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Healthcare Finance Trends for 2024 – Progress, but Major Challenges Ahead

During 2023, healthcare systems, hospitals, and practices made progress rebounding from the pandemic’s many disruptions. While 2024 should see continuation of the positive momentum, significant headwinds remain on the path to further improvement, growth and innovation. Most leaders are adopting a cautious stance.

Healthcare Finance Trends for 2024 (Trends Report) by CommerceHealthcare® presents the bank’s annual outlook on major factors commanding leadership attention. The trends identified reflect analysis of a broad spectrum of industry data and perspectives. This year’s report explores ten themes in four focal areas:

  • Financial. Financial challenges will impact all decision-making, as will workforce shortages and the need to pursue top-line growth alongside cost control.
  • Patient financial experience. Many will elevate their efforts to make the overall patient financial experience less fragmented, more streamlined and fully responsive. Healthcare affordability poses risks to the financial health of organizations and will stimulate growth in patient financing programs.
  • Automation and Technology. Finance and revenue cycle management (RCM) processes represent attractive automation targets, prompting growing investment. Technology to further digital transformation will also be a priority — with integration, cybersecurity, and artificial intelligence in the forefront. And four perspectives are explored on today’s digital payments landscape.
  • Collaboration and Trust. Strategic success rests on the twin leadership pillars of meaningful collaboration and trust among all constituencies.

It is a full and complex set of considerations for healthcare leaders to address.

Integration, Cybersecurity, Artificial Intelligence Headline 2024 Technology Investment

An important starting point is technology, which remains at the heart of provider strategies and influences all of the trends in this report. Technology is a top-three priority for 56% of providers, and 75% plan spending growth in the next twelve months.1 Consistent with the cautious investment stance described earlier, budgets will see 2024 increases characterized as “minor” or “moderate” (Figure 1).2

How is your digital and IT budget expected to change in 2024 compared to 2023?
View PDF of Figure 1[PDF]

Organizations are foregrounding three information technologies among many in 2024.

Robust system integration

CommerceHealthcare® sees its clients seeking a flexible payments platform centered on electronic health records (EHR) and integrating various systems to streamline and improve processes for all users. This growing platform trend is accompanied by a clear drive to IT simplification. Observers perceive a “shift from purchasing multiple bolt-on and modular applications to selecting a single, comprehensive vendor.”3 Though single-vendor models are elusive, the opportunity to streamline is substantial, as evidenced by survey results showing that 55% of organizations rely on over 50 solutions to run healthcare operations.4

Cybersecurity

The 2023 Trends Report characterized the healthcare cybersecurity predicament as “no rest for the weary.” Little relief is in sight for 2024. In a recent survey of healthcare IT and security practitioners, over half of the respondents said they suffered a ransomware attack during the most recent twelve-month period, with 40% paying the ransom and 68% experiencing a disruption to patient care.5 Another poll revealed that 78% of respondents had at least one security incident over the past year spanning asset types such as IT systems, medical devices and building management systems.6 Fifteen percent of them cited a severe care delivery impact that “compromised patient health or safety.”

Healthcare continues to rank as the top industry for data breach costs, which have increased more than 50% over the past three years and averaged just under $11 million for each incident in 2023.7 Analysts consistently identify the four chief vulnerabilities as cloud compromise, business email compromise, supply chain, and ransomware. Shoring up cybersecurity infrastructure was cited as a top priority for 55% of surveyed providers.8

Artificial Intelligence (AI)

Almost one-third of leaders recently named AI and machine learning as the biggest current topic in healthcare technology.9 Heightened visibility has come from the introduction of “generative AI.” This variation can produce complete reports, images and other creative output from straightforward prompts and inquiries. According to one study, almost 50% of healthcare systems are developing a generative AI strategy.10

What uses are contemplated for AI in healthcare? Gartner’s Opportunity Radar is a helpful framework to assess the breadth of applications that can be identified (Figure 2).11

AI opportunity radar, external customer-facing, everyday AI, game-changing AI, internal operations
View PDF of Figure 2[PDF]

Finance and RCM uses are already emerging. Great potential for AI success is seen in prior authorization, analyzing accounts receivable, remittance management and many others.

Moody’s cautions that AI brings various investment risks. Developing successful applications will be expensive and may siphon funds from other priority IT projects. AI’s fast-changing nature could quickly obsolete some applications. The industry also risks creating a “race for hospitals to keep up with AI investments” that could “widen the gap” in market strength between those who succeed and those who do not.12

Difficult Financial Pressures and Conditions Frame 2024 Actions

As in 2023, financial struggles will prevail and cost control will be a dominant strategy. Decision-making will be framed by a host of financial considerations.

