Becker's ASC Review

22 22 HEALTHCARE NEWS term borrowing to bridge that gap." Unsurprisingly, technology is also central to the plan. CommonSpirit has generated $100 million in combined annual value from AI applications and its teams have identified about $250 million in AI- driven value enhancements to date, against a goal of $500 million by June 2026. e system operates a proprietary AI tool called Insightli, which keeps data within CommonSpirit's network to manage privacy risk. Since launching two years ago, Insightli has logged roughly 1 million project submissions and generated more than 230 scalable AI interventions across the enterprise, CIO Daniel Barchi told Becker's. AI will play a leading role in the future of CommonSpirit's revenue cycle. "We believe AI can help reduce cost, improve outcomes, and give us better insight into which function should be in source and which should be supported externally," Mr. Browning said. "While we will use offshore vendors, that work would be limited to back office functions, not patient-facing activity." is revenue cycle work ties directly to CommonSpirit's broader payer strategy. "We cannot continue to provide high-quality care at reimbursement levels that do not reflect the true cost of care," Mr. Browning said. "Strengthening payer relationships, improving reimbursement and reducing the cost to collect are all part of building a more sustainable operating level." On that note, one of the largest single moves under the transformation umbrella is also underway: CommonSpirit is insourcing revenue cycle operations currently managed by Conifer, a subsidiary of Dallas-based Tenet Healthcare. e system entered into a termination agreement with Conifer in January — recording a $2.2 billion special charge — and leaving a substantial dent in its finances. e transition is expected to be complete by January 2027. e move is expected to reduce CommonSpirit's "cost to collect to close to industry average," Mr. Browning said. "From where we currently reside, we've caught up between 5.5% and 6% down to 3% and will generate more than $1 billion of operational cost savings on an annual basis — a 1% revenue realization improvement also adds $400 million in revenue." n Rural health's $50B won't cover $160B in HR 1 cuts: Report By Andrew Cass T he $50 billion Congress set aside for rural healthcare in HR 1 will be outpaced by Medicaid, ACA marketplace and SNAP cuts by 2029, according to a June 9 report from The Commonwealth Fund. The report's authors used an economic modeling system to examine the combined effects of HR 1 and the expiration of the ACA tax credits on every state's economy and employment in 2026 — the first year of implementation — and 2029, when the law's changes are fully implemented. Seven things to know: 1. The Rural Health Transformation Program is distributing $10 billion annually over five years for rural healthcare access and quality improvements. In 2026, the report projects it will generate 110,100 new jobs and $13.8 billion in GDP gains. Smaller rural states — Alaska, Vermont and Wyoming among them — stand to see net positive economic returns. But those gains are absorbed by simultaneous losses elsewhere in the same law. 2. HR 1 reduces federal Medicaid spending by $90.9 billion in 2029 alone, according to the report. ACA marketplace funding falls by more than $57 billion that year, and SNAP funding will be cut by $21.8 billion. Against the rural health transformation fund's $10 billion annual contribution, the net federal funding loss reaches $160 billion in 2029. 3. The Commonwealth Fund projects that the $160 billion in federal cuts will reduce state GDPs by $197 billion in 2029, about 23% more than the federal savings themselves. The report attributes the gap to a multiplier effect: federal healthcare dollars cycle through hospitals, pharmacies, grocery stores and local businesses, so cuts generate economic losses larger than the funding reductions that triggered them. 4. The report projects 1.65 million fewer jobs nationally in 2029, equivalent to a 1 percentage point increase in the unemployment rate. Nearly half of those losses — about 800,000 positions — would come from the healthcare sector. An additional 135,500 jobs are projected lost due to SNAP cuts, many in food-related industries. 5. In 2026, the losses are projected to be concentrated in states that did not expand Medicaid under the ACA and are therefore more reliant on ACA marketplace coverage. The January expiration of the enhanced premium tax credits is driving those losses. Georgia, Texas and Florida are projected to lose between 30,700 and 79,500 jobs in 2026, equivalent to a 0.5% to 0.6% decline in their employment rates. By contrast, 22 smaller, more rural states will see net job gains that year. 6. When Medicaid cuts are fully phased in by 2029, however, every state is projected to lose federal funding and "suffer substantial economic and employment losses," according to the report. States that expanded Medicaid face deeper losses because HR 1 specifically targeted expansion states with work requirements, stricter enrollment procedures and higher cost sharing. 7. As employment declines and incomes fall, state and local tax revenues are projected to drop by $14 billion in 2029. That limits the ability of states to offset lost federal funds through their own budgets.n

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