Q1. Could you start by giving us a brief overview of your professional background, particularly focusing on your expertise in the industry?

I've been in the healthcare space for a long time. I originally started my healthcare career on the provider side of the business, both outpatient and inpatient and moved into the realm of healthcare IT about 20 years ago.

Throughout my career, I have been involved in various implementations and professional services related to EHRS, practice management, and revenue cycle systems. Over the last 6 years, I have focused on 4 specific areas.

The first is consultation from an administrative and clinical standpoint. Thus, from a therapeutic standpoint, cradle to cure, and from an administrative/financial standpoint, credentialing to remit.

The second bucket, which is under managed services, would oversee the client's central office and/or IT applications, among other business-related components.

The third bucket is around analytics, which involves gathering data from various systems, aggregating it, and utilizing tools to present the information to different stakeholders.

The fourth bucket focuses on new solution development, leveraging learnings from the other three pillars and utilizing GenAI to automate processes, thereby enhancing effectiveness from both administrative and clinical perspectives.

Over the last year and a half, I've worked extensively with companies, helping them develop their go-to-market strategy through consulting and collaboration. I also worked with a few private equity and VC firms, helping them understand the market dynamics and competitive landscape as well as potential companies they are looking to invest in.  

 

Q2. What segments of the U.S. healthcare services market are most ripe for consolidation in 2025?

There are a few distinct dynamics at play in the US services market. One there is a severe labor shortage both providers and administrative staff. Two there is reimbursement pressures on providers that are having an impact on margins.  Finally the regulatory environment.   These three forces are driving a lot of consolidation in the provider space. 5 years ago roughly 50% of providers were independent today it’s less than 40%.  

The above factors will be a forcing mechanism for the services market and you are already starting to see this come into play. The Revenue Cycle (RCM) space is an area for consolidation. There are a lot of service players in this space, plus automation/AI can play a key role in RCM.  You are seeing not only consolidation of BPO providers but also BPO providers purchasing or building out their own AI/Automation solutions.  Advisory Firms, Staffing firms and Call Centers are other areas that are ripe for consolidation due to the market forces.      

 

Q3. What types of synergies are most achievable in recent successful roll-ups?

Companies and organizations often face challenges when they fail to rationalize their product or service portfolio. So when you look for adjacencies, you want to make sure that it complements and does not overlap with your existing portfolio. There are numerous examples of companies that will acquire another company and don’t do a good job rationalizing their product portfolio and they don’t end up getting the synergies they were looking.  

In regards to synergies that are achievable is ability to get into different markets or acquire additional client base or bring in technologies that will make you more efficient in your core operations.  An example, if you have a service organization that does just inpatient or hospital services and you acquire one that does ambulatory services, those would be complementary, or you acquire an AI company that allows you to automate your core services.  

 

Q4. Is there a growing appetite for platform integration plays (e.g., unified RCM + clinical + patient engagement) in the market?

The short answer to that question is yes, there is.

There's definitely a play in the marketplace for platforms. So, when you look at a health system or health entities ecosystem, having a platform that can go across the ecosystem and, more importantly, scale appropriately is going to become increasingly important.

There are large software vendors, such as Epic and Cerner, that offer a software platform spanning clinical practice management and RCM perspectives. Although not strictly service-oriented, they provide a comprehensive solution that covers the continuum of care, including administrative aspects. So really, those are probably the truth, you know what we call end-to-end platforms.

There are companies, such as R1, Conifer and Optum, that have end-to-end revenue cycle management from a services perspective and utilize this service platform and are technology (software) agnostic.  They have their own tools that lay on top of their clients platform and become part of their clients ecosystem.  

The platform integration will become more and more important especially with the macro dynamics going on in the US market place and the ability to scale using technology and services in unison in a seamless manner will become more and more critical in the US marketplace.  

 

Q5. What innovations in RCM—particularly AI, automation, or predictive analytics—are delivering measurable improvements in cost-to-collect or denial reduction?

When you look at that space from an AI perspective, the big focus these days is on a few different areas.

Autonomous Coding

Autonomous coding, especially in the ambulatory realm, has started to take off. There are a lot of companies that are offering what they call autonomous coding solutions. I would say we're still at the early phases of this.  The ability to do coding at scale at a very low price has a lot of potential and I think as things develop and improve in that area will take off in a very big way and I think you'll see that in the relatively near future.

Prior Authorization

The other use cases I see around AI automation that show positive results are around prior authorization. This is a big pain point for providers and has a lot of focus by a lot of different entities to make this more streamlined.  

Payment Posting

This process is significant for payment posting, particularly when automating the EOBS, as it has shown promising results compared to manual processes.

Charge Capture

Charge capture is another key process. It involves collecting information from various systems, including the lab, pharmacy, and other ancillary systems, as well as the core EHR system, and ensuring that all this data is accurately entered into the appropriate charge.

Analytics

Predicting denials based on trends and patterns—especially at the group level—is essential from an analytics standpoint. We can remain ahead of payers and their contract revisions thanks to these capabilities. From the standpoint of a KPI or measurable outcome, there have also been some excellent results in that area. Additionally, I believe that you are familiar with the analytics of some of the clinical metrics that can assist you in obtaining additional reimbursement measures, such as HEDIS, MIPS, and others.

Clinically, closing care gaps has shown promising results, ultimately leading to better patient care and financial incentives, while also demonstrating progress.

All of the above items will have an impact on reducing costs, increasing productivity and deliver better financial results both for providers and for service providers.  

 

Q6. Which vendors or technologies are gaining traction among mid-sized provider groups and why?

This is an interesting segment, they are faced with reimbursement pressures, increased labor costs and regulatory burdens. What is gaining traction in ths market is anything that helps reduce their cost structure.

Call Centers, Offshore RCM services or Automating administrative operations are very appealing to this market segment.  So, when you look at revenue cycle management, it falls into three buckets: front, mid, and back office. From a services perspective, it's more in the mid and back office.

If you're looking at specific technology companies, there's a whole plethora of them. Typically, when folks think of service companies, they think of: Omega, Gibbs, Access Health, and a few other ones. They all use different automation tools and AI to help them.

You also have companies like IKS, which just went out and bought a technology company. Sutherland is introducing a lot of technology from there global operations into the health care space. There are numerous point solution companies that specialize in AI, such as UI Path and Blue Prism, which work extensively with the master patient index. You have Health AI, which examines some of the coding aspects.

And then you have companies like Datavant, MedeAnalytics, which spend much time in the analytics space. And then, you have the big companies like Optum, R1, and Conifer, which have different platforms that help them out.

 

Q7. If you were an investor looking at companies within the space, what critical question would you pose to their senior management?

I would look at the market space that they're trying to capture.

Does it make sense? Is it a growing space? How fragmented is that space? Is there potential for enhancing an existing product to drive organic growth, or is there a need for a roll-up play? Are there many smaller players in that space that could facilitate consolidation or gain market share?

If you're considering investing in a technology service company, it's essential to understand their tech debt. This includes whether they're dealing with new technology, old technology, or the current buzzword: service debt. Do they have the ability to expand their technology capabilities or their service capabilities?

Do they have a strong customer base, and is retention low? Is there good organic growth, and does that portfolio make sense, or is there overlap in our portfolio that causes any channel conflicts?

I would like to understand the senior leadership team's capabilities, their experience in the marketplace, and how they're perceived by the client base, particularly in terms of their innovation. Are they generating cash and have the appropriate financial disciplines in place.