  • Profitability/Margins. Positive developments yielded a median hospital margin index of 1.2% through October 2023.13 That is slim, relative to traditional 3–5% average levels. Improvement will be an uphill climb as “longer-term industry dynamics continue to suggest protracted margin compression.”14
  • Volume: Through October 2023, discharges, emergency room visits and operating room minutes had each increased between 3% and 4% on a per-calendar-day basis over 2022.15 This recovery still left 44% of healthcare systems behind their pre-pandemic inpatient volumes.16 Academic healthcare systems are faring better than non-academic peers by a median inpatient occupancy rate differential of 70% to 53%.17 Moody’s sees another “modest rebound” in patient volumes in 2024.18
  • Cash: Cash flow has been negatively impacted throughout 2023 by well-publicized delays and denials in authorization from payers. Initial commercial insurance inpatient claims hit a denial rate over 3% early in the year, and nearly one-third took more than three months to be paid.19 Half of hospitals and healthcare systems reported $100 million in receivables for claims over 6 months old.20 The cash impact is clear: Median healthcare system days-cash-on-hand decreased 28% between January 2022 and June 2023, from 173 to 124 days.21 For 2024, Moody’s projects that median operating cash flow margins will increase 100 basis points to 7%.22
  • Debt/Credit: Almost one-quarter of hospitals encountered debt covenant challenges during the past 12 months.23 Impaired hospital municipal bonds have reached $12 billion in aggregate.24
  • Length of stay. From patients with more complex health problems, to workforce shortages, to delays placing discharged patients in post-acute facilities, multiple factors are driving up length of stay numbers. This trajectory will lead to a 6% increase in average length of stay over the next ten years.25

Healthcare reimbursement trends present a longer-run economic threat. Commercial insurance is being “hollowed out” as employers face a “benefits cliff.”26 Their average costs will increase 8.5% in 2024.27 Contribution to family health plan premiums has risen 19% from 2018–2023.28 Employers are exerting pressure on insurers and providers to restrain these costs, foretelling reimbursement cuts that will narrow the traditional premium that providers have relied on to balance their lower-margin Medicare business.

This financial landscape will be a difficult one to traverse. Two rating agencies have issued negative or deteriorating outlooks for 2024 for the non-profit hospital sector.

Workforce Shortages Maintain Hold on Leadership Attention

“Labordemic” is the term Fitch Ratings has coined to describe pervasive 2024 staffing shortages.29 A myriad of operational stresses created by these shortages guarantee that workforce management will be top of mind again in 2024.

Shortages span the workforce

Several statistics portray the extent of the crisis. Nursing continues to suffer persistent shortfalls. Annual national turnover has been calculated at 23%, and the vacancy rate recently stood at nearly 16%.30 Almost 90% of nurses regard current shortages as worse than five years ago, while 80% expect the situation to worsen further over the next five years.31

Finding and retaining RCM/finance staff is problematic as well. In a recent study, 80% of respondents said their turnover in RCM functions is between 11–40%, another 8% reported 41–60% turnover, while 73% cited “finding qualified staff” as a major challenge.32 Filling senior-level RCM vacancies takes an average of 207 days, and mid-level openings require 153 days.33

Ramifications and solutions

The fallout from the labor shortages is serious and extensive, impacting care, costs, workforce disengagement, and more. (Figure 3).

Consequences of staffing shortages
View PDF of Figure 3[PDF]

The competitive market has caused rising compensation. Healthcare systems, hospitals, and practices reduced use of expensive temporary/contingent labor in 2023. However, the ongoing staffing challenges make this strategy difficult. Some see potential market separation into those who can control costs by attracting and retaining permanent talent and those who have difficulty doing so and will continue to absorb high temporary labor expenses.34

Another solution is stepped-up retention and recruitment. For example, a survey of larger medical groups determined that 88% are offering referral bonuses, 78% sign-on bonuses, and 56% benefits changes.35

A note on remote work

The competitive labor situation has kept the remote work option a viable one in RCM. Asked about technology priorities, 39% of surveyed healthcare CFOs and finance executives said they are investing in solutions that foster “high productivity and data access for remote employees and creating collaborative spaces essential to implementing a flexible workplace approach.”36

Growth Strategies: An Imperative for Near-Term Financial Health and Long-Term Success

Top-line growth is an important path to improved profitability and a necessity for long-term success. Indeed, 49% of surveyed healthcare executives regard growth as their top challenge.37 Among many strategies, four principal growth avenues are being widely followed.

