人工智能与医疗计费的未来：供应商和投资者的突破

Summary............................................................................................................................3Introduction.......................................................................................................................5Set the Stage: A Detailed Review of Key Steps in the RCM Lifecycle (the ProviderPerspective).................................................................................................................6How AI Can Improve RCM Capabilities for Providers.....................................................12Key Focus Areas of AI Innovation in the Provider RCM Process....................................14Challenges to AI Adoption in Providers’ RCM Processes...............................................26Recent Product Launches Indicate the Land Grab Is Afoot............................................27Will AI Advancements Shift RCM Market Share From Outsourced Vendors toSoftware Providers?..................................................................................................31M&A and Funding Activity Also Point to a Dynamic Marketplace..................................34Company Profiles.............................................................................................................39 In our quarterlyHealthcare Mosaicreport, we select a far-reaching topic of interest in the health-care space and provide a variety of data points and analyses to offer a more complete picture ofwhat it means for the broader healthcare marketplace—and both public and private investors in In thisHealthcare Mosaicreport (now our 39th in the quarterly series), we take a deeper diveinto the growing importance of artificial intelligence (AI) in the healthcare provider revenue cyclemanagement (RCM) market. In our view, AI has the potential to revolutionize myriad RCM func-tions, which could reshape market dynamics between insourced and outsourced RCM providers We also believe there is a growing number of use-cases for AI solutions that can help drive pro-vider efficiencies, reduce waste, and enhance providers’ overall RCM processes (and thus financialhealth). In turn, we expect AI-based innovations to accelerate RCM software sales over the coming Accordingly, the purpose of this report is to help investors better understand this trend and thepotential market implications related to the growing use of AI in RCM activities over the comingyears (again, for this report we focus on provider RCM solutions, and will look to assess how pay- •How AI-enabled RCM solutions can help improve productivity, reduce waste, and improve pro- •How RCM software providers are rapidly adding novel AI solutions to their existing productand service portfolios; •Key areas of focus for AI adoption in the RCM lifecycle and which providers are best positionedto thrive in this market; •Key risks considerations when adopting AI for RCM activities; •Key market trends around M&A activity, partnerships, and financing activity in the AI RCM •Why AI may begin to shift market share from outsourced RCM vendors to internal RCMteams; and •How this market shift could impact industry growth rates for RCM software providers over Regarding our covered healthcare companies that we believe will be most impacted by thesetrends, our work is most relevant toWaystar (WAY),Phreesia (PHR),and, to a lesser extent,Health Catalyst (HCAT). report (and depicted in exhibit 1). In tandem with this quarter’s report,we are hosting a fireside chat with Chris Schremser, chief technology officer and head of engineering for Waystar (WAY). Schremser is a tenured executive with the organization and played a key role in the formation ofWaystar out of its predecessor companies, Navicure and Zirmed (where he served as CTO startingin 2002). In his current position, Schremser helps lead Waystar’s overall product vision, strategy, RCM, key technology roadmap initiatives, and how the integration of Iodine can accelerate productdevelopment for the organization, among other items. Please register for this live-only, virtual event, which will take place on December 9, 2025,at 12:00 p.m. Central time, via thislink. Revenue cycle management (RCM) has long been considered one of the most complex and misun-derstood segments of the healthcare industry. At its core, RCM encompasses the administrativeand financial processes that track patient care episodes from registration and appointment sched- The system sits at the intersection of providers, payers, patients, and regulators, and requiresconstant navigation of complex (and ever-changing) coding rules, prior authorizations, denials,appeals, and compliance requirements, among other items. The result is a web of financial and op-erational touchpoints that can be as opaque as they are essential to the functioning of the broaderhealthcare economy. It is also an area ripe for disruption, in our view, as groups such as CAQH esti- Despite its centrality to the healthc