By Grace Nam, Strategic Solutions Manager, Laserfiche.
As the healthcare industry continues to grapple with the dual challenges of rising costs and evolving patient expectations, the urgency to modernize and automate has never been greater.
A recent Deloitte report reveals that 75% of life sciences executives have a positive to cautiously positive outlook for 2025, signaling optimism despite ongoing challenges.
This optimism is rooted in the sector’s ability to innovate, leveraging technology to drive operational efficiency and improve patient outcomes.
With aging populations and increased demand for digital healthcare solutions, organizations must adapt quickly to remain competitive in a rapidly changing landscape. From integrating automated data processes to centralizing patient records, modernization is no longer a luxury—it is a necessity. These technological advancements not only streamline administrative tasks but also set the foundation for a more patient-centric approach to care. As we move into 2025, the industry stands at a critical crossroads, where the adoption of cutting-edge solutions will determine its trajectory for years to come.
Modernizing Legacy Systems
The modernization of legacy systems will be a cornerstone of healthcare innovation in 2025. Many institutions are shifting toward centralized and structured document management through integrated solutions. This approach streamlines operations, reduces manual processes, and lays the foundation for scalable automation. Tools that auto-extract and auto-populate healthcare data are increasingly becoming the norm, driving operational efficiency and improving data accessibility for healthcare staff.
These advancements not only reduce administrative burdens but also enhance the patient experience. Automation plays a critical role in managing patient information and streamlining tasks, such as appointment scheduling, billing, and record management. Younger generations, in particular, are pushing for rapid, digital-first engagement, favoring seamless interactions over traditional methods. By investing in these technologies, healthcare providers can better meet these expectations, creating a more responsive and patient-centric system.
By Ryan Chapin, executive director of strategic solutions, and Vijaya Krishna Veeravalli, senior vice president of cloud engineering, AGS Health.
Ryan chapin
As we head into 2025, several key trends are expected to significantly shape the future of healthcare revenue cycle management (RCM). From managing surging denial rates and evolving workforce dynamics to mitigating rising cybersecurity risks and integrating cutting-edge technologies, healthcare organizations are entering the new year while navigating a complex—often contentious—environment to enhance patient care and operational efficiency.
Navigating an Adverse RCM Environment
Denials, evolving payer relationships, and greater administrative burdens have come together to create what may best be described as an adverse RCM environment for healthcare organizations.
Climbing denial rates, prior authorization requirements, and the costs associated with managing both are among the most significant challenges confronting healthcare organizations going into 2025. According to an American Medical Association (AMA) survey, physicians reported spending nearly two business days per week completing an average of 43 prior authorizations—many of which end in denial.
Vijaya Krishna Veeravalli
In terms of denials, the surge is driven in large part by the growth in commercial and government third-party audits, including an increase in the volume of prepayment audits. According to MDaudit, external audit volume more than doubled between 2023 and 2024 and total at-risk dollars increased fivefold. The result was a sharp uptick in final denial dollars across professional (34%), hospital outpatient (84%), and hospital inpatient (148%) settings.
Healthcare providers participating in increasingly popular Medicare Advantage (MA) plans have been especially hard-hit. MDaudit reports that MA-related denials increased by 59% on average across professional and hospital settings in 2024, and the total denials amount for MA plans rose by 51%—a trend that has a growing number of providers reconsidering or dropping participation based on high denial rates and poor payments.
The impact of these trends goes deeper than financial. They add to already high administrative demands that in turn increase the strain on an overburdened—and increasingly costly—workforce that RCM leaders struggle to shore up in a tough recruitment and retention environment. To avoid staff burnout, healthcare leaders are continuing to adapt strategically, including exploring onshore, nearshore, and offshore outsourcing models.
Healthcare access in the United States remains fraught with barriers, none as pervasive as the issues surrounding prior authorizations (PAs). Originally designed as a mechanism to ensure that care is both necessary and cost-efficient, PAs have become one of the largest obstacles to timely and affordable healthcare.
A recent survey revealed that over 80% of patients have delayed or foregone necessary procedures, lab work, or medications due to confusion or frustration over PA processes. These numbers highlight an urgent call to address systemic inefficiencies.
