Navigating the evolving healthcare landscape
The healthcare industry is engaged in massive innovation while also having to respond to demanding regulations. That leaves organizations like yours challenged with finding solutions that allow you to provide a revolutionary patient experience and still meet evolving legislative demands.
Rising denials, reimbursement pressure and staffing shortages are making it harder to protect margins and maintain financial stability. Healthcare organizations need greater visibility into revenue cycle performance and support for navigating complex Medicare, Medicaid and commercial payer requirements. Wipfli helps you identify revenue leakage, optimize reimbursement processes and strengthen revenue cycle management so you can improve cash flow and support long-term financial health.
Increasing labor expenses, inflationary pressures and limited reimbursement growth continue to strain healthcare organizations. Leaders are being asked to do more with fewer resources while maintaining quality care and patient outcomes. We take a comprehensive approach to financial and operational performance, helping you improve efficiency and build strategies that support sustainable growth.
Many healthcare organizations struggle with disconnected systems, cybersecurity risks and uncertainty around how to prioritize technology investments. Wipfli combines healthcare industry experience with comprehensive technology services to help you modernize confidently and maximize the value of your technology investments.
Evolving regulations, changing reimbursement models, shifting patient demographics and growing patient expectations are reshaping healthcare at an unprecedented pace. Wipfli provides specialized healthcare advisory services that connect strategy, finance, operations and technology, helping you respond proactively to disruption and position your organization for what’s next.
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Our specialized team of healthcare professionals thoroughly understands the pressures placed on your leadership team. We provide tailored solutions to help you increase market share through partner alignment, embrace new payment structures and leverage technological advancements to gain real-time insights.
Insights for healthcare leaders
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Digital behavioral health therapy and Medicare opportunity
Behavioral health leaders are facing a familiar, but increasingly difficult equation: Demand is growing faster than the workforce, waitlists are lengthening and adding more appointments is not always financially or operationally realistic. The question is no longer whether organizations need more capacity. It is how to create that capacity without simply asking an already-constrained clinical team to do more. Digital mental health treatment may offer one part of the answer. Used appropriately, these tools can reinforce a clinician-led treatment plan between appointments, give patients another way to engage with care and support a more scalable operating model. Medicare reimbursement makes the opportunity more tangible, but reimbursement alone does not make the model sustainable. Why the traditional outpatient model is under pressure Outpatient behavioral health is labor-intensive. Revenue is closely tied to clinician time, yet organizations are competing for a limited supply of licensed professionals while managing payer rates that may not fully support the cost of recruiting and retaining them. More demand, by itself, does not solve that problem. That is why the strategic question should be broader than “How do we add appointments?” Leaders should ask: Which parts of care require a clinician in real time, which activities can be reinforced digitally and where could technology improve access without weakening clinical accountability? Where digital therapy can fit Digital therapy is most useful when it supports a defined clinical purpose. A clinician still evaluates the patient, establishes the treatment plan and determines whether a particular tool is appropriate. The technology can then support structured exercises, education, symptom tracking or skill reinforcement between visits. This is not about replacing therapists. It is about reserving clinician time for the work that requires judgment, relationship and intervention, while allowing patients to engage with structured elements of care on their own schedule. For the right patient population, this can improve continuity and help a clinician support more patients without simply adding hours to the calendar. Potential applications include structured support for conditions such as depression, anxiety, insomnia, post-traumatic stress and substance use disorders. The specific use must follow the product’s authorized indication and the organization’s clinical protocols. Not every app is a medical device, not every device is appropriate for every patient and not every digital interaction is reimbursable. Medicare creates an opening, not a guarantee Medicare now recognizes services associated with qualifying digital mental health treatment devices, including the supply of the device and related treatment-management work. That is an important change because it gives providers a defined pathway to evaluate. It should not be interpreted to mean that any behavioral health app can be prescribed and billed. Coverage and payment depend on the device, the patient, the professional furnishing the service, documentation, time requirements and other billing conditions. Organizations also need to confirm how their Medicare Administrative Contractor prices the service and whether Medicaid and commercial payers follow the same pathway. Medicare can be a starting point, but it is not a universal reimbursement strategy. Five questions leaders should answer before investing 1. What capacity problem are we trying to solve? Start with a defined patient population, service line or access constraint. A focused use case is easier to evaluate than a broad “digital transformation” initiative. 