< + > How Continuous Risk Monitoring Is Transforming Healthcare Revenue Integrity Amid Rising Audits

One of the biggest challenges facing healthcare organizations today has to do with revenue integrity and healthcare compliance.  Every organization is focusing on improving its revenue while still ensuring compliance.  Plus, this is becoming even more challenging as the government is leveraging AI to increase the number of audits and holding payments from many providers. This crackdown means provider organizations operating in Medicare or Medicaid programs will feel the impact across their entire compliance and revenue cycle footprint.

What’s interesting about this is that MDaudit was built for exactly this situation.  With that in mind, I had a chance to chat with Ritesh Ramesh, CEO at MDaudit, to learn more about what he’s seeing in the market and some of the ways MDaudit uses its AI-powered continuous risk monitoring platform to help hospitals and health systems.

We start off our discussion with Ramesh talking about the major shifts he’s been seeing in the healthcare compliance and revenue integrity landscape. He also highlights the major risks provider organizations face today and how those risks are evolving.

After hearing about the current revenue integrity and compliance landscape, I ask Ramesh to share what continuous risk monitoring actually looks like operationally for a health system or physician organization.  Most organizations are used to random audits, but the idea of continuously monitoring and “auditing” your organization’s revenue is a new idea for many. Ramesh shares how it works, along with examples of how proactive monitoring and AI-driven auditing have helped organizations identify and prevent major financial and compliance issues.

Of course, we couldn’t talk about this without diving into some discussion of AI.  Ramesh shares how MDaudit built AI into the platform from the beginning rather than layering it on afterward and how that makes all the difference for its customers.  What’s particularly impressive is that MDaudit has helped their customers achieve more than $500 million in ROI in 2025.  So, I had to learn more about what was actually driving these savings. We wrapped up our interview with Ramesh sharing his advice on how healthcare organizations can move from a reactive to a more proactive revenue integrity strategy.

Check out our interview with Ritesh Ramesh from MDaudit to learn more about how your organization can benefit from continuous risk monitoring that improves your organization’s revenue.

Learn more about MDaudit: https://mdaudit.com/

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 MDaudit is a proud sponsor of Healthcare Scene.

< + > Rethinking Clinical Denials and Clinical Documentation Integrity Strategy

The following is a guest article by Amanda Dean, Director of Clinical Education at AGS Health

Picture a patient admitted for heart failure, treated appropriately, discharged in stable condition, then denied. Not because the care was wrong, but because the documentation didn’t clearly articulate why inpatient admission was medically necessary. By the time the denial lands on a reviewer’s desk, the attending physician has moved on to dozens of other patients, the appeal window is narrowing, and the revenue cycle team is already buried in last month’s backlog.

This scenario plays out countless times every day in U.S. health systems, and it is almost entirely preventable. Clinical denial rates have climbed more than 20% over the past five years, driven by payer automation that has industrialized the scrutiny once reserved for only the most complex claims. The administrative cost of fighting those battles, in staff time, delayed reimbursement, and clinician frustration, can come close to rivaling the cost of the denials themselves.

The appeal-first response to this pressure is no longer sufficient. Leading organizations have come to the realization that their focus should be on: 1) streamlining communication between utilization review and physician advisory services; 2) enhancing clinical documentation integrity (CDI) practices; and 3) leveraging advanced analytics to identify denial trends early.

That kind of change doesn’t happen by tweaking a process here or adding a staff member there. It requires clinical, operational, and revenue cycle teams to function as one coordinated effort with a shared goal: keeping preventable denials from happening in the first place.

Why Clinical Denials are Growing

The payer automation described above is only part of a broader set of industry trends accelerating denial rates across hospitals and health systems.

Automated review tools now allow payers to flag claims for additional scrutiny at a scale and speed that wasn’t possible even a few years ago. These tools can rapidly identify cases in which documentation appears insufficient or medical necessity criteria are unclear, applying consistent algorithmic pressure across claim volumes that would overwhelm any manual review process.

Retrospective audits have expanded the problem further. Claims that were once paid and considered closed can be revisited and reversed well after initial reimbursement, creating financial exposure that stretches beyond the initial claim cycle and puts additional pressure on already stretched clinical teams.

Medical necessity requirements compound both issues. Standards are more complex than ever and applied inconsistently across payers. Small gaps in clinical documentation, such as incomplete physician notes or unclear admission rationale, can lead to denials even when the care provided was entirely appropriate.

Taken all together, these pressures increase denial volume by capitalizing on every weak point in the handoff between clinical care and documentation. Preventable documentation issues often lead to lost or delayed reimbursement, and organizations without a coordinated response across those functions will continue to absorb significant financial consequences.

The Hidden Cost of Fragmented Workflows

Weak points in the clinical-to-documentation handoff rarely occur in isolation. In most cases, they are symptoms of a deeper structural problem where the teams responsible for catching them are operating on separate tracks.