This is not just a patient problem—it is a systemic issue with implications for providers and the broader healthcare ecosystem. As healthcare policies evolve, including recent Medicare Advantage proposals from the Centers for Medicare & Medicaid Services (CMS), the need to streamline PA processes and enhance transparency becomes increasingly urgent.
CMS’s proposed changes, aimed at tightening rules around PAs, reflect a growing recognition of their role in impeding care. One proposal calls for Medicare Advantage plans to respond to routine PAs within seven days and urgent cases within 72 hours, a move intended to reduce patient wait times and administrative burdens.
However, challenges persist as stakeholders navigate the complexities of balancing oversight with access.
The Tangled Web of Prior Authorization
Survey data underscores the widespread impact of PA inefficiencies. More than half of patients experience delays in care, with over 40% waiting one to two weeks or more for authorization approvals1. For conditions requiring timely interventions, such delays can lead to deteriorating health outcomes, increased stress, and higher long-term costs for patients and payors alike. Financial burdens further compound these delays, with nearly 40% of patients reporting paying out-of-pocket because of denials or unclear coverage details.
The administrative toll on providers is equally staggering. Navigating PA requirements drains time and resources that could otherwise be directed toward patient care. The recent CMS proposals highlight this strain, as Medicare Advantage enrollees now make up over half of all Medicare beneficiaries. Administrative overhead for these plans often includes increased scrutiny of claims, leaving providers overwhelmed with inconsistent policies and requirements.
By Errol Weiss, chief security officer, Health-ISAC.
Healthcare data breaches are reaching unprecedented levels, with attacks that target the industry surging in both frequency and sophistication. Cybercriminals are zeroing in on vulnerabilities across healthcare systems, exploiting outdated and unpatched systems to steal and manipulate sensitive patient data.
From medical histories to genomic information, this data has immense value, making it a lucrative target for ransomware, phishing schemes, and insider threats. As healthcare organizations scramble to shore up defenses, the risks extend beyond financial losses to jeopardize patient safety and trust.
The urgency is exemplified by two landmark pieces of legislation—the Healthcare Cybersecurity Act of 2024 and the Health Infrastructure Security and Accountability Act of 2024 (HISAA). These laws aim to confront the mounting threats, but they also raise critical questions: Can they outpace the rapidly evolving tactics of cybercriminals? Are they enough to close the gaps left by outdated regulations like HIPAA?
Limitations of existing legislation
The limitations of existing regulations like the Health Insurance Portability and Accountability Act (HIPAA), reveal why new measures are necessary to address today’s cybersecurity challenges. When HIPAA was enacted in 1996, its primary focus was ensuring the confidentiality of patient information and establishing basic standards for privacy and compliance. While it has played a pivotal role in protecting patient data, HIPAA’s framework has not kept pace with the increasingly sophisticated cyber threats facing healthcare organizations.
As it stands, HIPAA has become largely a reactive framework for punishment, focusing on penalizing organizations after data breaches occur, rather than implementing proactive measures to prevent them. Its provisions leave much of the “how-to” for securing digital infrastructure undefined, offering flexibility but creating wide disparities in cybersecurity practices. Large healthcare providers with robust resources have the ability to invest in advanced protections, while smaller clinics and rural providers struggle to implement even basic measures due to financial and technical limitations.
Healthcare professionals dedicate their lives to caring for others, and while encountering traumatic events is an unfortunate part of their job, physical or verbal assault is unacceptable and should never be tolerated.
Nevertheless, healthcare workers are under the constant threat of violence, a disturbing trend that continues to plague our healthcare systems. Workplace violence has become so endemic that 40% of healthcare employees have experienced such acts in the last two years, according to a 2023 Premier’s survey.
Although some strategies have shown promise, a truly effective approach should incorporate three key elements:
A discreet means of alerting security
Accurate location tracking, indoors and outdoors
Unhindered communication with the necessary personnel
A Discreet Means of Alerting Security
Traditional wall-mounted panic buttons, often located at the head of a patient’s bed or in other fixed positions, can pose challenges. Their stationary nature limits accessibility, particularly during escalating incidents with patients or visitors. Moreover, the act of reaching for and pressing these buttons can further escalate tensions, contrary to the intended purpose of a duress solution.
