With aging populations, critical patient needs, rising costs and stringent regulations, the challenges in healthcare have never been greater.
Healthcare organizations face mounting pressure to sustain performance amid tightening margins, increasing complexity and heightened accountability across the ecosystem. Whether delivering care, managing risk or enabling services, success increasingly depends on how well financial, operational and commercial foundations are structured and governed.
ISG partners with healthcare organizations across the value chain to improve enterprise performance where it matters most — from revenue and cost structures to operating models, sourcing strategies and AI‑enabled execution. With deep healthcare experience and market‑backed insight, we help clients make change measurable, governable and built for long‑term resilience.
Our healthcare advisory services help organizations:
Improve revenue, cost and cashflow performance across complex operating environments
Design operating models aligned to financial and regulatory realities
Structure, negotiate and govern strategic relationships to accelerate value and reduce risk
Apply AI and advanced analytics to reduce administrative burden and improve efficiency at scale
Modernize sourcing strategies and enterprise platforms
Realize value from mergers, acquisitions and largescale change initiatives
Revenue cycle performance is increasingly central to the financial sustainability of healthcare organizations. As reimbursement models evolve and administrative complexity grows, leaders face mounting pressure to protect cash flow, reduce revenue leakage and improve efficiency across end-to-end revenue operations.
This enables healthcare organizations to improve cash flow, reduce leakage and operate RCM as a governed business program, typically delivering up to 50% operating cost savings and 2–4% net patient revenue uplift.
This results in higher accuracy, reduced labor volatility, stronger performance across denials and underpayments, and an improved patient financial experience.
Sustained improvement in revenue cycle performance requires more than incremental fixes. Organizations must address the key operational and commercial drivers across the end-to-end revenue cycle, supported by defined ownership and measurable outcomes.
ISG activates its approach across five critical drivers:
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Front-end activities directly shape downstream revenue performance. Inaccurate scheduling, registration or eligibility verification increases denials, delays reimbursement and drives avoidable cost.
ISG helps organizations strengthen front-end execution to improve data quality, reduce rework and protect revenue integrity across the patient and payer journey.
Revenue cycle operations face persistent workforce constraints and demand volatility. Performance depends on an operating model that balances capacity, flexibility and cost control.
ISG supports the design of scalable delivery models that align retained and sourced capabilities with financial and operational targets..
AI is reshaping revenue cycle economics across coding, billing, denials and collections. The challenge is not access to technology, but disciplined adoption that translates into operational impact.
ISG helps organizations prioritize high-impact use cases and integrate AI into daily workflows to reduce administrative burden and improve performance.
Sustained improvement requires clear performance visibility and ownership. Without consistent measurement, revenue cycle performance cannot be effectively managed.
ISG helps organizations define KPI frameworks, establish baselines and create transparency to support continuous performance improvement.
Revenue cycle outcomes are directly influenced by how services are structured and governed commercially. Misaligned incentives and unclear terms can limit value realization.
ISG helps organizations structure and negotiate revenue cycle agreements with aligned incentives and performance-based mechanisms to reduce cost to collect and improve financial outcomes.
Organizations that implement a structured approach to RCM transformation can achieve:
Revenue cycle transformation often underperforms when value is left to execution alone. Sustainable results require a model in which economics, accountability and performance are built into how services are structured, measured and governed from the outset.
Revenue cycle management is the end-to-end financial process from patient access and billing through reimbursement and collections.
Revenue cycle performance directly impacts cash flow, revenue integrity and overall financial sustainability, making it a core operational and strategic priority.
ISG brings a first-of-its-kind approach to revenue cycle transformation, combining sourcing leadership with AI-enabled transformation in a disciplined commercial model.
A structured approach to revenue cycle transformation can deliver up to 50% operating cost savings and 2–4% net patient revenue uplift, depending on the starting point and execution model.
AI improves efficiency and accuracy across key processes such as coding, billing, denials management and collections, helping reduce administrative burden and improve financial outcomes.
Healthcare organizations
Of the largest 20 US Payers
Of the largest US Providers
Years of healthcare expertise
ISG supports healthcare organizations across the value chain, including:
Providers
Payers
Pharmacy Benefit Managers (PBMs)
Healthcare solution and service providers
AI investment is accelerating, but results remain uneven. Only one in four initiatives is meeting revenue impact expectations, at an average spend of $1.3M per use case. Enterprises are no longer asking whether AI works. They are being asked to prove that it pays.
We help you identify where AI agents deliver the most value, restructure workflows around them and build the accountability models that keep autonomous execution auditable. The enterprises that win won't be the ones that reacted. They'll be the ones that designed for it first.
