SCAN

Healthcare organizations are moving quickly to adopt AI — but too often, teams jump into implementation before defining the strategy, governance, and operational boundaries needed for success. That’s why Week 1 of a strong 4 week AI Readiness Audit is critical: 🔹 Strategic Alignment & Use-Case Mapping Objective: Define the “Why” and “Where” before deployment. Avoid the “shiny object syndrome” by ensuring clinical and administrative leaders align on the exact scope, purpose, and intended outcomes of the AI solution. Key questions every healthcare organization should answer before implementation: ✅ What does the AI actually do? Clearly define the system capabilities and intended use domain. ✅ Who is the intended user? Is the tool designed for clinicians, care managers, pharmacists, operational teams, or patients? ✅ What are the boundaries and limitations? AI governance requires understanding not only what the system can do — but also what it should not do. ✅ Who could be impacted? Assess inclusion/exclusion criteria, downstream workflow implications, and potential operational or patient safety risks. ✅ How mature is the solution? Is the technology: • Experimental with minimal validation? • Emerging with early clinical evidence? • Or well-established with robust safety and effectiveness data? Healthcare AI success is not just about innovation — it’s about disciplined implementation, governance, and alignment with clinical workflows. The organizations that scale AI effectively will be the ones that build trust, define guardrails early, and focus on measurable operational and patient outcomes. To inquire about AI- driven vendor solutions designed to streamline clinical workflows, reduce administrative burdens and improve patient safety message me directly. #HealthcareAI #DigitalHealth #AIinHealthcare #ClinicalInnovation #HealthcareLeadership #HealthTech #AIReadiness #HealthcareTransformation #CareInnovation

The ACA coverage cliff started bleeding into Q1 earnings. Medicaid work requirements went live. A 100% tariff on branded pharmaceuticals is eight weeks out. And CMS accidentally published provider Social Security numbers in a public database for weeks before anyone noticed. None of this is a surprise if you have been paying attention. All of it is in this week's RCM 2030 Weekly. 📋 Subscribe on LinkedIn and read it before your next board meeting: https://lnkd.in/dmZDwfeD

After more than three decades in the health insurance industry, my dear friend and colleague Michael Blea has announced his retirement from SCAN. It’s hard to fully capture what Michael has meant to our organization. Not just through his leadership as Chief Growth Officer, but through the way he has consistently shown up for people. During a period of remarkable growth at SCAN, Michael helped lead some of the most important chapters in our recent history, including the strongest AEP our company has ever experienced (127,000!). His leadership helped position SCAN among the top ten Medicare Advantage plans in the country and the #1 non-Kaiser MA plan in California. He also launched SCAN’s Brokers as Health Navigators program, a pioneering program that reimagines the role of Brokers in our business. He’s truly going out on top. But titles, rankings, and growth metrics only tell part of the story. What stands out most to me about Michael is his ability to connect with others. He brings deep empathy to this work and never loses sight of who our health care system is supposed to serve. He is a consummate professional and a leader of the highest capability. But this is not goodbye. Although Michael will officially retire in July, he will continue advising SCAN going forward as a Senior Advisor to the CEO and President. I know Karen Schulte , Senthu Arumugam, and I will continue to benefit from his wisdom, experience, and perspective in the months ahead. Michael, thank you for your partnership and your unwavering commitment to improving the lives of older adults. SCAN is stronger because of your contributions. Wishing you joy and fulfillment in this next chapter. (Photo: Stanton Sasaki , Karen Schulte , and I with Michael and Natalie Birchard and our close partners at Applied General Agency earlier this year)

NABIP ~ Professional Development Day. Great time mingling and networking alongside our amazing partners. It’s always rewarding to have conversations and connect. 💛❤️💛❤️💛❤️💛❤️💛❤️💛❤️💛 #NABIP #TEAMWORK #BROKERS #SCANANTONIO

PE firms ask me the same question constantly: which RCM vendors are going to survive 2030 and which ones are dead weight? After 13 years building RCM software products and writing RCM 2030, here is how I actually think about it. Ask one question about every vendor in your stack: is this function preventing the problem up front, or cleaning it up after the fact? If it is clean-up, plan to sunset it. The categories most at risk by 2030: standalone payment portals, point-solution estimation tools, denial management platforms built for reactive workqueue chasing, paper statement vendors, and insurance discovery running batch jobs. The categories that survive: cybersecurity and compliance platforms with real-time monitoring, integrated financial experience platforms, analytics tools with cross-client payer intelligence, and fraud detection that no single hospital can replicate internally. I just published a full breakdown on this in a blog post on my website at aprilwilson.net , including what Waystar's big quarter actually means, why Epic is playing Switzerland on claims editing, and the four questions every CFO should be asking their vendor stack before 2027.