Outpatient Services

It is hardly a new story that care delivery continues to shift steadily from inpatient to outpatient settings. Forecasted volume growth is 16% between 2023 and 2033, compared to just 2% for inpatient, and ambulatory surgeries are expected to grow 18%.38 Particularly robust outpatient expansion is seen in behavioral health, cardiovascular, and neurosciences service lines.39

Telehealth

Virtual care appears to be maintaining the momentum it established in many specialties over the past few years. Encounters are projected to increase 28% over the next decade.40 Telehealth enjoys support from patients and clinicians alike:

  • 83% of patients plan to maintain or increase usage.
  • 54% said their experience has increased satisfaction with their overall care.
  • 88% of physicians agree that telehealth improves patient access and 41% have used it to expand their community and referral networks.41

Home Care

A broad array of health services are now provided in the home. While some systems have scaled back traditional home health activities, many see promise in the budding Hospital-at-Home (HaH) movement. HaH enables remote caregivers to perform selected acute care functions in the patient’s home using current and emerging enabling technologies in remote monitoring, high-speed networks and algorithmic guidance from artificial intelligence. Growth is expected, given that 26% of healthcare systems that are capable of developing a program have fully implemented one.42

Mergers and Acquisitions (M&A)

Mergers are a time-tested expansion strategy. The third quarter of 2023 saw increased transaction levels relative to both 2021 and 2022. The 2023 deals exhibited several trends43:

  • Financial distress was the seller’s lead motivator in 39% of the transactions, especially for healthcare systems in the $250 million to $750 million revenue range.
  • Academic centers acquired community hospitals to “relieve some of the occupancy pressures at the academic flagship” and open “expanded opportunities for residency programs, clinical research trials, and patient access to tertiary and quaternary services.”
  • Several acquirers took minority stakes in healthcare systems rather than full takeovers.

In a mid-2023 survey, 75% of respondents expected M&A activity in the coming 12- to 18-month time frame, and 65% will increase activity over the next three years.44 CFOs cite the primary drivers as new market expansion (28%), increased market share (25%), and enhanced product/service offerings (18%).45

Taking Patient Financial Experience to the Next Level

Providers have for some time devoted significant effort to improving the overall patient financial experience. They aim to make their processes less fragmented, more streamlined and fully responsive to patient needs. This year is expected to bring a concerted push by many to elevate their game.

Consumers are clearly demanding better experiences. Unfortunately, their expectations are not being fully met:

  • 26% of patients feel their payment experience has worsened over the past year.46
  • 65% did not receive a pre-service estimate, and 40% might cancel or postpone procedures as a result.47
  • 60% who receive an inaccurate estimate or bill would prefer to switch providers.48

Healthcare system leaders are also dissatisfied with the patient financial experience they offer and cite a daunting range of roadblocks impeding improvements, starting with the need for greater automation (Figure 4).49

Barriers preventing investment in the patient financial experience | % of executives that selected rank
View PDF of Figure 4[PDF]

A consensus is forming that success requires more comprehensive strategies that span the patient journey. As one report puts it, “Without a holistic, unified strategy and high-quality services, the patient financial experience will remain fragmented and continue to disappoint consumer expectations.”50

An optimally unified approach includes integration of patient insurance information to permit accurate estimates and appropriate financing options automatically presented to the patient. Post-service integration is aided by technology-enabled refund management that speeds payment. Patient refunds totaled an estimated $3.1 billion in 2022.51 To achieve the holistic strategy, leading healthcare systems are seeking to partner with a set of reliable, full-service financial partners.

Persistent Affordability Issues Fueling Patient Financing Expansion

For many patients, an integral element of a positive financial experience is help paying for their care. Healthcare affordability is a persistent problem that poses risks to organizations’ financial wellbeing and patient access goals.

Concern over out-of-pocket care expenses regularly tops survey rankings (Figure 5). In a Harris poll, 26% of Americans said healthcare costs strain their finances, and 23% stated insurance fails to cover their care.52 Middle income respondents ($30,000 – $100,000) placed healthcare outlays at the head of their list of financial worries (35%), topping inflation (32%) and household expenses (27%).53

Which healthcare issues are most important to you? (Top 3)
View PDF of Figure 5[PDF]

Various analyses provide quantification:

  • Employee contribution to family-level health insurance coverage averaged $6,575 in 2023, up 19% since 2018. The percentage of employees in High Deductible Health Plans that impose a single-person deductible of at least $2,000 now stands at 31%.54
  • Those working for smaller firms are vulnerable. Only half of companies in the 3–49 employee range offer health benefits.55
  • Patient spending is poised to continue its seemingly inexorable upward march, growing 10% annually through 2028.56

Over the past several years, seniors who rely on Medicare have turned to Medicare Advantage (MA) plans to address affordability. In 2023, 51% of Medicare Parts A and B beneficiaries were enrolled in a private MA plan, and government projections see the figure reaching 62% by 2033.57 These plans fill coverage gaps in Medicare and also promote using in-network providers to reduce cost. Plans offered by Humana and United Healthcare dominate the market with close to 50% share between them. Recently, Cigna announced the sale of its MA division.

