HFMA Metropolitan New York Joseph A. Levi 66th Annual Institute

March 19, 2026 | Marriott Marquis, Times Square

The New York HFMA Annual Institute brings together healthcare finance and revenue cycle leaders from across the region for a full day of sessions, panels, and conversations on the issues shaping the industry.

These are my reflections on the sessions, panels, and conversations that stood out.

The first conversation I had was with a revenue cycle consultant who told me their firm is no longer softening the message around automation and AI. Leaders are cutting costs. Repurposing team members is the optimistic version of the story. Layoffs are the real one, and the industry is starting to say that out loud.

That tone, direct and a little uncomfortable, set the stage for a day full of honest conversation.

Trust, change, and what it takes to move fast without breaking things

Stanley Cup Champion Adam Graves opened the day by talking about humility. His father was a police officer, a community man, and someone who left large shoes to fill. The through line from his career to leadership in any field was the same: hard work combined with genuine care for the people around you makes a disproportionate impact. Communication sits at the center of everything. Smile, hug, be humble, be humorous, and challenge yourself and those around you. Whether you are coaching a team or running a health system, the fundamentals are the same.

A session on AI governance picked up that thread and pushed it further. The most useful frame I heard came from Marc d. Paradis, who described change as living in the world of exponentials. We have to actively seek it out because it is constant. And the obstacle to embracing it, he argued, is almost always trust rather than technology. He distinguished between trust that is built slowly through repeated interaction and trust that emerges instantly when two people share a common stake in the outcome. Both matter as organizations try to move at the pace the industry now requires.

David H Berger, MD, MHCM extended that into execution: change has to be built into the DNA of an organization, not bolted on. It needs to align with your strategic goals and be communicated far more repeatedly than most leaders expect before the majority of people actually hear it. The risk of getting this wrong cuts both ways. There is risk in change, but there is also risk in staying still.

Lisa Stump offered a grounding observation: change happens at the speed of trust. That means connecting with patients and team members to understand where the gap is between hype and reality before making structural decisions. Governance structures work when they surface both operational needs and legal and compliance exposure together. She made a point I found particularly clarifying: humans have made mistakes in call centers for years. An AI agent making a mistake is not a reason to shut down the call center. The standard for AI does not need to be perfection; it needs to be honest evaluation.

Deepesh Chandra closed out the session with the piece that felt most practically applicable. Too many people are taking AI output at face value. The organizations that are getting this right have done the harder work of integrating humans into the loop, building enterprise AI policies that clear legal, compliance, and finance, and reframing AI as a tool in the workflow rather than an autonomous authority. Subject matter experts embracing AI as one input among many is a very different outcome than the same experts being replaced by it or, just as problematically, deferring to it uncritically.

The affordability problem is getting harder before it gets easier

A session on hospital advocacy and policy surfaced some numbers worth sitting with. As a result of $7.5 billion in federal funding cuts related to the ACA, approximately 450,000 low-to-moderate-income New Yorkers are set to lose zero-premium or low-cost Essential Plan coverage on July 1, 2026. The downstream effect is already visible: people are shifting to high-deductible plans or dropping coverage altogether as premiums rise.

The session also covered the New York Fair Pricing Act, which seeks to cap commercial insurance payments for select routine outpatient services at 150% of the Medicare rate. The panel noted that affordability is not just a pricing question but also a delivery question, and that making care less expensive to fulfill is as important as what gets charged for it.

I struggled with one comment from a panelist who said that cutting prices is not making the delivery of healthcare any more affordable. Price reduction directly and positively impacts affordability for the people paying the bills. What I think the comment was getting at is that a rate cap on outpatient services does not make those services cheaper to deliver. Supply chain costs and salaries show no sign of slowing down, and that creates real financial pressure for hospitals regardless of what the contracted rate looks like. This tension raises a question I would have liked to dig into: what price controls have hospitals been able to place on their suppliers, and what efforts exist there? Salaries are among the largest expenses any health system carries, and I have yet to meet an employee who wants to be paid less next year. Those pressures are real and worth calling out. One panelist asked why hospitals have not fixed healthcare yet, then asked who is actually responsible for fixing it. Both questions hung in the air for the audience to think about.

How health systems are thinking about the technology they bring in

A session titled "Hospital of the Future: Redefining Care, Innovation, and Design" dove into how healthcare delivery models are transforming as patient needs and expectations evolve. One leader discussed how they have expanded their footprint with ambulatory care settings to improve patient access and affordability. They have six hospitals and nearly 320 ambulatory settings, a number that has grown rapidly in recent years.

The panel shared a clear framework for how health systems think about integrating new technology and working with vendor partners:

1. Health systems rarely build anything internally that is commoditized and reasonably priced. This gets at the classic buy vs. build discussion.

2. Health systems look to leverage what their EHR can provide before looking externally.

3. Point solutions get examined for functional redundancy with what is already in the ecosystem. Solution stability and sustainability matter too. Health systems want confidence that the innovation they are bringing in will not be replaced in the short term.

4. Experience is more important than the underlying technology. The panel used Southwest versus Spirit as the example, suggesting that even assuming both airlines flew the same planes, one is more highly regarded than the other. The operators make the difference. Point solutions need to be tried, tested, and proven before approaching health systems. At the end of the day, leadership is placing a bet on new solutions and technologies. These are the lenses they use to evaluate that bet.