Utilization review teams may flag potential admission status or documentation risks early, but their findings often do not reach physician advisors or CDI specialists in time to act on them. CDI may uncover documentation gaps after the window to influence a claim has already closed. Revenue cycle teams typically enter the picture only after a denial has been issued. Each function is doing its job, and likely quite well, but without visibility into what the others are seeing.

The financial consequences of that disconnect are significant and largely invisible—until they compound. A single missed timely escalation from utilization review to physician advisor may result in only one denied claim, but multiply that across hundreds of admissions a month, and that same gap eats into reimbursement at a scale that becomes visible in aggregate (but long after any proactive opportunities to intervene have passed).

When these workflows operate independently, the organization is left managing the damage rather than preventing it, processing appeals for denials that should never have occurred in the first place.

A Proactive Framework for Denial Prevention

Addressing these gaps requires moving denial prevention upstream, into the care episode itself rather than the claims process that follows it. Payers have already made that investment on their side, deploying automated tools that flag documentation issues at scale and speed no manual review process can match. Organizations positioned for optimal response are those building equivalent capability on their own.

The foundation of that effort is earlier, more structured collaboration between utilization review teams and physician advisors. When potential medical necessity concerns are identified at the point of admission or during the hospital stay, there is still time to clarify documentation, adjust clinical rationale, and ensure the record accurately reflects why the level of care was appropriate. That window closes quickly once a patient is discharged.

CDI programs extend that foundation by ensuring the documentation captured during the stay holds up to payer scrutiny. CDI specialists working alongside physicians in real time can identify gaps in how patient acuity, severity of illness, and care complexity are recorded before those gaps become denial triggers. The quality of the clinical record at discharge determines much of what happens downstream.

Analytics and automation make both functions more precise and more proactive. Platforms that surface denial trends, identify documentation patterns that draw payer scrutiny, and flag high-risk cases early allow teams to direct their attention where it matters most. Automation reduces the manual burden of documentation workflows and improves consistency in how clinical details are captured and communicated across teams, applying the same systematic rigor to prevention that payers are already applying to scrutiny.

Together, these capabilities shift the organization’s posture from responding to denials to systematically reducing the conditions that produce them by focusing on upstream denial prevention, fostering closer collaboration between teams, implementing advanced analytics, and ensuring consistent, timely documentation to minimize lost revenue.

Scaling the Model Through Hybrid Expertise

Even well-designed frameworks run into a practical constraint: the clinical specialists needed to execute them, physician advisors, CDI professionals, and utilization review experts, are in short supply at most health systems. Building internal capability is the right goal, but for many organizations, the staffing gaps are too significant to close quickly enough to keep pace with rising denial volumes.

Hybrid staffing models address that gap directly by combining local clinical teams with specialized external expertise, including both onshore and global talent, to extend coverage, reduce turnaround times, and maintain continuity across time zones. Rather than replacing internal teams, the model is designed to amplify what they can do.

The results of that approach can be substantial. One Midwest health system, facing rising denial volumes and limited internal capacity, partnered with AGS Health to deploy a nearshore clinical support model aligned with its denial management workflows. The team included physicians and CDI specialists who worked alongside internal staff to improve the quality and consistency of documentation review and appeals while strengthening upstream documentation practices.

The outcome was more than $12 million in annual revenue recovered from previously denied claims, a 55% recovery rate, and an approximately 40x return on investment. Those results reflect not just improved appeals performance but a more proactive documentation strategy that reduced downstream denial exposure over time.

For complex appeals, clinical validation reviews, and documentation improvement initiatives requiring deep clinical knowledge, hybrid models offer both the scalability to handle volume and the specialization to handle complexity, without the overhead of building capacity entirely in-house.

Turning Appeals into Evidence-Based Strategy

Even with a strong prevention framework in place, some denials will occur. The goal at that point is not to appeal them en masse and indiscriminately, but instead to appeal strategically and in a way that maximizes recovery while informing upstream prevention efforts.

That starts with treating denial patterns as data. When appeals are tracked and analyzed systematically, by payer, denial type, and clinical category, it becomes possible to identify which cases are most likely to succeed on appeal, where internal documentation practices are consistently falling short, and which specific payer challenges or trends warrant a more structured response. Appeals can cross-function as an intelligence loop.

Evidence-based appeal strategies built on that analysis, supported by detailed clinical documentation and payer-specific insights, can significantly improve overturn rates and accelerate revenue recovery. Equally important, the patterns surfaced through appeals work can feed directly back into CDI and utilization review priorities, tightening the prevention framework over time.

The result is a denial management strategy that operates as a continuous cycle rather than a series of disconnected responses: prevent what can be prevented, recover what slips through, and use both to reduce future exposure.