MA has become a significant point of contention between payers and many providers who feel the reimbursement rates are two low and the administrative hassles too high. As one hospital CEO put it, “A program intended to promote seamless and higher quality care has instead become a fragmented patchwork of administrative delays, denials, and frustrations.”58 Some health systems are terminating their MA contracts, which could create new turmoil and uncertainty for patients.

Even with expansion of programs like MA, patient obligation for costs remains an issue for many. Self-pay carries revenue risks for healthcare systems, hospitals, and practices. Patients may defer elective procedures or avoid care altogether due to cost, threatening to derail the industry’s recent volume improvement.

A critical solution is to meet the burgeoning demand for more patient financing options. No- and low-interest plans, as well as those covering longer durations, are needed and valued by patients. Such expansion challenges many organizations who lack the means or desire to “act like a bank.” They are increasingly turning to outside help. As they entered 2023, 61% of surveyed leaders of hospitals and group practices anticipated greater use of third parties such as banks for patient financing options over the next two years.59

Momentum Building for Greater Finance/RCM Automation and Outsourcing

Automation is a cornerstone in achieving a trio of goals: sustained cost savings, management of workforce shortages, and removal of complexity and friction from administrative processes. Finance/RCM departments represent attractive automation potential.

The opportunity is sizeable. The Council for Affordable Quality Healthcare (CAQH) annually calculates the industry cost-saving potential from moving to fully electronic administrative financial transactions. The current estimate is $22 billion (Figure 6).60 The driver is a cost differential estimated at about $5.00 for manual transactions versus $0.67 for electronic.

Medical cost savings opportunity
View PDF of Figure 6[PDF]

Despite progress, many transaction types have considerable room to automate further. Adoption of fully electronic transactions varies widely, standing at 83% for remittance advices, 75% for claims payments, 28% for prior authorizations, and 24% for attachments.

A recent focused poll of RCM executives revealed that 34% have fully automated between 10% and 25% of their operations, while 28% have automated 25% to 50%. Just over half also expressed disappointment with their current automation technology.61

Automation Investment Directions

Nearly one-third of healthcare systems plan automation of two or more RCM or finance functions in 2024, with a top focus being accounts receivable62 while 39% of CFOs anticipate increased digital investment in revenue cycle optimization.63

Three criteria are being applied to automation initiatives:

  • Return on Investment (ROI). Leaders are demanding a “hard ROI” to green-light any significant investment. They are looking to specific metrics such as cost-to-collect (C2C). A 2022 HFMA survey found that RCM automation decreased average C2C by 0.23%, which can generate meaningful dollar savings for most organizations.64
  • Technology Risk Reduction. A related standard favors “modest investments in proven technologies” as “part of a general hesitancy to support initiatives that could produce high rewards but that also require teams to fail fast and pivot quickly.”65
  • Analytics Upside. Providers want to harness automation’s potential to capture comprehensive and consistent data that yields more granular understanding of operations. A helpful step is “unifying the RCM process to remove silos,” the top improvement objective cited by 28% of respondents in a recent study.66

Outsourcing

Often deployed in tandem with automation, outsourcing of technology and services is a growing trend. One-third of CFOs and other leaders polled by HFMA indicated they have initiated or expanded relationships with outsourcing vendors in recent years for digital and IT initiatives.67 Half of RCM outsourcing firms reported that hospital clients have increased spending over the past year.68 The metrics portend further uptake:

  • 59% of hospitals over 150 beds plan greater outsourcing in non-clinical services.
  • 93% of leaders have intensified planning to employ more third-party vendors to achieve cost efficiencies.
  • The outsourcing market will experience a “dramatic increase” from $304 billion in 2022 to $650 billion in 2027.69 

Multiple Avenues for Expanded Use of Digital Payments in Healthcare

Based on the experience of other industries, healthcare is likely to expand adoption of various digital payment rails over the next 24 months. These alternative payment methods (APM) cover both business-to-business (B2B) and business-to-consumer (B2C) transactions and offer attractive benefits. Assessing digital payments from four vantage points helps leaders formulate strategies.

Variety of modes

Forecasts are healthy for several types of digital rails:

  • Automated Clearing House (ACH). Electronic bank-to-bank transactions through ACH remain popular. Healthcare experienced volume growth of 5.8% through the third quarter of 2023, continuing a multi-year record of increases.70 Same-day ACH is also rapidly gaining usage.
  • ePayables/Virtual Cards. This mode grants the Accounts Payable (AP) function an alternative to paying suppliers by check or ACH. Vendors are issued a virtual card by the provider’s partner bank, which pre-loads specific dollar amounts for single payments or deposits funds to the vendor’s account to enable ongoing use. These ePayables are used by 37% of healthcare organizations, and 59% of those who have yet to adopt say they plan to do so.71
  • Mobile payments. Mobile devices are fast becoming the preferred vehicle for a host of payments. This category encompasses contactless and tap-to-pay technologies as well as eWallets. Mobile payments are projected to experience 17% compound annual growth in transaction volume across industries through 2025.72 Use of wallets is also growing, and 61% of consumers express being very or extremely satisfied with them.73 One study revealed that 15.5% of consumers have used one to pay for healthcare services, suggesting that “providers may want to prioritize mobile wallets as a payment choice to get ahead of the digital curve.”74
  • Real Time Payments (RTP). Making payments in real time is attractive to providers as it allows them to hold onto cash longer and pay bills with precision timing. Some speculate that the Federal Reserve’s launch of the “FedNow” platform, which joins Clearing House in facilitating 24-hour instant settling and clearing of payments, may provide fresh impetus to RTP expansion.75 Surveying the current status in various business sectors shows that RTP is being used for a range of B2B and B2C payments and will see solid growth over the next several years (Figure 7).76 Gartner concurs with a prediction that over 70% of consumer payments will be account-to-account by 2028, a figure likely to weigh heavily toward RTP.77

Real-time payments use by transaction
View PDF of Figure 7[PDF]

  • Buy Now, Pay Later (BNPL). A BNPL platform lets consumers pay at the point-of-sale over several installments without interest. An estimated $50 billion of retail purchases was processed through BNPL in 2021, and substantial growth is forecasted over the next several years.78 Some providers may see BNPL as one alternative to their own direct management of smaller dollar patient payments needing financing.
  • Central Bank Digital Currency (CBDC). On the longer term horizon may be a virtual currency replacing cash and sponsored by the Federal Reserve. Unlike Bitcoin, CBDC would be a centralized system and official government currency. It is being studied in the U.S. at present with no specific introduction timelines.

Strong drivers for digital payments

Healthcare APM growth will be propelled by a confluence of forces:

  • The convenience that digital payments offer to patients and vendors
  • Uptake by younger patients who generally find such payment modes attractive
  • Cost savings for payers and providers relative to checks and other manual-intensive rails
  • Competition from digital-first retail health providers
  • Use of EHRs. Some assessments indicate that electronic payments become more accepted as patients transact through EHR portals.79
  • Improved collections and cash flow. Cashless payments provide easy ways for patients to fulfill their obligations at point-of-service.

It is important to note that there are “unbanked” patients who lack checking or savings accounts that would enable them to utilize many of these digital rails.

Productive emerging uses

One expanding beneficial use is Earned Wage Access (EWA). Systems such as PreferPay® from CommerceHealthcare® use electronic payments to allow employees “instant access to earned wages right after the work is performed, at the end of the shift, or upon completion of a project.”80 Such solutions can be applied to a wide range of B2C payments, and the bank recently supported this mode for a client needing to make daily payments to workers on strike.

EWA can bolster employee engagement and retention. Serious short-term financial concerns loom large for many employees, making on-demand wage receipt attractive (Figure 8).81

Top stress-causing financial issues
View PDF of Figure 8[PDF]

Platform innovation

CommerceHealthcare® is monitoring broader trends toward single platforms that unify the digital payment rails. A concept gaining currency is “embedded finance,” a solution set designed to “…embed financial products into a single seamless, convenient, and easy-to-use customer experience.”82 Many believe a “mobile super app” will emerge as part of this unified experience to enable consumers to manage all types of financial transactions, from healthcare to utilities to autos and more. A consumer survey saw strong preferences for a digital health platform possessing the “ability to pay all types of medical bills”(79%) and to offer financing options (72%).83 Embedded finance is projected to grow from covering $2.6 trillion of U.S. financial transactions in 2021 to $7 trillion in 2026, powered by the perceived convenience benefits for consumers and cost savings for companies.84

Some envision the architecture that will underpin a unified platform as a “financial operating system (OS) for healthcare” described as “a real-time, action-oriented engine that ingests financial data from the EHR, RCM, banking and credit products, and payroll to become the financial system of record.”85

Need to Adapt to a Fast-Changing Competitive Landscape

Non-traditional healthcare providers made further inroads in 2023 in primary, urgent, and home health care as well as some specialties. Many major retail, technology, and insurance firms expanded offerings, as a few highlights indicate:

  • CVS, the leader in retail clinic locations, continued to acquire primary care and home health companies.
  • Walmart announced a doubling of its primary care centers to 75 across five states, and the company partnered with United Healthcare to offer telehealth services.
  • Amazon added an option for Prime members to gain unlimited access to virtual health through the company’s One Medical division.
  • Optum says it now employs some 90,000 physicians and 40,000 advanced practice clinicians in 2,700 care sites.
  • New offerings continue to emerge. Dollar General announced mobile health clinics, GNC added virtual health, and others have entered the market in various forms.