The mission panel was the one I will think about longest

One of my favorite sessions of the day was "Beyond the Bottom Line: Re-Centering Mission in Healthcare." It is easy for innovation, financial pressure, and regulatory complexity to crowd out the reason most people got into this work. This panel brought it back.

Every panelist was asked why they are in healthcare. Several came from clinical families. One told a story about a front-line administrative worker who came and sat with him and his wife during a difficult medical event. That image stayed with me. Another talked about how the challenges and rewards in healthcare exceed anything available in other industries.

What made the conversation particularly striking was how direct it got. "Everyone likes their doctor but no one likes their billing experience." "There is an affordability crisis at the individual and employer level." "We rarely put the patient at the center of things." One panelist made a point about misaligned incentives that I think a lot of people in the room recognized as true and uncomfortable: high costs and low quality are at least partly a product of incentive structures that were never really designed around patients. The panel was willing to say that plainly, which is not always the case at industry events.

The line I will keep thinking about: patients and employers are the true payers of healthcare. A healthcare investor on the panel said that as a mother of three, it takes her hours to determine whether her bills and claims are correct. That is the problem at its most human scale, and it deserves our best effort.

Revenue cycle: cash is still the metric that matters most

A session with health system CROs and SVPs made clear that for all the evolution in the field, the core measure has not changed. Cash. Days in accounts receivable, cash-to-net-revenue, net collection rate, point-of-service collection rate. These are the numbers that drive daily decisions.

Patient financial literacy was a recurring theme. Understanding your benefits, your coverage, and your out-of-pocket exposure is genuinely complicated, and most patients do not engage with it until they are already facing a large bill. The panelists shared how their systems deploy hundreds of financial counselors to help patients find coverage they are eligible for and enroll in assistance programs when they are not. One stat that stuck: patients with insurance are three to four times more likely to access care. Helping patients find coverage is not just good patient experience; it directly affects whether care happens at all.

One panelist mentioned that their organization uses two vendors under separate MSAs for the same process. Another noted their health system works with 120 revenue cycle vendors, a significant portion of them overseas. These examples are a reflection of how genuinely complicated the revenue cycle has become. As AI gets integrated into more of the communication between hospitals and insurers, determining the net financial impact on either side becomes harder.

Price transparency: well-intentioned, still finding its footing

Price transparency came up in the revenue cycle session in a way that felt representative of how a lot of health system leaders think about it. The legislation was well-intentioned. Execution has been uneven.

The complexity inside chargemasters and contracted rate structures is real, and a lot of it does not translate cleanly into machine-readable files. One CRO shared an example of redefining a DRG related to a one-midnight stay rule in a way that saved millions in transaction fatigue with insurers. That kind of nuanced contract management is exactly what the current MRF infrastructure struggles to capture.

The observation that resonated most: the original intent was to put information in patients' hands. That has not happened at scale. What has happened is that vendors are parsing MRFs and selling the analysis back to the hospitals that produced them, helping health systems understand how their rates compare to peers and how effective their pricing strategies are. That is genuinely useful. It is just a different use case than what was originally envisioned, and the patient-facing piece still has a long way to go.

How the day ended

The conference closed with two health system CEOs in a conversation that was some of the most candid I have heard at an event like this. The competitive dynamic between them was real, but the collaborative energy between them was stronger.

They talked about patients becoming the CEOs of their own health, with wearables like WHOOP as one example of how that shift is happening. They talked about how health systems are paid well for reducing acute care burden and not particularly well for preventing illness in the first place. Being proactive does not pay well. That is a structural problem, not a personal one, and both of them seemed willing to sit with the difficulty of it.

The line that will stick with me: "Patients are more afraid of the bills we send them than of getting subpar medical advice from AI." That is either a significant indictment of how we have built the financial experience of care, or a sign of how far AI still has to go to earn trust, or both. Probably both.

Agentic care models are getting stronger. Telehealth and hospital-at-home programs are expanding the definition of where and how care happens. The executives made clear that traditional care settings need to be active participants in shaping that future, not observers of it.

There is a lot of work ahead. The through line from the morning's first conversation to the closing session was the same: the problems are real, the urgency is real, and the people in that room are trying. That is worth noting. So is the distance still left to travel.

Great to see Navesh Kandiyil MD,MBA,FACHE, Simon Gisby, Pavani Munjuluri, Ruth Landé, Karl Hellerich, David H Berger, MD, MHCM, Jitendra Barmecha, MD, MPH, MACP, SFHM, Danny Demetrops, Ken Leonczyk Jr., Nick Stefanizzi, Michele Hagerman, Scott E. Foster, MBA, CHFP, Terry Brown, CRCR, Heath M. McDaniel, Mike Motsay, Bret Boland

Nice to meet Brendan G. Carr, MD, MA, MS, John D'Angelo, MD, FACEP, Peter Gordon, Rick Singh, Becky Greenfield, JD, MPH, Peter Clardy, Marc d. Paradis, Tara Bishop MD, MPH, Kevin Brennan, Michael Ruiz de Somocurcio, Oliver Kharraz, MD, Svetlana DeBellis, Elliot Melement, Turner Norsworthy, Adam Stern, Jim Hall, Michael Chang, MBA, Amy Nash, Elise Thomson, Jean Romano, Mary D. Athitang, Fatma Mirza, John Scanlan, Jay M. Tolchinsky, James Beacham, Steve Stella