Payer scrutiny is not going to ease. Reimbursement pressures will continue to push automated audits further into clinical territory, and the documentation bar will keep rising. Organizations that treat that reality as an administrative burden to manage will remain in a reactive posture, absorbing costs that compound over time. Those that treat it as a structural challenge requiring coordinated clinical, operational, and analytical investment will be better positioned to protect revenue, reduce waste, and free their clinical teams to focus on care rather than paperwork.

< + > This Week’s Health IT Jobs – June 3, 2026

It can be very overwhelming scrolling through job board after job board in search of a position that fits your wants and needs. Let us take that stress away by finding a mix of great health IT jobs for you! We hope you enjoy this look at some of the health IT jobs we saw healthcare organizations trying to fill this week.

Here’s a quick look at some of the health IT jobs we found:

• HIMS Tech – Encompass Health
• Revenue Cycle Patient Representative – Centra Health
• Clinical Engineering Cyber Specialist – Sodexo
• Chief Information Officer (CIO) – Summa Health
• AI Strategy Associate Director – State Health – Guidehouse
• Healthcare Payer Relations Credentialing and Contract Support Specialist – VITAS Healthcare
• Coding Rep I – Cincinnati Children’s
• Patient Experience Representative I – MultiCare Health System
• Healthcare Operations Analyst (Provider Data) – Healthfirst
• Patient Access Assoc I – R1 RCM
• Associate Chief Digital Information Officer – AMN Healthcare Leadership Solutions | B.E. Smith
• ROI Medical Records Specialist – MRO
• Healthcare AI Engagement Lead (Remote) – Cognizant
• Database Administrator II – Health Outcomes – CHRISTUS Health
• Technology Director, Billing and Enrollment – Medica
• HIM ROI Analyst II – Intermountain Health
• Cybersecurity Advisor – Healthcare TPRM – Cortile
• Patient Care Technician – DaVita Kidney Care
• Fractional CIO/IT Executive Advisor – Hackley Community Care
• Director, Quality & Patient Safety – Boston Medical Center (BMC)

If none of these jobs fit your needs, be sure to check out our previous health IT job listings.

Do you have an open health IT position that you are looking to fill? Contact us here with a link to the open position and we’ll be happy to feature it in next week’s article at no charge!

*Note: These jobs are listed by Healthcare IT Today as a free service to the community. Healthcare IT Today does not endorse or vouch for the company or the job posting. We encourage anyone applying to these jobs to do their own due diligence.

< + > The Payment Integrity Reckoning

The following is a guest article by Mark Noel, SVP and GM of ClaimInsight at AMPS

Why transparency and defensibility have become non-negotiable for health plans — and what it takes to build a program that actually holds up.

Payment integrity is at an inflection point. Scrutiny is increasing across the industry, and the structural vulnerabilities that many health plans have operated around for years are surfacing. The consequences are no longer theoretical.

The core issue is not whether savings are being generated. It is whether those savings are accurate, explainable, defensible, and ultimately realized. For many plans, the honest answer to at least one of those questions is uncomfortable.

This piece is for the health plan leaders who are asking hard questions about what their payment integrity program is actually producing and what a better model looks like.

The Structural Problem No One Wants to Name

For years, the payment integrity market has operated on a deceptively simple value proposition: find claims savings, report the numbers, collect the fees. Vendors compete on volume. Health plans track “identified savings” as the headline metric. Everyone moves on.

The problem is that identified savings and realized savings are not the same thing and that gap has become one of the most consequential blind spots in health plan finance.

When a claim is adjusted and an appeal follows, the logic behind the original decision matters enormously. If that logic is opaque, buried in a proprietary algorithm the health plan cannot explain, reproduce, or defend, then the finding erodes. An overturn is not just a lost dollar. It is a signal that the original savings never really existed.

This is the structural problem the industry has avoided naming directly: a meaningful portion of reported payment integrity savings is, under scrutiny, not durable. And health plans that cannot see inside their own programs have no way to know how much of their book falls into that category.

Four Ways Health Plans Absorb the Cost

The financial and operational consequences of this model are well distributed, which makes them easy to underestimate. They don’t show up in a single line item. They accumulate across four vectors.

1. Appeal Erosion

Provider disputes and insufficient clinical rationale reduce identified savings after the fact. The gap between what was reported and what was collected is often larger than plans realize and rarely tracked rigorously enough to surface the full picture.

2. Missed High-Dollar Opportunities

High-cost inpatient claims are among the largest drivers of medical spend and among the most likely to receive generalized review rather than the clinical depth they require. Volume-based processing systematically underperforms on the cases where precision matters most.

3. Administrative Friction

Dispute volume drives resource strain, internally and across provider relationships. When adjustments aren’t defensible, every challenge takes longer, requires more documentation, and strains the relationships that operational efficiency depends on.