Retail health is garnering both consumer mind-share and growing use (Figures 9, 10).8687 Bain projects that the non-traditional providers will capture a 30% primary care market share by 2030.88

 Quarterly news mentions of direct-to-customer healthcare, Q3 2021 - Q2 2023
View PDF of Figure 9[PDF]

Retail clinic patients, US, 2020 - 2024
View PDF of Figure 10[PDF]

The unfolding competitive strategies present traditional providers with threats and opportunities:

  • The downside scenario involves erosion of the revenue base from outpatient business and the acute and specialty referrals that accompany it.
  • At the same time, healthcare systems can partner with retail health companies. Amazon, Walmart, Best Buy and others have already linked creatively with healthcare systems.

Over the years, healthcare has proven a difficult hill to climb for firms from outside of the industry. There have been some noteworthy recent retrenchments such as Walgreens decision to reduce costs by closing 60 of its VillageMD clinics as well as adopting a less aggressive expansion stance. However, 2024 is likely to reinforce the idea that the disruptive alternative providers align well with powerful industry trends. Healthcare systems, hospitals, and practices will need to build on their strengths to compete and to partner successfully.

Collaboration and Trust Increasingly Central to Strategic Success

Healthcare’s complex challenges and diverse constituencies place a premium on two leadership pillars of success.

Creating an agile, collaborative environment

McKinsey believes a leader will need to become a “catalyst, engaging people to collaborate in open, empowered networks” and a “coach, enabling the organization to constantly evolve through rapid learning, and enabling colleagues to build new mindsets, knowledge, and skills.”89

Building trust across constituencies

The 2023 CommerceHealthcare® Trends report highlighted the importance of trust in healthcare. Trust-based relationships among patients, staff, clinicians, suppliers, and other providers — including competitors — are essential. Unfortunately, the gulf between desired and actual trust needs to narrow:

  • Only 45% of frontline clinicians trust their leadership to do what is right for patients.90
  • 60% of consumers feel the healthcare system puts profits above patient care.91
  • 63% of nurses said they do not believe their organizations make their wellbeing a priority.92

Trust is a fundamental attribute for banks and represents a core feature of their role as partners in the healthcare ecosystem. Two-thirds of surveyed consumers said they trust banks, a level that has held steady despite high-profile banking disruptions over the past year.93 They are trusted to provide payment “super apps,” making banks excellent candidates to help usher in healthcare financial automation and digital payments.

Conclusion

Progress continues, but leaders are navigating a 2024 filled with uncertainty, difficult tradeoff decisions, and increasing urgency to effect meaningful organizational change. It is a challenging, dynamic environment replete with higher risks and rewards. The overarching takeaway from this report’s data synthesis is the imperative not only to improve financial health, but also address serious issues in workforce management, patient financial experience, and trust-building. Automation, digital payments, and AI are delivering real benefits and offer an expanding menu of solutions. This report also underscores an equally valuable tool: strong partnerships with outside firms that can tailor the technology, processes and advice that an organization needs to meet healthcare’s rigorous demands today and well into the future.

CommerceHealthcare® solutions are provided by Commerce Bank.

Disclosures:

[1]. A. Feinberg, E. Berger, and R. Hammond, “2023 Healthcare Provider IT Report: Doubling Down on Innovation,” Bain & Company Brief, September 12, 2023.

[2]. Healthcare Finance Management Association and Guidehouse, 2024 Health System Digital & IT Investment Trends Report, November 2023.

[3]. Black Book Market Research, “Black Book Announces 2023 Top Client-Rated Financial & RCM Solutions Delivering Digital Transformation and Managing Liquidity,” June 7, 2023.

[4]. Symplr, 2023 Symplr Compass Report, October 2023.

[5]. D. Raths, “Survey: Ransomware Attacks Increase, But Cloud Compromise More Concerning,” Healthcare Innovation, October 11, 2023.

[6]. J. Lagasse, “Almost 80% of Healthcare Organizations Experienced Cyber Incidents in the Past Year,” Healthcare Finance, August 30, 2023.

[7]. IBM, Cost of a Data Breach Report, July 2023.

[8]. Healthcare Finance Management Association and Guidehouse, 2024 Health System Digital & IT Investment Trends Report, November 2023.

[9]. Stoltenberg Consulting, 11th Annual Health IT Industry Outlook Survey, October 26, 2023.

[10]. A. Feinberg, E. Berger, and R. Hammond, “2023 Healthcare Provider IT Report: Doubling Down on Innovation,” Bain & Company Brief, September 12, 2023.

[11]. Gartner Research, “We Shape AI, AI Shapes Us,” October 16, 2023.

[12]. S. Morse, “AI Can Improve the Revenue Cycle But Increases Risk, Moody’s Says,” Healthcare Finance, October 25, 2023.

[13]. Kaufman Hall, National Hospital Flash Report, November 2023.

[14]. Fitch Ratings, “2023 Median Ratios: Not-for-Profit Hospitals and Healthcare Systems,” July 25, 2023.