To help address the issue, RTLS platforms started offering wearable badges that allowed staff to signal for help during escalating situations. However, early models often lacked the desired level of discretion, potentially alerting aggressors to the staff member’s call for assistance. Manufacturers then developed discrete personal staff buttons designed to be easily concealed, enabling staff to signal for help without drawing attention to themselves. To alleviate anxiety and uncertainty, some safety solutions incorporate a haptic response feature. This silent alert, triggered after activating the panic button, confirms that a duress call was sent, providing the distressed staff member peace of mind.
Accurate Location Tracking, Indoors and Outdoors
Time is of the essence when a staff member activates a duress badge. These incidents can unfold rapidly and unpredictably, potentially moving across different areas of the hospital or even spilling into the parking lot or garage. Therefore, a robust solution is required to accurately locate, both indoors and outdoors.
Unfortunately, legacy RTLS solutions often struggle with outdoor operation due to their reliance on heavy infrastructure, making installations costly or infeasible. Additionally, they leverage technology that doesn’t provide the needed accuracy. For example, cellular technology is great at providing GPS coordinates; however, it struggles with accurate altitude measurements in multi-story buildings, returning someone’s GPS coordinates but failing to determine which floor they are on.
AI-based location intelligence overcomes these challenges, resulting in a highly accurate system that provides real-time location intelligence within a facility or outdoors. Unlike traditional RTLS platforms, AI-enabled staff duress solutions use ultralight infrastructure, which makes them easy and inexpensive to install across an entire campus, inside and outdoors.
Despite the rapid adoption of digital tools, healthcare practices still rely heavily on manual workflows, with staff spending countless hours on phone calls, paperwork, and fragmented systems. While most solutions focus on automating individual tasks, Confido Health secured a $3 million funding round to tackle creating digital workers that manage end-to-end operations in specialty healthcare practices.
Together Fund led the seed funding round, with participation from MedMountain Ventures, Rebellion VC, DeVC, Operators Studio and strategic healthcare operators. The company previously raised a pre-seed round led by Momentum Capital.
Founded by serial entrepreneurs Chetan Reddy and Vichar Shroff, Confido Health represents the culmination of their expertise in AI-driven automation. The founders’ journey began with winning a prestigious Lockheed Martin grant for innovative technology, leading to their first venture, DroneNation. This AI infrastructure mapping company operated across India, Australia, and US markets, earning recognition in The New York Times before its successful acquisition. Now with Confido Health, they’re joined by Simran Parikh, who brings extensive government healthcare department expertise to the team.
“When building Confido Health, we focused on what healthcare providers truly need: tools that don’t just automate tasks but take on the operational burden entirely,” said Chetan Reddy, CEO of Confido Health. “Our digital workers are designed to integrate seamlessly with legacy systems like EHRs, IVRs, and even outdated communication tools. By automating and optimizing entire workflows, we’re not just saving time; we’re helping enterprises recover lost revenue and create sustainable growth.”
Confido Health’s platform creates specialized AI workers that handle specific tasks like appointment management, insurance verification, and care coordination. These digital workers connect to existing healthcare systems in under five minutes through no-code deployment, delivering end-to-end task automation without requiring practices to overhaul their infrastructure. Unlike traditional software companies, Confido Health charges on an hourly basis similar to full-time employees, eliminating integration and training fees.
Harris Data Integrity Solutions, the leading provider of best-in-class person data integrity services and software, announced today the appointment of Julie Pursley, MSHI, RHIA, CHDA, FAHIMA, as its director of industry relations.
In this role, which oversees all facets of sales activities, Pursley will focus on building team and client success and business operational efficiencies through a strong blend of management, strategic selling principles, industry presence, and thought leadership.
“Julie’s experience, reputation as a change agent in the evolving health information landscape, and her focus on ensuring the integrity, accuracy, and completeness of health data complements Harris Data Integrity Solutions’ commitment to providing innovative person matching and MPI management solutions and services,” says Rachel Podczervinski, MS, RHIA, senior vice president, Harris Data Integrity Solutions. “We are fortunate to have her as part of our team and are excited to see the results of her focus on leading and cultivating strategic initiatives and to promote thought leadership and best practices in health information management.”