Everyone keeps asking when AI is going to fix the revenue cycle. That's the wrong question. The right question is: do you have a single person on your team who can take what the AI surfaces and actually change a workflow? Mayo Clinic has 466 AI algorithms deployed. Jefferson Health built eight literal SWAT teams just to make AI operational. Houston Methodist had to play call recordings for skeptical staff because nobody believed a voice agent had handled a scheduling call without a human. The technology worked fine in every one of those cases. But... the people weren't ready. This is the gap nobody is budgeting for. Not the AI. The humans who supervise it, question it, and translate its output into cash. By 2030, the winning revenue cycles won't be the ones that bought the most tools. They'll be the ones that built that muscle first. I wrote the framework for exactly this problem. It's in the RCM Workforce Modernization Guide, available on Amazon.

We spend a lot of time thinking about reciprocity. Is this relationship balanced? Am I giving as much as I’m getting? But some of the most important relationships in our lives were never meant to be balanced. Parents. Teachers. Mentors. They give in ways that can’t be repaid. Not later. Not ever. And that’s the point. You can honor them. You can thank them. You should. But trying to “even it out” misses what those relationships actually are. The real obligation isn’t to pay them back. It’s to carry it forward. For someone else who can’t repay you either.

I spoke recently with an early career executive who was thinking about leaving her company after three years. I asked why. She has a good job and it felt like she was just getting started. She gave two reasons. She wanted to move closer to family. And she didn’t feel like she was learning anymore. The first one made sense to me and I encouraged her to follow that instinct. The second one didn’t, at least not on its face. Early in your career, it’s easy to think learning means something new is happening all the time. New job, new problems, new title. But a lot of the real learning comes from staying long enough to see how your own decisions actually turn out. What did you miss? What did you get right except for the wrong reasons? What created problems you didn’t anticipate? What people judgments were right? And which ones were dead wrong? You don’t get those answers in year one or two. And way too many people leave chasing novelty before they ever find out. I’ve seen too many early career executives stall out because they confuse activity with progress. They stay in motion (sometimes getting promoted and chasing higher titles) but their judgment doesn’t really deepen in parralel. Of course that doesn’t mean you should never leave. Sometimes you should. But when someone says “I’m not learning,” it’s worth asking what they really mean. Because sometimes what they’re actually avoiding is the slower, less comfortable kind of learning that only comes from sticking around and seeing things through longer than you might initially think.

David Blumenthal of Harvard T.H. Chan School of Public Health and Brown University ’s James Morone joined us at SCAN today to discuss their new book, “Whiplash: From the Battle for Obamacare to the War on Science.” What struck me most wasn’t just the history—it was the humanity behind it. Their research includes a remarkably candid interview with President Obama. When asked why he chose to pursue health reform—despite near-universal advice not to—his answer wasn’t political. It was personal: his mother’s cancer, and watching her struggle with insurers who failed her when she needed them most. They draw a parallel to the COVID-19 pandemic. In their telling, President Trump’s response was shaped, at least in part, by proximity to the crisis—how deeply New York was affected, and the experience of a close friend suffering respiratory failure and requiring intubation. The throughline is hard to ignore. Policy is often framed as ideology, strategy, or economics. But more often than we admit, it’s shaped by lived experience; by what leaders have seen up close, and what they haven’t. It raises an uncomfortable but important question: whose experiences actually make it into the room where decisions are made? Because if proximity drives policy, then the distance between policymakers and the people most affected by their decisions matters more than we think. For those of us working in healthcare, it’s a reminder. Data and analysis are essential. But they’re not always sufficient. Sometimes the most powerful force for change is helping others see, firsthand, what’s at stake.