By Dhruv Chopra

The 2026 budgeting season is underway, and healthcare executives can acutely feel the financial pressures brought on by this year’s increasing claims denials and labor shortages. At the same time, patients’ expectations for convenience, transparency, and personalization continue to climb.

Healthcare providers are being asked to do more with less. To meet these demands, many executives are focusing on short-term cost-containment measures to mitigate reimbursement challenges, but this approach only delays the inevitable. Today’s challenges call for decisive action, which is why 2026 is the year healthcare executives must invest in tools that will actually solve their problems: interoperable, automated technology.
Claims denials, labor shortages, and patient demands are the core catalysts driving artificial intelligence (AI) and interoperability innovations. AI actually can do more with less, which is why adopting this technology can’t wait until 2027 or later.

The ROI of AI and interoperability.
The cost of claims denials cannot be understated. As reported in Health Affairs Scholar, the current administrative U.S. healthcare financial transactions ecosystem sees more than 9 billion claims per year at an average transaction cost of $12-19 per claim. Each claim takes an average of four to six weeks to process and pay. Claims transaction costs break down to the following:

● Simple claims: $7-10 across private payers and providers.
● Complex claims: $35-40 across private payers and providers.
● Prior authorization: $40-50 per submission for private payers, $20-30 for providers.

These costs reflect a smooth transaction. When claims are denied, the above costs can grow exponentially, along with indirect costs such as wasted time, staff burnout, and turnover. As a KFF analysis shows, ACA marketplace plans saw an average denial rate of 20% in 2023.

Earmarking funds for technology in 2026 will enable hospital systems to improve the entire system, including efficiency, patient outcomes, and financial sustainability. Failing to do so not only results in additional costs in the long run, but also affects the quality of care providers give and patients receive.

From clinical workflows to claims management, technology improves employee efficiencies across the board. To use the radiology discipline, for instance, technology can improve:

● Imaging reads and interpretations by reducing read times and the need for repeat tests.
● Interoperability that streamlines clinician access across facilities, reducing duplicate studies, and speeding transfers.

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