2. Which patients and treatments fit the model? Establish eligibility criteria, exclusions, escalation protocols and expectations for clinician involvement. Safety and clinical appropriateness have to lead the design. 3. Do the unit economics hold? Model device cost, expected payment by payer, staff time, patient activation, documentation, denials, integration and cybersecurity. The objective is not to claim volume. It is a sustainable care model that improves access and uses clinician capacity wisely. 4. Can the workflow support defensible billing? Ordering, onboarding, time capture, patient communication, device use and continued eligibility must be documented consistently. If those steps sit outside normal clinical and revenue-cycle workflows, the program may add work without producing corresponding value. 5. How will we govern and measure the program? Define accountability for clinical escalation, informed consent, privacy, cybersecurity, vendor oversight, outcomes and adverse-event response. Decide in advance what success means and when the organization will expand, redesign or stop the program. A practical path forward For most providers, the right next step is not an enterprise-wide rollout. It is a disciplined pilot. Select one clinically appropriate population, confirm the device and payer requirements, map the workflow, train the team and monitor access, patient engagement, clinician time, denials and net financial contribution. Digital therapy has real potential to extend care and improve the economics of outpatient behavioral health. But the opportunity will not come from the app alone. It will come from combining the right clinical use case with a defensible reimbursement strategy and an operating model that clinicians and patients can actually use. Read more Revenue leakage in healthcare: How to find and prevent it AI in healthcare finance: Practicality over hype, strategy over speculation 5 reimbursement strategies for rural health clinics
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How innovation in senior living can be a catalyst for growth and transformation
The senior living sector is at an inflection point, facing numerous challenges that require immediate attention and action. As the landscape evolves, so must the strategies employed by providers. The dissatisfaction with the status quo is palpable, and the need for modernization is more pressing than ever. Senior living providers must embrace change and invest proactively in innovation to thrive in an increasingly competitive environment. Why innovation is critical to senior living businesses The senior living industry is facing constant changes and challenges, including emerging competitors, changing customer demands, a volatile regulatory landscape and a difficult labor market. To remain competitive and meet evolving resident demands, your senior living business must be committed to innovation. Market disruption The senior living industry is undergoing significant transformation driven by various factors, including demographic shifts, evolving consumer expectations and regulatory changes. Providers that remain stagnant risk becoming obsolete as new entrants and innovative models disrupt traditional care paradigms. Demographic trends: The aging population is increasing, leading to a surge in demand for senior living services. Providers must adapt to meet the diverse needs of this growing demographic. Competitive landscape: New players are entering the market, often with fresh ideas and innovative service models that challenge the status quo. Consumer expectations are shifting Today’s seniors are more informed and discerning than previous generations. They expect high-quality services, personalized care and engaging environments. To remain relevant, providers must understand and respond to these evolving expectations. Modern residents seek tailored experiences that cater to their unique preferences and lifestyles. They want facilities that allow for freedom, with modern amenities and comforts. Nobody wants to get stuck in the stereotypical “old person’s home” — they’re looking for a bistro. Technology can play a critical role in modernizing the senior living experience for these discerning residents. With the rise of digital solutions, seniors now expect technology to enhance their living experience, from health monitoring to social engagement. Workforce challenges The senior living sector is grappling with a labor shortage that impacts service delivery. Providers must address workforce challenges by investing in employee training and development, as well as implementing strategies to attract and retain talent. Staffing shortages: High turnover rates and a lack of qualified candidates can hinder service quality. Training and development: Investing in workforce development can improve employee satisfaction and retention, ultimately benefiting residents. Regulatory and reimbursement pressures Navigating the complex regulatory environment is a significant challenge for senior living providers. Changes in policies, particularly around Medicaid and Medicare, can have profound implications for service delivery and financial viability. Organizations must stay abreast of evolving regulations to avoid penalties and ensure quality care and will also need to adapt to changing reimbursement structures to maintain financial stability. Financial vulnerability In an environment of rising costs and increasing competition, financial vulnerability is a pressing concern for many senior living organizations. Providers must adopt strategic financial planning to help ensure sustainability. Cost management: Identifying areas for operational efficiency can help mitigate financial pressures. Investment in innovation: Proactively