4. Unpriced Reputational and Regulatory Risk

As industry scrutiny intensifies, the inability to explain how claim decisions were made creates real exposure. Regulatory inquiries, provider disputes that escalate, and the reputational costs of decisions that appear arbitrary under examination are all downstream of the same root cause: a lack of transparency into methodology and outcomes.

The Transparency Gap: Why Opacity Is No Longer a Differentiator

Many legacy payment integrity models were built around proprietary, algorithmic logic. The pitch was straightforward: trust the black box. For a period, this was commercially viable. The market didn’t demand accountability at the claim level, and most health plans lacked the internal capability to interrogate vendor methodology in detail.

That era is ending and faster than most plans have recalibrated for.

The transparency gap is a practical liability across multiple dimensions.

Accountable. When a plan cannot independently validate how a payment decision was made, it is wholly dependent on the vendor’s interpretation. This is not a partnership, it is a dependency. And dependencies are vulnerabilities during disputes, audits, and litigation.

Provider relationships. Providers are sophisticated counterparties. When they challenge a claim decision and the health plan cannot articulate a clear clinical or contractual rationale, the dispute escalates, the relationship strains, and the original finding often fails. Transparency is a prerequisite for defensibility.

Regulatory scrutiny. The regulatory environment for payment integrity practices is not static. Plans that rely on opaque vendor logic and cannot demonstrate that their processes are clinically grounded, consistently applied, and fully documented are poorly positioned as that environment evolves. What is currently a performance risk can become a compliance risk without meaningful advance notice.

Legacy vs. Modern: The Standard Has Shifted

The gap between where payment integrity programs operate today and where they need to operate is best understood by placing the two models side by side.

Legacy model:

• Opaque, proprietary algorithms
• Savings identified (gross), not realized (net)
• High appeal overturn rate
• Vendor-owned methodology
• Volume-based edits
• Limited auditability

Modern standard:

• Transparent logic, explainable at the claim level
• Savings realized after appeal, not just identified upfront
• High uphold rate, findings built to withstand challenge
• Plan-owned decisions, vendor is tool, not authority
• Clinically precise, case-specific review
• Full claim-level defensibility

The move from one model to the other is not just a technology upgrade. It is a fundamentally different philosophy about what a payment integrity program is for. Legacy models optimize for finding discrepancies. Modern programs optimize for findings that hold up and for the financial, operational, and institutional credibility that comes with them.

The High-Dollar Claim Problem Deserves Special Attention

The case for a more rigorous, transparent model is most acute in the context of high-dollar inpatient claims. These are the cases where the financial stakes are highest, appeal risk is greatest, and clinical nuance has the most direct influence on outcome validity.

High-cost claims represent a disproportionate share of medical spend for most health plans. They are also the cases most likely to receive inadequate depth of review under volume-driven models, because generalized rules and algorithmic processing are poorly suited to the complexity these claims actually contain.

A claim involving an extended inpatient admission, complex procedure coding, or uncommon clinical scenario does not yield to a standardized edit. It requires physician-level review, case-specific analysis, and a working understanding of how coding and reimbursement standards apply to the actual clinical record at hand. These are not capabilities that scale through automation alone.

When findings are clinically grounded, clearly documented, and built to withstand challenge, the result is not just higher savings but more durable savings. The financial difference between “savings identified” and “savings realized” is largest precisely where clinical depth is most often absent.

What Health Plans Actually Need to Demand

The question is not whether the payment integrity market will change, it is whether individual health plans will lead that change or follow it. Plans that continue to accept opaque, volume-based programs without demanding claim-level visibility will absorb the costs of that decision for as long as they remain in that posture.

At minimum, every claim adjustment should be:

• Explainable — The health plan should be able to state clearly and specifically why any given claim was adjusted, in clinical and contractual terms a provider, regulator, or judge could evaluate.
• Grounded — Adjustments must be anchored in clinical evidence, coding standards, or contract language, not statistical pattern-matching. Clinically grounded decisions hold up under scrutiny.
• Reviewable — The health plan, not only the vendor, should have meaningful visibility into how outcomes are produced. This is what separates a plan that owns its program from one that rents another organization’s black box.
• Realized — The ultimate measure is not the number at the top of the funnel. It is the number at the bottom, after appeals, after disputes, after the program has been stress-tested by real-world challenges.

The Right Starting Point: Visibility, Not Disruption

For health plan leaders who recognize the problem but are uncertain where to begin, the answer is not a vendor replacement or a program overhaul. The right starting point is simpler and considerably less disruptive: an independent view of what your current program is actually producing.

There is almost always a gap between what is suspected and what can be demonstrated at the claim level. Plans that operate without independent validation of vendor performance are, in effect, accepting reported savings figures without review. That is a posture that creates financial risk, not manages it.

An independent, physician-led review of a targeted sample of high-dollar claims can surface a precise picture quickly: where is savings potential being left on the table? Where are existing findings at risk of not holding up on appeal? Where does the current program’s logic diverge from defensible clinical or coding standards?

