As patient expectations rise and healthcare delivery becomes more complex, access functions face increasing strain. Legacy systems and fragmented workflows can no longer handle real-time scheduling, eligibility verification, and financial clearance. Despite growing investments in AI, several organizations fail to achieve meaningful gains due to the absence of cohesive orchestration across access processes. This report introduces Systems of Execution (SoE) as healthcare enterprises’ next critical capability layer. Positioned between core systems and AI applications, SoE platforms enable coordinated, intelligent execution across patient access touchpoints. The report outlines key effective SoE tenets, including embedded AI, adaptive learning, and API-driven interoperability, and illustrates how they can transform critical touchpoints across the revenue cycle. It also profiles the evolving vendor landscape and offers strategic considerations for healthcare stakeholders seeking to optimize patient access with SoE-driven approaches.

As US healthcare providers grapple with a turbulent economic and regulatory landscape, new tariffs and evolving policies are reshaping operational and financial realities across the sector. In response, providers are reassessing spending, delaying technology investments, and seeking more cost-effective operations. This report explores how Revenue Cycle Management (RCM) providers can strategically help healthcare organizations navigate this disruption. It highlights key actions such as adopting flexible pricing, enhancing operational agility, and deploying targeted AI to improve efficiency and safeguard revenue. Designed for RCM leaders and healthcare stakeholders, the report offers practical guidance on turning disruption into opportunity by aligning solutions with shifting provider needs. Scope Industry: healthcare Geography: North America Contents This report covers the impact of tariffs and regulations on healthcare providers and outlines strategic and portfolio-specific actions RCM providers can take to mitigate risk, enhance value, and drive growth. Memberships Healthcare Payer and Provider Business Process Revenue Cycle Management Sourcing and Vendor Management

The evolving landscape of Revenue Cycle Management (RCM) highlights how AI, automation, and outsourcing are transforming financial and operational efficiencies for healthcare providers. Despite persistent challenges such as billing complexities and staffing shortages, healthcare leaders are increasingly prioritizing advanced automation, AI-driven decision-making, and cybersecurity to modernize RCM processes. Generative AI is expected to play a vital role in this modernization, with 85% of RCM leaders believing it will enhance efficiency within the next five years. Key applications include real-time eligibility verification, AI-driven chatbots, and automated medical coding, though organizations must address challenges such as data accuracy, compliance risks, and integration with legacy systems. As RCM continues to evolve, technology-enabled outsourcing models are becoming essential for sustainable growth, enabling providers to optimize workflows, reduce costs, and enhance patient experiences. This report underscores that AI-driven RCM is no longer an option but a necessity for healthcare providers seeking financial resilience and operational excellence. Additionally, it highlights key considerations for selecting the right RCM partner and outlines how third-party providers can enhance RCM workflows for greater efficiency and compliance. Scope Industry: healthcare Geography: North America Contents In this report, we explore: Key RCM challenges healthcare providers face Investment priorities for 2025 through 2030 Current adoption of advanced analytics and intelligent automation, along with priority use cases The emergence of generative AI in RCM, healthcare providers’ readiness, key use cases under consideration, and mitigation strategies for associated risks and barriers An outsourcing strategy for healthcare providers to transition to a technology-powered outsourcing model Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

In recent years, technology enterprise adoption and digitalization have significantly reshaped Revenue Cycle Management (RCM), transforming how healthcare providers optimize financial performance and patient engagement. To enhance provider reimbursements, streamline claims processing, and accelerate value-based care initiatives, healthcare providers have made digital adoption their RCM strategies’ foundation. To meet growing enterprise demands, RCM platform providers are expanding their capabilities through investments in AI/gen AI-driven automation, strategic partnerships, and acquisitions to drive efficiency and financial sustainability. In this report, we evaluate 22 RCM platform providers mapped on the Everest Group PEAK Matrix® framework. The report analyzes the RCM platform market size, growth trends, and key capabilities, offering insights into market success metrics. It offers enterprises the information they need to make informed sourcing decisions in the evolving RCM landscape. Scope Industry: healthcare Product: revenue cycle management Geography: US Contents In this report, we: Assess healthcare RCM platforms market trends Examine each platform provider’s capability and market success-related dimensions Analyze platform providers’ key strengths and limitations Membership(s) Healthcare Payer and Provider Information Technology Revenue Cycle Management Sourcing and Vendor Management

The payment integrity sector is transforming as the healthcare industry seeks to enhance payment process accuracy and efficiency. With rising financial pressures, the demand for effective payment integrity solutions has intensified, prompting stakeholders to explore innovative strategies to manage administrative waste and payment inaccuracies. This viewpoint focuses on a recent significant merger by New Mountain Capital in the payment integrity space that promises to reshape competitive dynamics within the industry. It highlights key enterprise priorities and trends, including the integration of advanced technologies and strategic partnerships aimed at improving operational effectiveness. As stakeholders navigate this changing landscape, insights into the merger's implications will be important for them in understanding how to adapt and optimize their approaches to payment integrity. By examining the evolving market, this viewpoint equips readers with the knowledge to make informed decisions and improve their operations. Scope Industry: healthcare Geography: global Contents In this viewpoint, we explore: A landmark merger in the payment integrity market How the merger addresses key demands in the payment integrity market The merger’s future implications Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