investing in innovative solutions can drive long-term growth and profitability. Technology’s role in senior living Investing in innovative solutions can enhance operational efficiency, allowing providers to deliver higher-quality care while reducing costs. Implementing a tech stack that fits your operations can free staff to focus on resident care, improve decision-making and optimize operational performance. The right technology for the senior living industry Embracing technology is no longer optional; it is essential for success in the senior living sector. Providers must integrate advanced technologies to enhance service delivery and resident experiences. Artificial intelligence: AI can optimize staffing, improve care coordination and enhance resident engagement. Telehealth solutions: Offering telehealth services can improve access to healthcare for residents, particularly in rural areas. Enterprise resource planning (ERP): Modern ERP systems can facilitate interoperability with your accounting, billing, payroll and planning systems to help your team make informed, strategic decisions. Automation: Automated tools can play a pivotal role in enhancing service delivery within senior living communities. Automating administrative tasks can reduce the burden on staff and improve efficiency. Implementing automated communication tools can also enhance engagement between staff and residents. Data analytics: Leveraging data analytics can empower organizations to make informed decisions that enhance service delivery and operational performance. Data-driven decision-making can help your organization assess effectiveness and identify areas for improvement, as well as gather data on resident preferences and needs that can inform program development and service delivery. Workforce innovation strategies for senior living organizations To navigate the challenges of the modern senior living landscape, organizations must prioritize workforce development and leadership innovation. Some key areas to focus on include: Training programs: Investing in continuous training can equip staff with the skills needed to provide exceptional care. Leadership development: Fostering a culture of innovation and collaboration among leadership can drive organizational success. Middle market opportunities in senior living The middle market represents a significant opportunity for senior living providers. Many older adults do not qualify for subsidized housing but cannot afford luxury options. Technology can go a long way toward bringing down operating expenses, allowing providers to build for an underserved middle market in the senior living space, but more investment needs to be made to fill the gap. Tailored services for middle-income seniors Providers must develop tailored services that address the unique needs of middle-income seniors. Value-based care: Integrating value-based care models can help ensure that seniors receive the support they need while managing costs. Community engagement : Creating community-focused programs can enhance the living experience for middle-income residents. Public-private partnerships: Collaborating with government entities may be a cost-effective way to create affordable housing options without sacrificing quality. How senior living organizations can build a culture of innovation Most senior living organizations would probably say they are committed to innovation. But to actually embed a culture of innovation, your business needs to take the following actions: Embrace change management To successfully implement change, senior living providers must adopt effective change management strategies. Leadership buy-in: Securing buy-in from leadership is crucial for driving organizational change. Stakeholder engagement: Involving staff, residents and families in the change process can foster a sense of ownership and commitment. Develop a long-term vision A clear long-term vision can guide organizations in navigating the complexities of the senior living landscape. Strategic goals: Establishing measurable goals can help track progress and help ensure alignment with organizational objectives. Adaptability: Organizations must remain flexible and open to adjusting their strategies in response to changing market conditions. Fostering creativity and collaboration To thrive in a competitive landscape, senior living providers must cultivate a culture of innovation. Encouraging ideas: Creating an environment where staff feel empowered to share ideas can lead to creative solutions. Cross-department collaboration: Encouraging collaboration across departments can foster a holistic approach to service delivery. Incentive programs: Implementing programs that reward innovative ideas and solutions can encourage staff to think creatively. Celebrating successes: Highlighting successful initiatives can inspire others to pursue innovative approaches. The path forward for senior living providers The senior living sector must embrace change and proactively invest in innovation to navigate the challenges ahead. By understanding the risks of complacency, prioritizing operational efficiency and fostering a culture of innovation, providers can position themselves for success in an increasingly competitive landscape. The future of senior living depends on the willingness to adapt, innovate and prioritize the needs of residents. By implementing these strategies, senior living providers can not only enhance their service delivery but also create a sustainable business model that meets the needs of today’s seniors. The time for change is now, and those who embrace it will lead the way in shaping the future of senior living. Read more 6 strategic planning imperatives for senior living organizations Tax strategies for senior living providers: New ways to maximize savings 5 benefits of data and analytics for senior living facilities
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