[15]. Kaufman Hall, National Hospital Flash Report, November 2023.

[16]. Kaufman Hall, 2023 State of Healthcare Performance Improvement: Signs of Stabilization Emerge, October 2023.

[17]. J. Lagasse, “Financial Challenges Spurring Healthcare Merger and Acquisition Activity,” Healthcare Finance, October 16, 2023.

[18]. L. Dyrda, “Hospital Cash Flow. Margins to Surge in 2024: Moody’s,” Becker’s Hospital CFO Report, November 8, 2023.

[19]. Crowe, Time for a Commercial Break: Crowe RCA Benchmarking Analysis, May 2023.

[20]. American Hospital Association, “Infographic: Commercial Health Insurance Practices that Delay Care, Increase Costs,” November 2022.

[21]. R. Southwick, “Hospitals See Big Drop in Cash Reserves,” Chief Healthcare Executive, November 21, 2023.

[22]. L. Dyrda, “Hospital Cash Flow, Margins to Surge in 2024: Moody’s,” Becker’s Hospital CFO Report, November 8, 2023.

[23]. Kaufman Hall, 2023 State of Healthcare Performance Improvement: Signs of Stabilization Emerge, October 2023.

[24]. H. Gillers and M. Evans, “Some Hospitals That Spent Big on Nurses During Pandemic are Now Short on Cash,” Wall Street Journal, July 5, 2023.

[25]. Sg2, 2023 Impact of Change Forecast Highlights, 2023.

[26]. J. S. Choudhury, “The Employer Strikes Back: The Hollowing of the Commercial Health Insurance Market and its Impact on Payers and Providers,” Kaufman Hall, October 10, 2023.

[27]. Aon, “U.S. Employer Health Care Costs Projected To Increase 8.5 Percent Next Year,” August 22, 2023.

[28]. KFF, 2023 Employer Health Benefits Survey, October 18, 2023.

[29]. Fitch Ratings, “Controlling Labor Costs Will be Key to NFP Hospital Margin Improvement,” October 2, 2023.

[30]. Nursing Solutions, Inc., 2023 NSI National Health Care Retention & RN Staffing Report, March 2023.

[31]. AMN Healthcare, 2023 Survey of Registered Nurses, May 1, 2023.

[32]. Experian Health, Short-Staffed for the Long Term, November 2023.

[33]. Akasa, “No Resignation: Solving Today's Greatest Staffing Challenges in the Healthcare Revenue Cycle,” January 26, 2022.

[34]. Fitch Ratings, “Controlling Labor Costs Will be Key to NFP Hospital Margin Improvement,” October 2, 2023.

[35]. M. Hagland, “AMGA Survey: Clinics Struggling with Chronic Staffing Shortages, Costs,” Healthcare Innovation, May 30, 2023.

[36]. Black Book Market Research, “Black Book Announces 2023 Top Client-Rated Financial & RCM Solutions Delivering Digital Transformation and Managing Liquidity,” June 7, 2023.

[37]. A. Kayser, “The No. 1 Healthcare Challenge, Per 150 Leaders,” Becker’s Hospital Review, August 15, 2023.

[38]. Sg2, 2023 Impact of Change Forecast Highlights, 2023.

[39]. Ibid.

[40]. Ibid.

[41]. Doximity, 2023 State of Telemedicine Report, 2023.

[42]. Healthcare Innovation, 2023 State of the Industry Survey, January/February 2023.

[43]. Kaufman Hall, M&A Quarterly Activity Report: Q3 2023, October 12, 2023.

[44]. HealthLeaders, “Intelligence Report: What’s Driving M&A,” July–August 2023.

[45]. BDO, 2023 Healthcare CFO Outlook Survey, 2023.

[46]. Experian Health, The State of Patient Access: The Digital Front Door, 2023.

[47]. Ibid.

[48]. Health Management Academy, First to Last Touch:Investment in Patient Financial Experience Key to Revenue Improvement, April 2023.

[49]. Ibid.

[50]. Health Management Academy, First to Last Touch:Investment in Patient Financial Experience Key to Revenue Improvement, April 2023.

[51]. Aite-Novarica, U.S. Patient Refunds: A Market Sizing, November 27, 2019.

[52]. The Harris Poll and American Academy of Physician Associates, The Patient Experience: Perspectives on Today’s Healthcare, May 20, 2023.

[53]. Primerica and Change Research, Q1 U.S. Financial Security Monitor, April 2023.

[54]. KFF, 2023 Employer Health Benefits Survey, October 18, 2023.

[55]. Ibid.

[56]. Kalorama Information, Out of Pocket Spending in Healthcare, July 2023.

[57]. N. Ochieng, J. Fugelsten Biniek, M. Freed, et. al, “Medicare Advantage in 2023: Enrollment Update and Key Trends,” KFF, August 9, 2023.

