Revenue cycle leaders across healthcare are facing a familiar set of pressures: growing financial strain, patient affordability concerns, staffing constraints, and rising expectations for better consumer experiences.
For rural hospitals, these challenges are even greater, with 40% operating at a loss and one in three at risk of closure.
At HFMA Annual Conference 2026, Lake Regional Health System‘s Associate Vice President of Revenue Cycle, Alicia Johnson, joined RevSpring President Nicole Rogas to share how a struggling revenue cycle operation became a high-performing financial engine. The playbook rested on three fundamentals. Leadership, simplification, and patient-centered engagement drove everything that followed.
When Johnson arrived at Lake Regional, she inherited multiple payment vendors, thousands of pending denials, and inconsistent operational processes. Some departments had not held a team meeting in over two years.
Rather than launching straight into technology projects, she spent her first 90 days meeting one-on-one with every revenue cycle employee. The feedback was consistent. Years of unstable leadership, poor communication, and inconsistency had taken their toll.
Johnson was clear on this point that the numbers follow the people, not the other way around. Regular department meetings were reinstated, leadership roles were strengthened, and a culture of accountability and psychological safety was established.
With the leadership foundation in place, Lake Regional tackled vendor and technology consolidation. The organization was running five or six separate payment processors simultaneously, creating confusion for both patients and staff.
Johnson reviewed every vendor agreement to eliminate duplicative solutions and consolidated to a single unified payment platform across web, portal, and in-person channels.
A key insight from the session was that patient access teams often underestimate their role as revenue integrity gatekeepers. When front-end teams understand how registration, eligibility, and authorization accuracy prevents downstream denials, the entire operation performs better.
The results speak for themselves with over $4.2 million in denial prevention, 7,000 denials addressed, a $450,000 daily cash increase, and an operating margin that flipped from deeply negative to positive year over year.
The next phase of Lake Regional’s journey focuses on understanding patients more deeply. An analysis of the organization’s patient population revealed that patients have 51% less monthly payment capacity than the national average, are 31% less likely to pay online, and 62% of accounts receivable fall outside existing payment plan terms.
These findings reinforce what Johnson learned when an earlier push to move all patients to digital statements generated community pushback. Her response was to send a letter explaining the options and make it opt-in. Her broader philosophy was simple. Care for people first and let engagement strategies meet patients where they are instead of forcing them into one channel.
Lake Regional’s transformation offers a practical roadmap for organizations of all sizes:
Lake Regional’s financial transformation began not with technology, but with listening, simplifying, and rebuilding trust with both employees and patients.
Want to see the full numbers behind Lake Regional’s turnaround? Read the complete case study.