Healthcare organizations are under pressure from every direction. Consumers increasingly expect the same convenience, transparency and responsiveness they receive from retail, banking and hospitality brands. At the same time, providers and health systems face shrinking reimbursement rates, labor shortages, administrative burdens and rising operational costs.
The tension is becoming impossible to ignore. According to a 2025 McKinsey analysis of the U.S. healthcare industry, financial pressures remain severe across hospitals and physician groups despite gradual margin stabilization. Meanwhile, a growing number of patients delay or avoid care because of cost concerns and confusion around billing and insurance coverage.
Members of the Senior Executive Healthcare Think Tank argue that organizations cannot solve this challenge through cost-cutting alone. Instead, they believe healthcare leaders must rethink how care is delivered, coordinated and experienced. Below, Think Tank members share how healthcare leaders can reduce waste, improve patient trust and modernize care delivery while navigating the financial realities reshaping the industry.
Operational Efficiency Is the Foundation of Affordability
Skinly Aesthetics Founder and Medical Director Dr. Dmitriy Schwarzburg believes healthcare organizations often underestimate how much operational friction drives both costs and patient dissatisfaction.
“Consumers judge healthcare by the same standards they apply to every other service industry: convenience, speed, transparency and communication,” Schwarzburg says. “At the same time, reimbursement pressure and rising operating costs continue to tighten margins.”
Schwarzburg, whose work spans medical aesthetics, telemedicine and consumer healthcare through Skinly Aesthetics and Health Source Online, says organizations frequently focus too heavily on pricing rather than operational redesign.
“In my experience, the biggest opportunity lies in operational efficiency,” he says. “Many patient frustrations and expenses come from friction within the system itself: delays, poor coordination, unnecessary administrative layers and inefficient workflows.”
Healthcare leaders are beginning to recognize the scale of this issue. A 2024 American Medical Association survey on prior authorization found that physicians continue to report significant administrative burdens that delay care and negatively impact patient outcomes.
Schwarzburg argues that organizations capable of simplifying workflows and improving communication will gain both financial and competitive advantages.
“Organizations that simplify the patient experience, improve transparency and use technology to streamline operations will be better positioned to balance affordability with financial sustainability,” he says. “Lower cost doesn’t always come from charging less; often it comes from operating smarter.”
“Healthcare organizations should prioritize transparency regarding costs, patient responsibility and the status of in- and out-of-network providers.”
Transparency and Consumer Experience Must Become Priorities
CaregiverZone, Inc. Founder and CEO Mark Francis says healthcare organizations should borrow lessons from consumer technology companies that prioritize customer experience at every level.
“Having been at Amazon, where customer obsession drives decisions, I believe healthcare leaders need to focus on improving the patient experience as well as transparency,” Francis says.
Francis, whose career includes leadership roles at Amazon Web Services, Intel and Health Hero Network, believes there are immediate opportunities to reduce patient frustration without fundamentally restructuring care delivery.
“There is a lot of low-hanging fruit to improve the patient experience, from eliminating redundant tasks and streamlining information flow across patient records to deploying agentic AI care navigators to schedule appointments, facilitate referrals and explain costs,” he says.
Francis argues that healthcare organizations can no longer treat billing confusion and network complexity as unavoidable side effects of the system.
“Healthcare organizations should prioritize transparency regarding costs, patient responsibility and the status of in- and out-of-network providers,” he says. “The burden—and surprise—of discovering that a provider is out of network and thus incurring a large cost after the fact shows disdain to the patient and is irresponsible of the healthcare organization. That needs to end.”
Preventive Intelligence Can Reduce Downstream Costs
Sriharsha Chavali, Enterprise Technology Leader at The Aspen Group, says affordability challenges are often addressed too late in the care cycle.
“In my experience, affordability and patient experience don’t get reconciled at the billing layer,” Chavali says. “They’re solved upstream.”
Chavali, who has spent more than a decade building enterprise-scale platforms for healthcare organizations, says organizations should focus on preventing costly clinical events before they occur.
“At my prior organization, real-time clinical surveillance caught early sepsis signals and inappropriate antibiotic use before they became extended stays,” he says. “Prevent the event, and the downstream chain disappears: no non-reimbursable cost, no denial, no surprise bill.”
Chavali believes many organizations still focus too heavily on utilization management after clinical decisions have already been made.
“Most organizations still focus on utilization management after the clinical decision—prior authorization, denials and appeals,” he says. “The bigger opportunity is shifting utilization management upstream using real-time surveillance and AI-driven workflows.”
He adds that the technology already exists to support this transformation.
“The capability exists but the gap is executing those insights,” Chavali says. “Get that right, and affordability, experience and reimbursement finally align.”
“Affordability cannot be reconciled in the current operating model; the model has to be restructured.”
Healthcare’s Core Operating Model Needs a Redesign
Mitchell Universal Network, LLC CEO Donna Mitchell argues that operational improvements alone are not enough because the healthcare system itself is fundamentally flawed.
“Affordability cannot be reconciled in the current operating model,” Mitchell says. “The model has to be restructured.”
Mitchell, who brings nearly five decades of Fortune 500 transformation experience across healthcare, aviation, telecommunications and emerging technology, believes the current reimbursement structure incentivizes reactive care instead of prevention.
