Improving Fiscal Health for Providers with RCM Cost Strategies

For hospitals, 2026 is a landscape characterized by persistent financial pressures that are more than cyclical. While hospital operating margins improved through the end of 2025 — with Kaufman Hall reporting a year-end indexed operating margin of 1.3% YTD and a 5% monthly margin for December 2025 — health systems continue to face rising operating costs, an eroding payer mix, and increasing bad debt. The American Hospital Association’s 2025 analysis underscores these dynamics, noting that 56% of hospital costs are labor, persistent Medicaid/Medicare underpayments, and financial strain driven by workforce shortages and payer practices, including increased delays and denials.

At the same time, the outsourcing market is exploding. Black Book’s 2025–2028 report forecasts U.S. healthcare outsourcing to grow from $366.6B in 2025 to $662B by 2028 due to workforce shortages and rising operational complexity. In fact, 97% of RCM leaders now outsource at least one function.

Against this backdrop, providers are pursuing precision cost removal in three high-impact operational areas:

Call center and patient access functions
Accounts receivable (AR) and denial resolution
Clinical support functions (e.g., prior authorization, UM, care management)

Below is how these areas have shifted heading into 2026 — and where cost takeout is most achievable.

1. Call Center / Patient Access: Scaling Capacity and Reducing Friction

Over the last decade, providers have invested heavily in the patient financial journey and multi-channel access. Yet despite technology gains, access performance has deteriorated due to labor shortages, higher call volumes, and more complex payer requirements.

Key 2026 realities:

Workforce shortages continue to strain operations; globally, 75% of employers can’t fill vacancies, and the U.S. healthcare sector affected significantly.
Rising outpatient demand (projected to grow 18% by 2035) increases pressure on patient access teams.
Hold times and abandon rates remain elevated nationally, driving down patient satisfaction.

As hospitals work to reduce avoidable leakage and ensure accurate financial clearance, many are turning to hybrid workforce models that blend onshore, nearshore, and offshore capacity.

Why outsourcing is accelerating:

Global talent pools offer bilingual coverage and improved off-hours availability.
Workforce expansion through partners stabilizes scheduling, prior authorization outreach, and counseling queues.
Outsourcing provides operational resilience, particularly during seasonal demand spikes.

This area remains one of the fastest paths to cost reduction because it addresses labor arbitrage, efficiency gains, and improved patient experience simultaneously.

2. Accounts Receivable (AR) Resolution: Increasing Throughput While Reducing Cost to Collect

Revenue cycle teams continue to absorb the brunt of rising claim complexity and payer requirements. Despite automation improving the status of claims and routing, human expertise remains critical for exception handling, appeals, and root-cause analysis.

Relevant 2026 data:

Hospitals’ total daily expenses increased 8% year-over-year by the end of 2025.
96% of RCM leaders report payer behavior — delays, denials, and underpayments — worsened due to workforce shortages.
97% of organizations outsource at least one RCM function, as mentioned above, and advanced-automation users see significantly fewer staffing challenges.
Black Book shows RCM outsourcing will grow from $34.7B in 2025 to $51.8B in 2028.

Payer outsourcing also affects the labor market. Insurers have aggressively expanded offshore call centers to reduce administrative cost; many providers now mirror this shift, using offshore/nearshore teams for:

Claim follow-up
Denial prevention and resolution
Appeals writing
Benefits and eligibility verification
AR inventory management

Cost savings are often 40–60% in labor, while improving throughput and shrinking aging buckets (30/60/90+).

Why this matters in 2026:

With payer mix deteriorating and government reimbursements lagging inflation, CFOs are prioritizing cost-to-collect reduction, variance management, and outsourcing models that offer performance guarantees.

3. Clinical Support Resources: Prior Authorization, UM, and Care Management

Clinical labor has become one of the most inflationary categories. AHA data shows clinical staffing costs continue to rise due to shortages, and many providers spend increasing time on prior authorizations.

Priority challenges in 2026 include:

Prior authorization is now the #1 burden for insured patients navigating care, according to a February 2026 KFF survey.
Research shows prior authorization delays contribute to patient harm, including exacerbations, hospitalizations, and prolonged inpatient stays.
New CMS rules taking effect in 2026 require faster turnaround — 7 days for standard PA and 72 hours for urgent cases — intensifying staffing needs.

Given these pressures, providers increasingly partner with clinical outsourcing companies to support:

Prior authorization processing
UM support (nurse review, documentation prep)
Care management and case management
Transitions of care programs
Clinical documentation improvement
Nurse triage and remote patient monitoring
Care coordination and navigation

Blended delivery models (U.S. + Philippines + India) provide registered nurses, therapists, and care coordinators at predictable cost structures, often reducing expense by 30–50% compared to domestic hiring.

The Strategic Payoff: Cost Takeout That Also Improves Patient Experience

Cost removal is essential — but the best provider strategies in 2026 also improve:

Speed to appointment (shorter hold times; quicker scheduling)
Financial transparency (clearer counseling; proactive benefits checks)
Authorization throughput (fewer delays; reduced rescheduling)
Billing clarity (fewer surprises; faster resolution)

With growing outpatient demand, rising uncompensated care, and a payer mix shifting toward government coverage, efficiency and scale are no longer optional — they’re conditions for survival.

Hospitals and health systems are increasingly leaning on RCM and clinical services partners not only to remove cost but also to mitigate operational risk, maintain quality, and support the workforce through ongoing shortages.