In 2023, US healthcare providers faced formidable challenges. Although patient volumes have started to recover, increased labor expense and talent shortage caused administrative burdens and workflow issues to become more pronounced. Despite slight improvements in hospital margins, denial rates continue to increase, putting pressure on revenue cycle performance and financial stability. Furthermore, being able to access and leverage clean data has become critical given medical coding’s rising complexity and the dynamic regulatory environment. Additionally, the increase in patient responsibility has underscored third-party Revenue Cycle Management (RCM) service providers’ need to provide effective support. As healthcare providers strive to future-proof their revenue cycle operations, the focus remains on enhancing efficiency and mitigating current obstacles. Service providers are responding by scaling their talent pools, enhancing their technology portfolios with automation and analytics, and pursuing mergers and acquisitions to deepen their value chain coverage and remain competitive in the dynamic revenue cycle market. In this report, we assess 29 providers featured on the RCM Operations PEAK Matrix® Assessment 2024. Each profile offers a comprehensive picture of the provider’s service focus through a snapshot of its key strengths and limitations. Scope Industry: healthcare Geography: global Contents In this report, we examine: The RCM Operations PEAK Matrix® Assessment 2024 Key insights into PEAK Matrix® dimensions The RCM business process services provider landscape Providers’ key strengths, limitations, capabilities, and market shares Memberships Healthcare Payer and Provider Business Process Revenue Cycle Management Sourcing and Vendor Management

Healthcare organizations use Revenue Cycle Management (RCM) to manage the administrative and clinical functions related to processing claims, receiving payments, and generating revenue. The cycle begins with a patient scheduling an appointment and continues until the final payment is received. Due to increasing staff burnout cases, changing regulations, rising costs, and prioritizing improved patient experiences, there is a growing demand for third-party services to assist healthcare providers with their RCM operations. This has led to significant growth in the RCM services market, making it one of the fastest-growing segments in the healthcare industry. Within RCM, managed services and technology products are two key solution types. Both play vital roles in optimizing healthcare financial processes and have unique advantages. In this viewpoint, we explore the collaborative relationship between healthcare enterprises and RCM service providers, particularly examining the contributions of these two partnership models (technology products and managed services). The report examines how these models address challenges and looks ahead to future-proofing RCM in the ever-evolving healthcare landscape. Scope Industry: RCM Geography: global The assessment is based on Everest Group’s proprietary research and transactional intelligence Membership(s) Healthcare Payer and Provider Information Technology Healthcare Payer and Provider Business Process Sourcing and Vendor Management

Revenue Cycle Management (RCM) platforms automate financial processes in the healthcare industry, optimizing the revenue cycle from patient registration and appointment scheduling to final bill payment. Healthcare organizations increasingly evaluate RCM platform providers based on the functionalities, features, and technical support they provide. Demand is high for solutions such as patient engagement, denial management, and medical coding, as healthcare providers prioritize solutions that address current challenges and provide flexibility for future developments in the healthcare landscape. In this compendium, we assess 20 RCM platform providers on the RCM Platforms PEAK Matrix®. The study will enable buyers to choose the best-fit providers based on their sourcing considerations, while providers will be able to benchmark their performance against the competition. Scope Industry: healthcare Geography: US The assessment is based on Everest Group’s annual RFI process for calendar year 2023, interactions with leading RCM platform providers, client reference checks, and an ongoing analysis of the RCM platforms market Contents In this report, we examine 20 RCM platform providers for their: Scale of operations: client base overview, revenue, revenue split by value chain and buyer size Key case studies Proprietary solutions and key events Membership(s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management

The year 2022 proved to be a challenging time for healthcare providers in the United States. With patient volumes still lower than pre-pandemic levels, longer average lengths of stay, talent shortages, and rising costs, almost half of the country's hospitals experienced negative margins. To address the mounting revenue pressures, healthcare providers focused on future-proofing their revenue cycle operations and turned to third-party providers to enhance and improve their revenue cycle processes. Revenue Cycle Management (RCM) Operations Provider Compendium 2023 provides accurate, comprehensive, and fact-based snapshots of 31 providers, including their scale of operations, company overview, recent developments, key delivery locations, major clients, technological solutions, and Everest Group’s PEAK Matrix® provider assessment. The compendium also examines the RCM operations service provider landscape. The study will enable providers to benchmark their strengths against their competitors while RCM operations’ buyers will be able to assess the providers on their desired set of capabilities. Scope Industry: healthcare Business Process Services (BPS) Geography: global The assessment is based on Everest Group’s annual RFI process for the calendar year 2023, interactions with leading RCM operations service providers, client reference checks, and an ongoing analysis of the RCM operations market Contents In this report, we assess 31 provider profiles and include: Service suite and scale of operations: key leaders, services suite, FTEs, revenue, recent developments, and partnerships Capabilities and clients: major engagements, revenue split by geography, FTE split by process coverage and location, and revenue split by engagement model Key delivery locations and technology solutions Providers’ key strengths and limitations Membership(s) Healthcare Payer and Provider Business Process Sourcing and Vendor Management

Revenue Cycle Management (RCM) platforms automate financial processes in the healthcare industry. These platforms optimize the revenue cycle, from patient registration and appointment scheduling to the final bill payment. Healthcare organizations are increasingly evaluating RCM platform providers based on the functionalities, features, and technical support they provide. Solutions such as patient engagement, denial management, and medical coding are in demand as healthcare providers are expected to continue prioritizing solutions that not only address current challenges but also provide flexibility for future developments in the healthcare landscape. In this research, we assess 20 RCM platform providers on the RCM Platforms PEAK Matrix®. The study will enable buyers to choose best-fit providers based on their sourcing considerations, while providers will be able to benchmark their performance against the competition. Scope Industry: healthcare Geography: US The assessment is based on Everest Group’s annual RFI process for calendar year 2023, interactions with leading RCM platform providers, client reference checks, and an ongoing analysis of the RCM platforms market Contents In this report, we: Evaluate market trends for RCM platforms Assess 20 RCM platform providers on capability- and market success-related parameters Analyze enterprise sourcing considerations, highlighting the strengths and limitations of each RCM platform provider  Membership(s) Healthcare Payer and Provider Information Technology Sourcing and Vendor Management