CASE STUDY
Midwest health system improves patient experience, AR and denials in year one.
A Franciscan legacy meets modern revenue cycle transformation
SNAPSHOT
A Midwest health system chose Ensemble to lead an end-to-end revenue cycle transformation in service of a larger purpose: protecting the organization’s healing mission and helping patients, families and caregivers focus more fully on care. With Ensemble’s coordinated RCM model, the health system reduced financial friction, improved operational consistency and saw measurable gains in cash, AR, unbilled days, denials and patient experience within the first year of partnership.
PROFILE
- Nonprofit Catholic health system
- > $2B NPR
- 13 hospitals
- Midwest
- End-to-end RCM
Challenges
Guided by a mission to deliver high-quality, patient-centered care, this nonprofit Catholic health system serves communities across the Midwest through 13 hospitals and a broad network of health and wellness programs, primary and specialty care and acute and post-acute services. Rooted in a Franciscan heritage, the organization is known for clinical excellence and a deep commitment to the communities it serves.
The health system faced an increasingly difficult financial environment shaped by growing payer and regulatory complexity. These pressures led leadership to ask a foundational question: Is our revenue cycle positioned to succeed in the future?
After conducting an end-to-end revenue cycle assessment in spring 2024 with Ensemble, they had the answer.
“Our assessment confirmed that although we were doing some things really well, we dramatically needed to improve consistency and scalability as well as our use of advanced technology tools and best practices,” explained the health system’s president and CEO.
Specifically, the leadership team wanted to:
- Reduce friction across the patient financial journey so patients and families could focus on healing, not paperwork
- Modernize revenue cycle operations with proven technology, best practices and scale
- Strengthen financial performance to reinvest in clinical services, ministries and the communities they serve
- Combat rising denial pressure and stabilize cash flow amid growing payer complexity
- Empower associates with the tools and expertise to succeed
Solutions
In 2025, the health system selected Ensemble as its strategic end-to-end revenue cycle partner to accelerate revenue cycle transformation across front-end, mid-cycle and back-end operations, aligning people, process, technology and performance management across the full revenue cycle. More than a traditional outsourcing model, this work was rooted in cultural fit and shared accountability. Less than 90 days after the contract was signed, Ensemble completed go-live, transitioning nearly 750 health system associates while keeping them on-site at their facilities with support from Ensemble leaders embedded at each hospital.
Ensemble paired certified revenue cycle operators with AI-driven technology and a proven standard operating model to help the health system improve consistency, scale best practices and strengthen results across every stage of the patient financial journey. Shared performance goals and dashboards created a single source of truth, helping both organizations stay aligned on priorities, progress and outcomes.
Reducing patient friction + accelerating financial clearance
- Financial clearance + POS collections — Expanded pre-service estimates and MyChart digital payments, driving greater than 115% year-over-year growth in pre-service collections
- Scheduling modernization — Streamlined central scheduling so referrals route directly to schedulers, patients are reached and booked sooner and more calls are answered
- Epic front-end automation — Optimized MyChart text outreach automation, enhanced self-scheduling roadmap and initiated welcome kiosk deployment
- Automated eligibility + credentialing — Launched Medicare/Medicaid query chaining and credentialing work queues that automatically trigger added eligibility checks
Preventing denials + strengthening revenue integrity
- Denial prevention governance — Stood up monthly denial-prevention committees targeting medical necessity, authorization and eligibility drivers
- Clinical Documentation Integrity — Launched TAVR, NICU, sepsis and pediatric provider-education initiatives to strengthen documentation, improve case mix and reduce coding queries
- Payer strategy + performance — Issued demand letters to major payers, filed state complaints and policy-exemption requests, driving ongoing payer performance management
Results
Within the first year, this revenue cycle transformation moved the health system from stabilization to sustained operating discipline with measurable gains across cash, unbilled, denials, aging, pre-service performance, patient experience and staff engagement.
Acute performance
Metric
Year 1
Improvement vs. baseline
Cash collections
as % of goal
102.0%
+1.5%
Total unbilled days
3.6
–4.9 days
Net AR days
45.0
–17.5 days
Insurance
AR > 90 days
27.5%
–7.6%
Final denial % of NPR
2.2%
–3.5%
Physician performance
Metric
Year 1
Improvement vs. baseline
Cash collections
as % of goal
104.6%
+5.8%
Charge lag days
7.1
–10.8 days
Net AR days
20.9
–21.5 days
Insurance AR > 90 days
16.2%
–24.2%
Final denial % of NPR
0.4%
–4.0%
Additional performance highlights:
- $2.1M recovered through payer demand letters with two major payers
- 30% reduction in coordination-of-benefits first-pass denials
- Call center average speed-to-answer decreased from 1 min 9 sec to 9 seconds
- 75% reduction in call abandonment rate
- 91.3% overall Secret Shopper score
- 93% of patients said they were “very likely” to seek future care with the health system
The transformation reflects the power of a shared vision: a Franciscan healthcare leader committed to its mission, partnered with a revenue cycle organization committed to eliminating friction so caregivers can focus on care. Together, the health system and Ensemble prove that mission-driven healthcare and modern operational excellence amplify each other.
Year-one results
cash collections
net AR days
unbilled days
denials as a % of NPR
were “very likely”
to seek future care
with the health system