Academic Medical Centers Turn Pressure into Momentum

Operating with high stakes, thin margins and rising expectations

Academic medical centers (AMCs) sit at the intersection of some of the most challenging problems in healthcare today. They deliver the most complex care, train the next generation clinical workforce, push research forward – and do it while navigating payer friction, relentless cost pressure and rapidly accelerating expectations for digital and AI adoption. The result is a uniquely high-stakes operating environment. AMCs must innovate and grow, even when operating margins and the margin for error are thin.

Insights from four AMC leaders we interviewed at the last Becker’s CEO + CFO Roundtable spanning executive, financial and perioperative perspectives point to a common theme – the path forward is less about chasing shiny tools, and more about disciplined execution across payer relations, regulatory compliance, AI governance and workforce enablement.

Payer relations improve with real conversations

For AMCs, payer relations are complicated by case complexity, novel therapies and high-cost drug trends where “coverage policy” and “clinical reality” collide daily. Nick Barcellona, CFO of WVU Medicine, described the operational drag that comes from avoidable back-and-forth and how technology can help both sides get to real issues faster.

“I think the more that we can leverage technology to take out some of the noise and actually get down to the tough conversations about pre-authorizations and denials the better,” Barcellona said. “GLP ones are a good example, gene therapy, et cetera. These are exceptionally expensive.”

From a system strategy perspective, Saad Ehtisham, President and CEO of Atlantic Health, underscored the uncertainty that AMCs must plan through, especially as payer mix and policy continue to shift.

“We are being a little bit cautious, but we still need to grow. The payer mix gives us an opportunity to look at it not just from the governmental side but also from a commercial side.”

For AMCs, being proactive in payer strategy is not optional; it is a prerequisite for sustaining mission-driven care.

AI adoption must pair enthusiasm with governance or it breaks

AMC leaders consistently see AI as a genuine inflection point, but not one to approach casually. Ehtisham summarized the mindset many AMCs are adopting.

“Most people are looking at technology as the next wave…without really understanding what you’re trying to get better at. What is the problem you’re trying to solve? Identify the problem. Once you know all those things, then go find the solution.”

At Hackensack University Medical Center, President and Chief Hospital Executive Lisa Tank described why strong governance is non-negotiable as AI moves from pilot to scale.

“As we developed AI, we created a governance model. There’s ethics involved, there’s clinicians involved, legal is involved, compliance, et cetera said Tank. “That infrastructure isn’t bureaucracy for its own sake. It’s how AMCs protect patients, clinicians and institutional credibility while still moving fast.”

Technology must be a productivity strategy, not a headcount strategy

AMCs are being forced to rethink productivity in both clinical and administrative domains without compromising quality. Mike Gertin, chief perioperative medical director at The Ohio State University Wexner Medical Center, puts it plainly. In perioperative care, where throughput and coordination are critical, AI-enabled workflows can reduce delays and missed prep steps while protecting the human connection.

“As we expand things that we do, we can’t always just hire more people to do all these things,” said Gerten. “It’s really about making the people more efficient and allowing them to really have more of that patient-facing encounter.”

That same “efficiency without dehumanization” theme shows up in revenue cycle. Ehtisham pointed to coding and denials as ripe areas for AI impact.

“There’s technology out there that can mine the electronic medical records and code the medical record ready for billing,” said Ehtisham. “The goal isn’t removing expertise but scaling it. So, it’s almost leveraging people to be more efficient.”

AI and technology adoption succeeds or fails at the front line

Even the best technology tends to fail if it’s imposed rather than integrated. Barcelona addressed the anxiety many teams feel as automation expands across the enterprise.

“I think there’s a lot of anxiety amongst the team about, ‘Does this mean my job is going away?’” said Barcellona. “And in some instances, you must be honest. Yes, it does.”

But Barcellona also emphasized the great opportunity AMCs have to retain staff and upscale the revenue cycle team. And he points out that, in his view, transformation works best when it’s co-designed with the people doing the work.

“The best ideas don’t always come from the CFO or the CEO,” said Barcellona. “They come from the frontline folks.”