This kind of analysis does not require operational disruption. It delivers immediate financial insight, produces data to support internal decision-making, and creates meaningful leverage for vendor conversations, whether the outcome is optimizing an existing relationship, adding targeted capabilities, or making a broader program change.

The Bottom Line: A New Bar for Payment Integrity

The health plans that will lead on payment integrity in the years ahead are not the ones with the most vendor relationships or the longest list of edits. They are the ones that know, at the claim level, what their program is producing and can demonstrate that every dollar of savings is accurate, defensible, and real.

That standard is not aspirational. It is increasingly the baseline expectation, from regulators, from providers, and from plan leadership that is asking harder questions about where reported savings actually go.

Health plans that adapt to this reality will gain materially: higher net savings, greater internal confidence in outcomes, stronger positioning with providers and regulators, and meaningful control over how medical spend is managed. Those that don’t will continue absorbing costs that are easy to overlook until they’re not.

The question is not whether savings are being generated. The question is whether you know, with confidence and specificity, how those savings are produced and whether they will hold up when challenged.

Getting that answer is the first step. And it is available faster than most plans expect.

About Advanced Medical Pricing Solutions

AMPS is a healthcare cost savings technology company helping organizations take control of rising healthcare costs while delivering a better, more supported member experience. With over two decades of experience, we bring together medical claims strategy, payment integrity, and pharmacy benefits into a connected ecosystem designed to reduce costs, improve accuracy, and support the people behind every claim. Through our three solutions (ClaimInsight, PriceDynamix, and Drexi), we deliver Healthcare Cost Savings, AMPLIFIED. For more information visit www.AMPS.com or www.ClaimInsight.com

AMPS is a proud sponsor of Healthcare Scene.

< + > Anomaly Secures an Additional $17M to Fundamentally Change How Health Systems Engage With Payers

Sound Ventures Leads Round, Joined by Alumni Ventures

New Funding Expands Anomaly’s AI-Powered Platform from Revenue Cycle Operations into Managed Care, Arming Providers with Payer Intelligence Across Every Contract Negotiation and Claims Interaction

Anomaly Insights, the first AI-powered payer intelligence company built to close the knowledge gap that fundamentally disadvantages healthcare providers, today announced $17 million in new funding led by Sound Ventures. Alumni Ventures also joined the round, alongside existing investors Link Ventures, Redesign Health, and RRE Ventures. The funding brings Anomaly’s total raised to $34 million.

Healthcare provider organizations lose billions in revenue because of payer denials, underpayments, downgrades, retractions, and delays that deviate from written contract terms and policy documents. They lack the visibility and insight to discern patterns from these revenue defects, and struggle at great expense to contest at scale. It’s common for an insurance plan today to deploy seven or more payment integrity vendors with the explicit mandate to find new justifications to reduce what providers are paid. The result is a structural knowledge asymmetry that plays out in every claim submission, every contract negotiation, and every conversation between a provider and the payer. Anomaly directly targets that asymmetry, using proven AI and Machine Learning technology provider organizations the intelligence to understand exactly how their payers behave and the tools to act on it.

“Providers have known intuitively for years that the system is rigged against them,” said Mike Desjadon, CEO at Anomaly Insights. “What they’ve never had is the intelligence to prove it, and a partner to ‘bring the receipts’ and help them act on it, and finally change payer behavior. This funding accelerates our ability to give healthcare organizations something they have never had before: a platform that demonstrates how their payers actually behave, and the leverage to engage them as equals when it comes to contesting payment issues or contract negotiations.”

Anomaly’s platform analyzes billions of healthcare transactions in real time, surfacing the payer behavior patterns, policy shifts, and adjudication deviations that determine what providers actually get paid. The platform serves both revenue cycle and managed care functions, connecting day-to-day claims management with contract negotiation strategy and giving leadership a unified view of the full payer relationship. To date, Anomaly has recovered tens of millions in provider revenue and produced measurable changes in payer behavior across health systems, large provider organizations, diagnostic laboratories, and outsourced RCM companies.

“Anomaly Insights has genuinely been an enjoyable partner to work with—something that is rarely true of vendors. Their curiosity and drive to explore new possibilities make them highly effective at consistently finding ways to add value,” said Isaac Horner, MBA, System Director of Revenue Cycle Operations at Bronson Healthcare. “They bring strong creativity and a willingness to pivot when a better approach emerges. We took a thoughtful approach to integrating with Epic, and Anomaly proved to be the right partner to invest alongside us to get it right.”

“Providers lose billions every year to an information asymmetry that has defined payer-provider dynamics for decades,” said Juliette Bolea, Anomaly Insights Board Member and Investor at Sound Ventures. “Anomaly flips that dynamic, arming providers with the data and AI to negotiate from a position of strength. We invested because this is not an abstract market problem: every one of us is a patient eventually. When we change how payers and providers interact at scale, providers can focus on care, and patients are the ones who benefit.”

