, in 2022 administrative expenses in healthcare account for approximately 15% to 30% of total healthcare spending, costing our nation between $735 billion to $1.4 trillion annually.

Matt Gattuso, Managing Partner of Healthcare and Life Sciences at LogicSource, a nonclinical procurement services and technology company, shared that “an average five-hospital to eight-hospital health system could see 7% to 15% savings across their total nonclinical expense base” by addressing only the nonclinical services. Furthermore, dynamic technologies such as AI contribute to solving the affordability conundrum by making revenue cycle teams more productive and workflows more efficient. Through technology-driven efficiency and innovation, this administrative cost burden may be cut in half.

While nearly every vendor in the exhibit hall claimed to have “the answer” to reducing administrative burdens through automation, no one size fits all. And, health systems will prioritize different use cases and no single company has the solution for every type of healthcare provider organization.

Mike Vigo, Chief Revenue Officer at University of California San Diego (UCSD), reiterated that point during his speaking session with Jeff Becker, Vice President Portfolio Marketing at FinThrive. The duo presented the industry’s first Revenue Cycle Management Technology Adoption Model (RCMTAM).

Like the HIMSS EMRAM adoption model, the vendor-agnostic benchmarking assessment is available at no charge for hospitals and health systems to measure their progress in revenue cycle technology adoption, including AI. Vigo affirmed that the tool is a “source of truth” for his team. RCMTAM is Vigo’s scorecard to identify functions that are performing well and where improvements are needed.

Vigo predicts the use of RCMTAM, and other modeling tools, are mission-critical innovations to guide automation priorities and investments in the healthcare revenue cycle. Support of these adoption models by health IT managed services firms, such as CereCore, will certainly help. Prior to the conference, the firm announced a strategic partnership with FinThrive to deploy RCMTAM.

For the industry to reach its ideal potential, the needs of all stakeholders must be met. AI transcends the hierarchy of needs, serving stakeholders now and in the future, often without human intervention. However, all healthcare organizations as well as patients should be part of the transformative journey.

TruBridge, one of the leading sponsors of the conference, met with attendees about the new Trustworthy & Responsible AI Network (TRAIN). The network includes 16 leading health systems, Microsoft, OCHIN, and TruBridge. The company serves as the voice of rural hospitals in the TRAIN initiative to ensure small, community hospitals are not left behind throughout the advancement of AI. As the network grows, TruBridge continues to provide industry updates with a focus on rural providers and the impact of AI on their organizations.

For example, Laura Osbourne, Sr. Director Revenue Cycle Solutions at TruBridge, is a staunch advocate for Tribal Health organizations serving underserved Native American communities. During our conversation, Laura shared three specific “new frontier” aspirations for Tribal Health:

• The use of AI technology to meet staffing challenges
• Expanded access to specialist care—especially behavioral health
• Community education to increase Medicaid enrollments

It was clear at HFMA that the frontier of healthcare finance in 2024 is an uncharted, blank map ready to be filled with remarkable detail, inspiring stories, and unimaginable utilization. As explorers, we must rely on our accumulated wisdom, remain humble about what we don’t know, and stay curious about what lies ahead. With this adventurous spirit, we will embrace the challenges ahead with maturity, creating some of the biggest opportunities of our time to improve the human experience. Because with health, we have everything.