Revenue cycle transformation has long been framed as a matter of technological advances. But in the AI-fueled era, the differentiator is shifting from individual technologies to enterprise operating model redesign, according to leaders from Mayo Clinic and Jefferson Health.
They described how their organizations are repositioning revenue cycle as a core component of care delivery, with AI serving as an accelerant rather than a strategy itself, during the panel session “Smarter RCM, Better Care for Patients” at digital healthcare conference ViVE.
“We’re entering a really important time where we start thinking about the work chart and not just the org chart for organizations,” said Patricia Henwood, MD, chief clinical officer and executive vice president at Jefferson Health in Philadelphia.
“For revenue cycle leaders that means mapping how work actually moves across the enterprise — from scheduling and authorization through coding, billing and payment — and then aligning decision rights and performance metrics accordingly,” she said. “It also requires an iterative approach in which workflows and technology evolve together rather than a traditional large-scale system deployment.”
The shift requires new organizational capabilities, including clear decision rights, cross-functional accountability and an operating model designed for continuous change.
Henwood describes such an approach as operationally complex, given the many decisions needed within each process, which likely have evolved naturally over the years, and that silos often exist between revenue cycle and care delivery processes.
The health system is redesigning the RCM processes as part of a sociotechnical transformation rather than a software implementation, said Henwood. She noted: In that model, AI enables scale — but only after workflows, roles and decision rights are redesigned.
“You have to be considering the people, the process and the technology,” she said. “If you think only AI technology is going to be the solution, you’re wrong.”
Enterprise redesign requires governance discipline
That kind of enterprise RCM redesign depends on governance. For Rochester, Minnesota-based Mayo Clinic that has become an early priority, according to panelist Maneesh Goyal, COO.
Revenue cycle processes are increasingly interconnected, linking access, clinical operations, patient experience and workforce efficiency. The number of stakeholders demands a more systematic approach to improvement, he notes.
“Revenue cycle is not a singular thing,” Goyal said. “We treat it that way. But it’s not a singular thing. The way it plugs into day-to-day decision-making goes down into the individual departments and subspecialties across the organization. And so, you must implement change in a way that is both broad and respects the individual nuances of each area affected. And I think that sometimes gets lost when you try to paint (large-scale workflow redesign) with a broad brush.”
Strong governance can help drive a culture of high reliability, integrity and decision agility while also supporting complex change management and enabling the right customizations.
The road to revenue cycle workflow changes and AI adoption
This governance work is closely tied to another major shift discussed by the panel: moving revenue cycle performance upstream. Providers increasingly are preventing avoidable downstream work, embedding financial clearance processes earlier in the care journey and connecting front-end processes to mid-cycle and back-end performance.