To date, Anomaly is deployed across 20+ health systems. Anomaly’s health system customers represent organizations that averaged over $4 billion in annual net patient revenue in 2024.

About Anomaly Insights

Anomaly Insights is the first AI-powered payer intelligence company built to close the knowledge gap that fundamentally disadvantages healthcare provider organizations. The healthcare transaction system is governed by incentives, not rules, and payers have long held the data advantage that shapes how those incentives play out. By analyzing billions of healthcare transactions in real time, Anomaly’s platform decodes payer behavior at a machine speed and precision – surfacing the patterns, policy shifts, and behavioral deviations that determine what providers actually get paid. The result is not just fewer denials and recovered revenue. It is a fundamentally different posture for providers in every contract negotiation and interaction they have with payers. Anomaly has recovered tens of millions in provider revenue and produced measurable changes in payer behavior. The company works with health systems, large provider organizations, diagnostic laboratories, and outsourced RCM companies across the country. Founded in 2020 and headquartered in New York, Anomaly is backed by Sound Ventures, RRE Ventures, Madrona, and Redesign Health.

Originally announced May 13th, 2026

< + > Improving the Patient Experience Across Access, Communication, and Continuity of Care

For the most part, the days of having no choice in your healthcare provider other than the only one in your area are gone. It’s becoming very common for people to not only have more options but to utilize them as well. If the level of care or the experience is not up to what the patient is seeking, they can and will go to a provider that can meet those needs. As such, improving the patient experience has quickly become one of the biggest priorities in the healthcare space. There are many different approaches and methods that people have been using, so today we are going to narrow our focus down to just the impact of health IT solutions.

We reached out to our brilliant Healthcare IT Today Community to ask — how are health IT solutions improving the patient experience across access, communication, and continuity of care? The following are their answers.

Sean Raj, Chief Medical Officer and Chief Innovation Officer at SimonMed
There’s a fundamental shift happening in healthcare—from reactive and episodic to proactive and continuous—and AI is accelerating that change faster than most systems are designed to handle.

Imaging sits at the center of this transformation. It has the potential to detect disease earlier and create a baseline for managing health over time. But for too long, that value has been trapped in static reports that patients don’t fully understand and rarely engage with.

What we’re now seeing is a redefinition of the patient experience. Digital health platforms are translating imaging results into clear, actionable, and mobile-friendly insights paired with seamless pathways to follow-up care. In many cases, that means a patient can move from diagnosis to the next step with a single click. The biggest shift is that technology now elevates care beyond just report delivery. We are now empowering patients to stay continuously connected to and proactive about their health, rather than only engaging when something goes wrong.

Keith Herron, MHS, PA-C, Global Product Owner – Clinical Solutions at CenTrak
Health IT solutions are improving continuity of care by pulling together information from fragmented encounters and making it available in the EHR, ensuring that care providers have the information they need to make informed decisions. Some, such as RTLS software solutions, provide tools that allow better coordination of care by tracking patient progress, status, and interactions to ensure staff have better situational awareness to provide more efficient delivery of services.

Mindy Fortson, Chief Client Officer at Experian Health
While technology is helping close operational gaps, providers must still address staffing pressures that impact the patient experience. Experian Health’s 2026 State of Patient Access survey found that more than half (64%) of providers are reporting a direct impact on staffing, which is up seven percent from last year. For patients, access to practitioners remained the top challenge for the fourth year in a row. While technology cannot fully solve workforce shortages, digital tools and automation can help optimize existing resources. We are seeing providers prioritizing several initiatives to improve the patient experience with technology. Providers are focusing on faster, more automated ways for comprehensive insurance coverage review (44%), automation of authorizations (40%), and we saw a significant drop in patient dissatisfaction (18%) by delivering more accurate cost estimates and reducing surprise billing.

Jen Goldsmith, Co-Founder & CEO at Tendo
We’re seeing the rise of more consumer-oriented healthcare marketplaces, where Health IT enables pricing transparency, a pathway to understanding provider quality, and bundled episodes of care. For uninsured or underinsured populations in particular, these tools make it easier to find affordable, high-quality options and engage with the healthcare system in a way that removes friction from the care process.

Dr. Rowland Illing, Global Chief Medical Officer and Director, Healthcare and Life Sciences at Amazon Web Services (AWS)
Today’s health IT solutions, particularly those powered by agentic AI, are transforming the patient experience by making care easier to navigate and freeing clinicians’ time to focus on their patients.

Across the care journey, AI agents are reducing friction at every touchpoint. Patients can more easily schedule appointments with an agent, even during off-hours, and spend less time repeating the same information to multiple people before and during appointments. The result is a more transparent, user-friendly healthcare experience that meets rising patient expectations.

