You can’t build the hospital of the future on a billing model designed for the past

HFMA’s “Hospital of the Future” report lays out a compelling vision: digital-first care, AI-enabled workflows and PwC’s projection that within 10 years $1 trillion will have been redirected from administrative waste toward next-generation care. The leaders quoted are right that hospitals are at a crossroads. They’re right that the platform model is gaining ground. They’re right that curiosity and storytelling matter.   

But one topic deserves more airtime in the conversation: the patient financial experience.  

The hospital of the future will be defined not just by how it delivers care, but also by how it gets paid for it. And increasingly, who pays.  

The financial experience most health systems invested in was built for a specific kind of patient: continuously insured, financially stable, comfortable navigating a portal. That patient still exists. But across Cedar’s platform, only 28% of patient dollars now resolve cleanly. The other 72% — patients cycling in and out of Medicaid, patients with commercial coverage and no financial cushion underneath it, and patients with no coverage at all (now nearly 40% of collectible dollars, up 54% in three years) — require specialized strategies the existing workflow was never designed to handle.   

And it only gets harder. When OBBBA’s Medicaid cuts take effect and expired enhanced ACA subsidies ripple through the system, it is widely projected that more than 10 million patients will lose coverage over the next 10 years — the same horizon that leaders in this research were asked to imagine.  

The care side is asking the right questions: What does this patient need, and how do we respond before they disengage? The financial side is still mostly asking: Did the statement go out on time?  

That gap has consequences. Patients have already moved on. According to Cedar’s research, half of patients are using AI tools like ChatGPT to interpret their bills, not because they prefer it, but because the system has not given them a better option. AI is already becoming part of the billing journey. Providers can either shape that experience directly or watch patients piece it together on their own.  

Building the hospital of the future requires the same precision on the financial side that the care model is developing on the clinical side. A uniform billing experience applied to a non-uniform patient population is a mission problem as much as it is revenue cycle problem.  

The care model is being redesigned for patients as they actually exist. The financial model has to follow.

Learn more about how hospitals need to redesign financial workflows for a better patient experience in HFMA’s The Hospital of the Future Part I report.