[58]. A. Norris, “Why More Organizations are Terminating Medicare Advantage Contracts,” HealthLeaders, January 9, 2024.

[59]. J. Asser, “Majority of Providers Expect to Outsource Patient Financing,” HealthLeaders, April 14, 2023.

[60]. CAQH, 2022 CAQH Index, 2023.

[61]. J. Ray, “Rev Cycle Leaders Double Down on Their Dissatisfaction with Automation and Payers,” HealthLeaders, November 9, 2023.

[62]. Healthcare Financial Management Association, “New Report Projects Robust Investment in Healthcare Revenue Cycle and Finance Solutions, Despite Economic Headwinds,” August 16, 2023.

[63]. BDO, Healthcare’s Challenging Road Ahead: 2023 BDO Healthcare CFO Outlook Survey, February 2023.

[64]. Akasa, “Survey: Cost-to-Collect Nearly .25% Lower for Hospitals and Health Systems That Leverage Automation in the Revenue Cycle,” September 15, 2022.

[65]. McKinsey & Company, “Setting The Revenue Cycle Up for Success in Automation and AI,” July 2023.

[66]. Plutus Health, Plutus Heath Revenue Cycle Management Challenges Index, September 2023.

[67]. Healthcare Finance Management Association and Guidehouse, 2024 Health System Digital & IT Investment Trends Report, November 2023.

[68]. Modern Healthcare, “Hospitals Need Help with Payer Processes, Federal Policies,” August 21, 2023.

[69]. Black Book Research, “Healthcare’s Outsourcing Boom on a Trajectory to Double by 2027,” November 1, 2023.

[70]. Nacha, “3Q 2023 ACH Network Infographic.”

[71]. PYMNTS, Digital Payments: Expanding the Payments Palette, March/April 2023.

[72]. Deutsche Bank Research, The Future of Payments, Series 4, April 2023.

[73]. PYMNTS and ACI Worldwide, “Digital Bill Payments: Frequent Mobile Wallet Bill Pay Users the Most Satisfied,” June 2023.

[74]. PYMNTS, “More Consumers Use Digital Wallets for Healthcare Expenses,” January 20, 2023.

[75]. K. Broughton, “Finance Chiefs Take Measured Approach to Using Real-Time Payments,” The Wall Street Journal, November 2, 2023.

[76]. Association for Financial Professionals, The 2023 Association for Financial Professionals (AFP) Real-time Payments Survey, October 2023.

[77] Gartner, “Webinar: Gartner Predictions for 2024: Financial Services,” January 25, 2024.

[78]. Bain & Company and Bain Capital, “Embedded Finance: What It Takes to Prosper in the New Value Chain,” September 12, 2022.

[79]. M. Sanders, “Considering Cashless Check-Ins for Your Front Desk?” Impact Advisors, November 3, 2023.

[80]. Mercator, “How Instant Payments Are Taking the Industry by Storm — And Why Businesses Don’t Want to Get Left Behind,” Payments Journal, December 8, 2022.

[81]. Employee Benefit Research Institute and Greenwald Research, 2023 Workplace Wellness Survey, October 8, 2023.

[82]. A. Dresner, A. Murati, B. Pike, and J. Zell, “Embedded Finance: Who Will Lead the Next Payments Revolution,” McKinsey & Company, October 2022.

[83]. PYMNTS and Lynx, Healthcare in the Digital Age: Consumers See Unified Platforms as Key to Better Health, December 2022.

[84]. Bain & Company and Bain Capital, “Embedded Finance: What It Takes to Prosper in the New Value Chain,” September 12, 2022.

[85]. M. Andrusko, A. Collins, D. Haber, D. Wolf, and J. Yoo, “Healthtech x Fintech’s Biggest Prize: The Financial Operating System for Healthcare,” a16z Bio + Health Newsletter, February 7, 2023.

[86]. Trilliant Health, Value for Money: Trends Shaping the Health Economy, 2023.

[87]. R. Leventhal, “Primary Care Practices Lose Patients to Alternative Sites of Care,” Insider Intelligence, December 1, 2022.

[88]. Bain & Company, “Primary Care 2030: Innovative Models Transform the Landscape,”July 11, 2022.

[89]. McKinsey & Company, What is Leadership?, August 2022.

[90]. Deloitte Center for Health Solutions, Addressing Health Care’s Talent Emergency, 2022.

[91]. P. Keckley, “Keckley Poll: The Public is Fed Up with the Health System…So What Else is New?” The Keckley Report, November 20, 2023.

[92]. Trusted Health, 2023 Frontline Nurse Mental Health and Well-being Survey, June 2023.

[93]. A. Hrushka, “Trust in Banks Remains Steady, While Fintechs Have Ground to Cover: Survey,” Banking Dive, November 2, 2023.