We give enterprises transparent, benchmarkable pricing models that tag each resource unit with the autonomy level used to deliver it. As AI capability advances, your pricing keeps pace. Both buyers and providers can quantify what that progress is worth.
We bring analysis of more than $2.6 billion in tracked AI spend to every sourcing decision. Procurement, technology and finance leaders get the independent intelligence to rationalize vendor portfolios and hold providers accountable to measurable outcomes.
We embed controls at the point of data creation, define accountability for autonomous actions and build adaptive frameworks that keep pace with AI without impeding it. Enterprises that get this right don't just manage risk. They build the trust that lets them scale faster.
We ground strategy in research across 2,400 enterprise use cases, aligning investment to where impact is proven and designing the data, talent and governance foundations that move AI from pilots into the workflows that drive commercial results.
We benchmark your AI readiness against peers across 75 countries, identify the dimensions holding you back and give you a personalized roadmap to close the gap.
AI investment is shifting decisively toward revenue-generating functions. CRM automation, sales enablement and forecasting have replaced chatbots and IT productivity tools as the leading use case priorities, reflecting enterprise recognition that productivity gains alone do not satisfy board-level scrutiny. At the same time, use cases in production have doubled since 2024, and the portfolio is diversifying rapidly, with over 300 distinct function and industry-specific use cases now in active deployment.
ISG research across 2,400 enterprise use cases shows that the strongest AI returns are currently concentrated in compliance, risk management and quality control, not in the growth and cost outcomes most enterprises originally set out to achieve
The gap between where enterprises are investing and where AI is actually delivering is the defining commercial tension of 2025. Organizations that close it by targeting functions with structured, revenue-attributable data and clear ROI measures will establish performance benchmarks that compress the window for competitors still cycling through pilots. The standard is being set now.
ISG is a leader in proprietary research, advisory consulting and executive event services focused on market trends and disruptive technologies.
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Learn MoreAI is redefining healthcare operations, shifting the focus from isolated innovation to enterprise-scale transformation. What began as experimentation with GenAI is now evolving into structured, outcome-driven adoption across clinical, administrative and payer workflows. The market is entering a phase where value realization, governance and scalability matter more than experimentation. At the center of this shift is the emergence of agentic AI and workflow-embedded intelligence, enabling healthcare organizations to move from assistive AI to accountable, action-oriented systems.
The U.S. healthcare environment is undergoing a structural shift as economic pressure, demographic change and technological acceleration reshape how payers, providers and life sciences organizations operate. With healthcare already representing 17 percent of the region’s GDP and advancing toward a 20 percent share by 2032, rising medical demand is paralleled by an unprecedented expansion in technology investment. Aging populations and the growing burden of chronic disease are increasing healthcare consumption, while intensifying cost pressures are heightening the urgency for new digital operating models that reduce friction and enable more sustainable delivery.
The advances in data, analytics, Generative AI (GenAI) and agentic AI are transforming how healthcare and life sciences (HCLS) organizations deliver care, accelerate research, manage operations and engage patients. These innovations are driving measurable improvements in efficiency, accuracy and patient outcomes; however, adoption is not without challenges. Regulatory complexity, talent shortages, operational pressures and the need for responsible AI use demand thoughtful strategies. Organizations that can simultaneously innovate, scale responsibly and work closely with analytics partners to translate analytics goals into tangible outcomes will be the ones to succeed.
The global next-gen application development and maintenance (ADM) market has branched out into areas such as analytics, IoT, cloud native architectures, SaaS-based offerings, security, customer experience (CX) and user experience (UX), mobile apps and others. Most next-gen development activities are focusing on solving business problems, improving profits or revenue, or enhancing brand value, rather than acting as a support mechanism for running IT operations.
See what’s happening globally with Next-Gen ADM in Healthcare and Life Sciences.
Enterprises in the U.S. are at the forefront of adopting and integrating next-gen ADM technologies. Enterprise-wide adoption of concepts such as DevOps is helping clients:
• Achieve agility and coordination among development, testing and production functions
• Develop a culture where application updates are shaped by user feedback
• Eliminate silos and realize maximum value across the application lifecycle
• Bridge the efficiency voids across business processes
See what’s happening with Next-Gen ADM in Healthcare and Life Sciences.
As a health insurer, you have less control than many other businesses over factors fundamental to your operations and profitability. Regulatory changes, peaks and valleys in claims volume, and medical innovations all have an outsized influence on the industry. Work processes that may have been considered efficient or even industry-leading now may be a competitive disadvantage. In the face of these challenges, you need to optimize where you can.
Get our expert insights on these developing market trends in our ISG Momentum® Strategic Perspectives report.