A recognized health information professional with broad expertise in health data integrity, interoperability, and industry relations, Pursley’s health information career spans more than 30 years and a variety of roles and settings. Prior to joining Harris Data Integrity Solutions, she was senior director of knowledge practice with AHIMA, where she previously served as senior director and director of health information thought leadership. Her academic career includes her current position as an adjunct professor with Charter Oak State College. She also served as a trusted advisor, patient identification and matching optimization sales executive, health information leader for an integrated healthcare delivery system, and owner of a regional medical transcription service.
Pursley is a prolific author, educator, and renowned public speaker who has shared her insights and expertise to audiences in the US and abroad. She holds a Master of Science in Health Informatics and a Bachelor of Science in Health Information Administration from the University of Cincinnati.
About Harris Data Integrity Solutions
Harris Data Integrity Solutions delivers industry-leading data integrity services and software to reduce duplicate medical records and minimize the ongoing cost of maintaining quality patient data. Created by the integration of two data integrity powerhouses, Just Associates, Inc. and QuadraMed Corporation, Harris Data Integrity Solutions offers the unparalleled depth and breadth of industry expertise and the commitment to ongoing innovation necessary to meet the changing needs of patients and healthcare organizations. Designed to address the broad spectrum of challenges associated with person matching and data integrity, its suite of advanced technology solutions and services includes CuraMatch automated duplicate resolution, SmartIX Enterprise Master Patient Index (EMPI) and MPI Clean-up Services. For more information, visit www.harrisdataintegritysolutions.com.
By Don Rucker, MD, chief strategy officer, 1up Health
Medicare Advantage is a capitated health plan and the government, which pays for the plan, needs massive amounts of performance data to ensure that plans do right by patients and don’t scrimp on care. With capitation’s pre-determined payment rates, there is an incentive to do less.
The main tool CMS has to monitor performance is the Star Ratings system (though there are lots of other regs to be sure with this as a goal). The data needed to optimize Star Ratings is what fuels the revenue cycle stack in MA plans. In 2025, health plans must
How do these MA payment policies force a rethink about data and technology?
Star Ratings measures of clinical and customer plan performance are reported, then scored and rolled up into overall scores by CMS. These are used to set MA plan, bonuses, other payments and are also reported to patients when they are choosing a plan. This incents two large patterns of behavior – one is to get the underlying data to show performance and the other is to improve that performance. Historically, quality measurement has involved lots of manual steps and even today some data is based on chart pulls and having humans read EMR computer screens. The modern world, a decade of EMR incentives, and modern APIs provide starkly different options to get and improve plan performance data.
Are classic claims dataflows enough or will payers need rich clinical data to succeed?
Not surprisingly, most of the measures deal directly with clinical performance. Today much of Star Ratings scoring is based on claims data – increasingly the winners will use clinical data both to measure performance and to improve performance. It is important to understand the scores are relative – if a plan uses more clinical data and gets a better score that means the plans that don’t use clinical data are more likely to get a lower score. Economists describe this as a “zero-sum game.”
How can plans think about getting clinical data?
Obviously clinical data is captured and stored in EMRs. Certified EMRs are now required to have both patient access APIs as well as Bulk FHIR APIs. Bulk FHIR APIs allow the US Clinical Data for Interoperability (USCDI) to be obtained by the payer from the provider EMR in one swoop if the provider and the payer can reach a satisfactory agreement to share this data in their network contract.
Is getting clinical data enough?
No. It is not just about documenting today’s clinical performance. While that is a large step, the key differentiator will be doing something to improve that performance.
What does a modern digital strategy look like?
A modern digital strategy, whether it is a merchant like Amazon, a service provider like a bank or airline, or a media company, relies on easy access to websites via smartphones and targeted outreach via messaging or email timed to optimize success. For payers that means thinking about what to “say” to patients and providers and how to “hear” from patient and provider feedback, device monitoring data, and clinical data. That is what APIs enable.
By Grace Nam, Strategic Solutions Manager, Laserfiche.
Despite the rapid adoption of digital tools, healthcare practices still rely heavily on manual workflows, with staff spending countless hours on phone calls, paperwork, and fragmented systems. While most solutions focus on automating individual tasks, 