What’s equally important about AI agents is that they not only can perform these tasks, but also provide a personalized experience. By understanding patients from their medical records and preferences, agents can tailor interactions in a way that is both specific to a patient and easy to engage with through natural language.

At the same time, AI is reshaping provider workflows. Agentic AI solutions can now automate time-intensive administrative tasks such as medical coding and clinical documentation, while delivering pre-visit patient health summaries that ensure clinicians are better equipped for each visit. This shift allows clinicians to spend more time building trust and delivering high-quality care, ultimately driving better patient experiences.

Stephen Vaccaro, President at HHAeXchange
Delivering quality care in the home requires infrastructure that supports coordination at every touchpoint. Providers focused on maintaining continuity of care and improving the patient experience understand they can often make the biggest difference by starting with simple but impactful changes at the operational level.

Using homecare management technology for complex daily tasks — including caregiver scheduling, payroll, and billing processes — helps agencies run smoothly and reduce issues like missed visits to ensure consistent care. While in clients’ homes, that same technology helps caregivers collect visit data on mobile devices to meet electronic visit verification (EVV) requirements.

Beyond day-to-day logistics, health IT solutions tailored for homecare are bridging communication gaps between payers, agencies, and frontline caregivers. Additionally, when all of these stakeholders share a single system, information flows freely, and families and clients gain visibility into the process. This alignment strengthens outcomes and allows caregivers to build trusted relationships with the people they serve.

Ultimately, health IT solutions help keep older adults and individuals with complex care needs safe, healthy, and independent in their own homes and communities.

Conrad Gudmundson, Chief Commercial Officer at Lucem Health
Improving the patient experience starts with an earlier, faster diagnostic process. We must move beyond legacy models that wait for symptoms to appear. The future is population-level precision medicine that personalizes every interaction. By identifying risk within an entire population, we guide patients to their next step before a crisis hits. This turns engagement into a proactive, scalable capability that finally closes the gap between detection and action.

Dan McDonald, Co-Founder and CEO at 86Borders
Health IT drives human efficiency and helps make care more connected, but the real impact comes when it reduces the burden on patients. Technology can help make it easier than ever to connect with health plan members, to support, stay in touch, and avoid delays, but too many people still face barriers that technology alone cannot solve.

The biggest shift is in continuity. When information seamlessly moves across systems, care teams can better understand a patient’s situation, including needs that go beyond clinical care. That human connection solves for social determinant needs, helps close care gaps, and creates a more consistent experience. Technology works best when it drives efficiency and supports real engagement and helps guide patients through a healthcare system that can otherwise feel overwhelming.

Tij Bedi, Executive Vice President and General Manager, Patient Access and Innovation at IKS Health
Health IT must improve the patient experience where it actually matters, by reducing the friction people feel when accessing, connecting, and paying for care. The goal is to make it easier for patients to engage in their care, which leads to improved health and lower total cost of care.

To achieve this, it’s so important to put patients first and understand why they make the choices they do. Using deep technology to create an intelligence layer helps the patient and the healthcare organization. By knowing and understanding patient preferences, behaviors, patterns, and insurance architecture, it’s possible to preactively manage a patient’s care journey. With nudges for patient action, patients are more prepared, more adherent, more reliable, and more operationally predictable.

The shift toward a more behaviorally focused approach is about easing patient activation. Using advanced behavioral models, health systems can better understand what a patient knows, what might be in their way, and what motivates them to take the next step. That’s what transforms communication into real engagement, creating value for both the patient and the care team.

Dr. Nicholas Testa, Chief Clinical Officer at Sentact
The patient experience is a growing priority for most hospitals and health systems, and many are turning to solutions designed to break down fragmented systems and workflows, provide visibility into patient needs, and proactively address barriers impacting outcomes. Digital tools such as comprehensive rounding solutions create a hybrid environment that provides two key solutions.

First, they allow leaders to gain global visibility into the aggregate results of leader rounding. Second, they help hold everyone accountable by ensuring clinical teams step away from their emails and out of meetings to stand at the patient’s bedside, gaining a clearer understanding of their experience and perspective. When these solutions are combined with self-directed feedback surveys that can be accessed across various locations throughout facilities, and analytics that provide real-time insight to help streamline grievance management, health systems are better able to create seamless connections between patients and care teams.

These solutions are pivotal for capturing patient satisfaction both during and after a visit, helping health systems identify underlying risks and areas for improvement to address concerns or gaps quickly. The result is stronger patient trust in care teams and lasting insights that continuously elevate the patient experience.

Bob Farrell, CEO at mPulse
Health IT solutions focused on health experience and insights are making care more intuitive, personalized, and connected, ultimately, powering consumer centricity. Over the last year, 57% of health plan members reported worsening healthcare experiences. As members are acting more like consumers in healthcare, they’re searching for partners in navigating their complex care journeys. By pairing healthcare behavior predictions with AI-driven outreach, healthcare stakeholders can anticipate the next best step for members, and generate tailored interactions, whether that’s prompting follow-up care, surfacing options, or helping make informed decisions.

