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AI That Pays: Lessons from Revenue Cycle โ€” Nathan Wan, Ensemble Health
AI Engineerยท 2025-07-24 16:15
Healthcare Industry Challenges - 40% of hospitals operate at a negative margin due to broken revenue cycle processes [1] - Healthcare administration has increased 30-fold in the past three decades, while clinicians have barely doubled, indicating growing complexity [11][12] - 20% of the GDP is attributed to the healthcare system, with a large proportion being the administration of healthcare [9] Revenue Cycle Management (RCM) & AI Opportunity - Revenue cycle management (RCM) refers to the financial process of the patient's journey within the healthcare system [3] - AI has a big opportunity to shift resources from bureaucracy towards clinical care by addressing inefficiencies in RCM [16] - Ensemble Health Partners estimates a large amount of the cost associated with healthcare is related to friction in communication between payers, providers, and patients [14] Ensemble Health Partners' Approach - Ensemble Health Partners is an end-to-end RCM organization with 14,000 employees, providing a unique lens into inefficiencies throughout the entire process [2][3] - Ensemble Health Partners uses its EIQ platform to bring together multiple data formats within a single platform to address the challenges of unstructured data scattered across systems [33][34] - Ensemble Health Partners has seen a 40% reduction in time in the clinical appeal process by using GenAI [30] - Ensemble Health Partners aims to build a smarter, more coordinated system to reduce waste in the overall revenue cycle process [37]