“The system is mathematically and functionally broken,” she says. “In prior authorization, AI and non-clinical staff deny care that licensed clinicians prescribed.”
Mitchell believes healthcare organizations must rethink workforce alignment, care delivery and AI oversight simultaneously.
“Healthcare needs a redesign,” she says. “People: Match staff, including decision-makers, to areas where credentials create value. Processes: Shift from reactive to preventive. Reimbursement pays for episodes; outcomes follow prevention. Systems: AI for diagnostics with clinical oversight.”
She also warns organizations against focusing exclusively on technology implementation without addressing adoption and accountability.
“After 48 years in enterprise transformation, I have watched organizations optimize the experience while leaving the model intact,” Mitchell says. “The math fails. The harm compounds.”
“The opportunity is to make healthcare simpler for consumers while removing waste from the system.”
Administrative Waste Remains One of Healthcare’s Biggest Problems
Tirumala Ashish Kumar Manne, Principal Cloud Architect at Optum, says healthcare organizations cannot solve affordability problems without addressing inefficiency across care delivery systems.
“Affordability in healthcare requires more than price reductions,” Manne says. “It requires redesigning how care is accessed, coordinated and delivered.”
Manne specializes in scalable and AI-enabled healthcare infrastructure and believes many patient frustrations stem from fragmented systems and poor coordination.
“Many consumer frustrations come from preventable inefficiencies: fragmented systems, unclear benefits, repeated paperwork, delayed approvals, duplicate services and poor guidance on where to seek care,” he says.
Administrative costs continue to consume a significant share of healthcare spending. Research published in Health Affairs estimates that U.S. healthcare administrative spending approaches $1 trillion annually.
Manne says healthcare leaders should focus on operational precision and measurable outcomes rather than relying solely on reimbursement increases.
“Organizations can reconcile cost pressure with consumer expectations by reducing administrative waste, improving transparency, automating routine workflows and helping patients reach the right care setting earlier,” he says.
He believes simplifying healthcare operations ultimately benefits both consumers and providers.
“Reimbursement constraints will remain, so leaders must focus on operational precision, value-based models and measurable outcomes,” Manne says. “The opportunity is to make healthcare simpler for consumers while removing waste from the system.”
Interoperability and Automation Are Critical to Sustainability
Digital Healthcare Architect Mahendran Chinnaiah, who works for a major U.S. healthcare and pharmacy services organization serving more than 100 million people, believes healthcare organizations must modernize the infrastructure underlying care delivery.
“The only way to reconcile affordability with rising costs is to move from manual intervention to automated, interoperable workflows,” Chinnaiah says.
With more than two decades of global experience building AI-enabled healthcare systems, Chinnaiah argues that administrative waste remains one of the industry’s largest financial burdens.
“Right now, administrative waste accounts for a massive portion of healthcare spend,” he says. “We can’t lower costs simply by cutting services; we must lower the cost of delivering those services.”
Chinnaiah believes organizations should invest in open, connected architectures that allow information to move seamlessly across providers and systems.
“Organizations must invest in an Open Health Ecosystem that allows for real-time data exchange,” he says. “This reduces the burden of prior authorizations and redundant testing—the friction points that frustrate patients and drain budgets.”
For Chinnaiah, patient experience improvements naturally follow operational modernization.
“By using architecture to automate the ‘plumbing’ of healthcare, we can protect reimbursement margins while lowering the price of care,” he says. “Better experience isn’t an added cost; it’s a byproduct of a more efficient system.”
Strategic Priorities for Healthcare Executives
- Focus on operational efficiency before reducing services. Streamlining workflows and reducing administrative friction can lower costs without compromising care quality or patient satisfaction.
- Make transparency a competitive advantage. Clear communication around pricing, insurance coverage and patient responsibility builds trust and reduces financial surprises.
- Shift affordability strategies upstream. Real-time clinical surveillance and preventive interventions can prevent expensive downstream complications and denied claims.
- Redesign systems, not just experiences. Sustainable affordability requires structural changes to reimbursement models, staffing alignment and AI oversight.
- Reduce administrative waste aggressively. Automating routine workflows and improving care coordination can eliminate unnecessary costs while improving access.
- Invest in interoperability and connected systems. Real-time data exchange reduces duplication, accelerates care decisions and improves operational sustainability.
The Real Cost Problem in Healthcare
For years, healthcare organizations have treated affordability and patient experience like competing priorities: lower costs meant tighter margins, fewer resources and more friction for patients. But the leaders featured here argue that assumption is outdated. In many cases, the same inefficiencies driving up operational costs are also driving patient frustration, clinician burnout and reimbursement challenges.
What emerges from these conversations is a different way of thinking about healthcare economics altogether. The path forward is not simply about charging less or asking consumers to absorb more. It is about building systems that waste less time, prevent more problems upstream and make it easier for people to navigate care without confusion or unnecessary delays. Whether through interoperability, automation, preventive intelligence or operational redesign, the organizations most likely to thrive will be the ones that stop treating better experiences as an added expense—and start recognizing them as evidence of a healthier, more efficient system.