When outreach meets members in their preferred language, in the right mode, at the right time, and with information that’s useful to their specific journey, the experience feels seamless rather than fragmented. This ultimately strengthens the continuity of care. By proactively identifying and addressing gaps in care, we keep members engaged and connected, even when challenges arise, ensuring they don’t fall through the cracks, getting the care they need to orchestrate better health outcomes, higher satisfaction, and lower costs.

Branden Pearson, VP of Technology at TeleMed2U
Technology is increasingly serving as a core enabler of scalable, equitable access to care, particularly in rural communities where both primary care capacity and specialist coverage are constrained. Telemedicine, for example, offers convenient virtual visits that meet patients where they are, removing common geographic barriers to care, such as the need for reliable transportation, taking time away from work to travel long distances to appointments, and extensive wait times for available providers that can span months.

Digital resources also support care accessibility initiatives by arming patients with easy-to-navigate tools to help them connect with the clinical services they require when they are needed. By reducing traditional access friction and offering advanced communication tools like secure messaging, personalized patient follow-ups, and well-integrated clinical documentation, patients are empowered to stay better connected to their care team and adhere to their care plans, which is crucial for patients managing chronic conditions or complex needs longitudinally.

Nicole Rogas, President at RevSpring
Health IT solutions are improving the patient experience by reducing fragmentation across access, communication, and financial engagement. Self-service tools like scheduling and price transparency make it easier for patients to access care, while more intelligent, data-driven communication platforms enable timely, personalized outreach on preferred channels. When these capabilities are connected, they create continuity across the patient journey – reducing friction, increasing transparency, and building trust while driving better outcomes for both patients and providers.

Blake Richards, COO at Elucid
For technology to be widely adopted and truly improve the patient experience, it generally must simultaneously reduce the burden on the clinician. In cardiovascular care, this means moving beyond simple data collection to providing actionable insight. By using advanced AI to analyze coronary CT angiographies (the standard for non-invasive assessment), clinicians can extract precise risk data that previously required invasive cardiac catheterization.

This transition not only spares the patient from unnecessary procedures but also provides a clear, high-fidelity visualization of their disease. When a patient can actually see their health status in an understandable format, it fosters a sense of ownership, leading to higher trust and better adherence to treatment. Ultimately, the most effective health IT solutions act as a bridge, turning complex diagnostics into a clear, shared pathway for both the primary care physician and the specialist

Such great insights here! Huge thank you to everyone who took the time out of their day to submit a quote to us! And thank you to all of you for taking the time out of your day to read this article! We could not do this without all of your support.

How do you think health IT solutions are improving the patient experience across access, communication, and continuity of care? Let us know over on social media, we’d love to hear from all of you!

< + > CIO Podcast – Episode 115: Healthcare Communication Solutions with John Gaede

For the 115th episode of the CIO podcast hosted by Healthcare IT Today, we are joined by John Gaede, CIO at San Juan Regional Medical Center, to talk about healthcare communication solutions! We kick this episode off by discussing the big challenges Gaede faces as a rural health CIO. Next, Gaede shares why he chose to go with the PerfectServe solution over the EHR functionality for his organization. Then, we dive deep into the scope of Gaede’s project with PerfectServe as he shares his main goals for it as a clinical project vs as an IT project. Gaede has mentioned that this is the most important project he’s undertaken and is the major focus of his transformation efforts, so we dive into why this is so important. Next, we talk about the other projects Gaede is working on/recently completed that he’s excited about. We then switch over to the technologies/solutions/vendors/etc. Gaede has not implemented, but is keeping an eye on. Lastly, we conclude this episode with Gaede sharing advice to anyone aspiring to be a CIO like him.

Here’s a look at the questions and topics we discuss in this episode:

• What are some of the big challenges you face as a rural health CIO?
• Talk about why you recently chose to go with the PerfectServe solution at your organization rather than using the EHR functionality.
• Describe the scope of the project with PerfectServe and your main goals for it as a clinical project vs an IT project.
• You mentioned that this is the “most important project you’re undertaking” and is a major focus of your transformation efforts. Why is this so important?
• What other projects are you working on or recently completed that you’re excited about?
• What technology, solution, vendor, etc., have you not implemented, but you’re watching?
• What advice would you give someone who aspires to be a CIO like you?

Now, without further ado, we’re excited to share with you the next episode of the CIO Podcast by Healthcare IT Today.

We release a new CIO Podcast every ~2 weeks. You can also subscribe to the Healthcare IT Today podcast on any of the following platforms:

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We’d love to hear what you think of the podcast and if there are other healthcare CIO you’d like to see us have on the program. Feel free to share your thoughts and perspectives in the comments of this post with @techguy on Twitter, or privately on our Contact Us page.

We appreciate you listening!

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