Three ways providers must prepare for fallout of One Big Beautiful Bill Act | Viewpoint

With the recent passage of the One Big Beautiful Bill Act (OBBBA), providers must adapt quickly or risk falling out of compliance and losing revenue.

America’s entire healthcare ecosystem is facing significant impacts, particularly sweeping changes to Medicaid and Affordable Care Act (ACA) coverage.

The law has a phased rollout, so providers won’t see the full impact until 2027. But providers must prepare now for the influx of self-pay patients, who are the highest percentage of bad debt write-offs, and additional administrative and documentation requirements like stricter eligibility checks and reporting mandates. Nearly every aspect of provider operations will be impacted.

The first step for providers is to understand the impact and invest in technology – particularly AI-powered automation and front-end data solutions – to streamline workflows, reduce administrative burdens, and ensure a more efficient response to the new Medicaid landscape.

AI can help identify patterns in patient data, predict coverage risks, and automate repetitive tasks, freeing up staff to focus on patient care.

1. Run a gap analysis to stay ahead of the curve

Seventy-one million individuals are currently enrolled in Medicaid, including children, pregnant women, older adults and people with disabilities. The Congressional Budget Office (CBO) anticipates that 11.8 million individuals will lose health insurance over the next decade due to policy changes, including new community engagement requirements, more frequent eligibility reviews and limits on eligibility for immigrants.

Providers need to perform a gap analysis to understand their Medicaid exposure and how funding cuts will affect their patient and payer mix. They should look at:

• Which patients are at risk of losing coverage?
• Where are processes vulnerable or lacking?
• What investments in advanced technologies can be made to streamline eligibility validation?

Current models for determining eligibility won’t be enough. Leveraging AI-driven tools to identify accurate patient demographic and financial data, automate eligibility checks, and enhance insurance discovery at or before the time of registration will be key.

Providers also need to carefully assess how a reduction in Medicaid enrollment has a ripple effect on 340B funding. The federal program allows certain healthcare organizations, like hospitals serving low-income communities, to purchase outpatient drugs at significantly reduced prices.

The funding is tied to Medicaid enrollment levels, therefore, if Medicaid enrollment drops, hospitals could see a reduction in 340B funding. Providers need to understand how potential Medicaid enrollment changes might affect their drug purchasing capabilities and overall financial health.

2. Prepare for an influx of self-pay patients

While the loss of coverage doesn’t necessarily mean patients will stop seeking care, it does impact how and if providers get paid.

One of the most pressing catalysts for providers is a surge of self-pay patients. Self-pay can often result in delayed payments, write-offs or no collection at all. Many self-pay patients are unable or unwilling to pay their balances in full.

According to a KFF report, nearly one in five adults with medical debt think they will never be able to pay it off, and an analysis of patient financial transactions showed providers collected about $500 million for services rendered in 2022 and 2023, which was less than half owed. Uncompensated care costs are projected to increase by upward of $84 billion by 2034, according to an analysis of the bill. Preparedness for financial strain is imperative.

Providers should expect reimbursement delays and need to shore up collection efforts. Organizations can use AI-powered analytics to gain insights that will improve collections performance. Specifically, segmentation and automation allow healthcare organizations to evolve their payment collection strategies with sophisticated, patient-centric insights. These tools help providers understand a patient’s ability and willingness to pay as well as identify charity eligibility and effective payment options to drive more self-pay revenue. 

A deep understanding of patient populations, augmented by external data capabilities, and new patient engagement strategies are critical for providers in this new environment. Many patients will be confused about their coverage and how to move forward. Investing in patient education, digital tools and building strategic partnerships with community organizations will be vital to support and guide patients through new complexities and maintain trust.

3. Address administrative burdens head on with AI and automation

The increased administrative burden will be just as disruptive as the financial implications for providers. Providers must immediately prioritize and optimize their operational efficiency, especially regarding the new compliance requirements.

The industry is facing uncertainty related to the new eligibility reviews, employment verification rules and immigration status checks. There is no one-size-fits-all plan. Medicaid eligibility, benefits, payment rates and administration vary across states, meaning these new requirements will likely manifest differently across states.

The paperwork for Medicaid is already burdensome, and additional employment verification requirements will create additional paperwork, which will fall to the provider organization. It is critical for healthcare organizations to implement AI-enhanced eligibility and insurance discovery processes, so when insurance is available, it’s easily identifiable and providers can accurately proceed with billing.

AI can help reduce billing errors and denials by flagging incomplete or inconsistent data before claims are submitted, and automate the integration of data back into provider EHR and billing systems, reducing administrative costs.

Providers have seen how fragmented front-end processes related to patient registration and data collection can sabotage claims before they are even submitted. Now, demographic, documentation or data errors won’t simply slow down the process— they have the potential to risk reimbursement dollars. This additional complexity will likely increase denials, delay reimbursements and burden an already overextended staff.

The journey forward is complex and will require some restructuring. If providers focus on breaking down silos and investing in predictive AI tools, comprehensive data, and adaptive workflows, there’s an opportunity for radical transformation through surviving the storm.

Jason Considine is president of Experian Health.