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Newsday: The ROI Ultimatum: Healthcare's New Survival Rule for 2026 with Zahid Rathore

[00:00:00] Chartis, A leading healthcare advisory firm, works with more than 900 clients annually to materially improve the delivery of care.

With more than 1,350 professionals, Chartis helps providers, payers, technology innovators, retail companies, and investors, create and embrace solutions that help reshape healthcare for the better. Learn more@charts.com.

I'm Bill Russell, creator of this week Health, where our mission is to transform healthcare one connection at a time. Welcome to Newsday, breaking Down the Health it headlines that matter most. Let's jump into the news.

Bill Russell: It's Newsday and we are uh, some of us are coming to you live from Silicon Valley following the JP Morgan conference and have some things going on here. And we're joined by the z the senior partner formerly with HealthLink Advisors.

Now with Chartis. And welcome to the [00:01:00] show.

Zahid Rathore: Thanks, Phil. It's

You.

Bill Russell: people are probably wondering why I call you the commish. Why are we calling you the commish?

Zahid Rathore: Well, in addition to my full-time career I wanted to give back to my community. I've lived in Washington, DC for 24 years and got really good at complaining about everything. And a fellow parent said, you know, you need to run for the advisory neighborhood commission. So I did foolishly and, had a three-way campaign and I sent out mailers and had yard signs. It's a unpaid job. So, it's my way of trying to give back to the community and effect change with mainly things like hyper-local politics, like zoning, pedestrian safety, street safety. You know, as a young father, now, I'm not young, but I have young kids, you know, I want them to be safe and it's important that they see that can do more than just complain about things.

You can actually do something about it.

Drex DeFord | This Week Health: Local politics are important and it's amazing how passionate people can be about things like one way streets, right?

Zahid Rathore: my God. [00:02:00] Uh,

Speed bump.

Sarah Richardson: Well, and it, the thing I like about what you've done though, and I remember when you were running your initial campaign about a year and a half ago, is that we always talk about healthcare being local as well, and we can talk about broad topics all the time. But if we're really gonna make those changes, it has to start with the grassroots efforts in our local communities. Even with national healthcare chains, your experience as a patient is still akin to what is experienced in your local hospital. That may be one of 40.

Zahid Rathore: You're exactly right and one bad interaction with technology or you feeling rushed by your PCP and maybe you'll never go back. So it really is like utilization and our perception is at the elbow bed bedside or elbow interaction. So you're right.

Bill Russell: Well, we are staying at the Citizen m hotel, which is now a Marriott property. Recently Marriott started operating these things. And I posted today on it that it is an example for all CIOs of what not to do. Like, you [00:03:00] know, talk to your users, talk to the people who are gonna stay in your hotel before you, like, design away all the things that people like just in the name of more efficiency and more I don't know, capacity.

I don't, I, am I whining here direction, Sarah, or.

Drex DeFord | This Week Health: So when I checked in so this is gonna turn into a big complaint thing now about citizen, but when I checked in, I felt like I, so I have a camper that I towed behind my truck. I felt like I checked into my camper. It's about that same size.

Bill Russell: they've compressed, just so you get the idea. They compress the rooms to just the width of the bed, and then they put in a shower complex if you've ever been on a cruise ship or a camper for that matter. It feels like that. I mean, everything's just like they couldn't fit another thing in there.

Sarah Richardson: Well, I couldn't figure out how to turn the shower off this morning. I sat and I live in California, which is a terrible thing to admit that I actually let it run for three hours while I did my work and got ready because I couldn't have someone come into my room at that point. I suppose I could have, but I [00:04:00] literally, the shower ran for three hours, but I could not figure out how to turn the darn thing off.

Bill Russell: The lesson for healthcare is before we roll software and stuff out to the end user, I dunno, consultant and maybe even patients for that matter. Go figure out heresy. That is well, we're coming off the JP Morgan conference. We, and a bunch of stuff happened.

You know, you had the anthropic, claude for Healthcare Launch you had just prior to that, I don't know if chat GPT got the memo that they were gonna release that at JPM, but they released their chat, GPT for Health and then their chat, GPT-4 Healthcare, where their two releases. by the way, this is a conference that is really spread out.

It, like there's sub conferences, there's there's meetings between you know, investors bond holders, and there's a portion of it that is the CEO and the CFO of probably about 15 to 20 major health systems presenting to bond holders. Which is important to them. If they're gonna [00:05:00] do any kind of expansion refinancing or that kinda stuff, they're gonna go to those bond markets.

So that's primarily what it's organized around, but then the entire ecosystem of health, tech and innovation. But by the way, farmers here as well life sciences here as well. We're not gonna focus on all the announcements because there's a million of them. But I will say this, that, in the majority of the announcements, AI was the central theme.

and focus. And as you would imagine it, it was all over the board. But a lot of it within the healthcare provider space is focused on efficiency, workflow optimization rev cycle. a lot of talk about, changing the operating model with with technology and AI really is the foundation for that.

Sarah Richardson: I'm curious, Z from when a big conference like JPM occurs. What do you start to see from your clients? Are they leaning in more to the day-to-day of their operations, or do [00:06:00] they look to some of the things that are coming out of these bigger events and then figuring out how to implement that and they know they need help doing it, so they're gonna reach out to you and say, Hey, by the way, we know this is a focus for this year.

Davos is coming up as an example. What is the impact to you after a major conference in terms of what people start to reach out and need and want most from you both strategically and how to operationalize those ideas?

Zahid Rathore: Yeah, I think it's on the spectrum of like where the client fits into the ecosystem. Are they big and at the front edge? You know, I can think of some of my bigger clients and they'd probably look into what are the trends that are coming out. Maybe they even participated. JP Morgan health, and then I have my other clients that are smaller and their margins are much tighter.

They're looking to keep the lights on. You know, I think they probably want validation of their approach. You know, should we go to Epic or not? Whereas I think you look at the larger clients and they're, what emerging technology can I go? And adopt. Maybe I can go be on the leading [00:07:00] edge.

Maybe not the bleeding edge, but it, I think it depends on the client that we're talking to, but we see clients across the spectrum, I think depending on how they're doing financially, that'll influence their receptivity to what comes out of these big conferences.

Bill Russell: Sarah I'm curious from from your perspective, you know, you, when you were sitting in the CIO chair. You saw these announcements from hims, from vi, from whatever, because they tee 'em all up and they're, a lot of 'em happen in the next three months. Right. So JPM as well, there's just an awful lot of announcements, you know.

Did that, Did that impact your day-to-day or were you already set and on a road?

Sarah Richardson: It was twofold. So I was very involved in all of the different chapters or different organizations that host these events. Not JPM, but definitely Vive and HIMSS and others. And we would take our strategy and bounce it against what we were hearing. And there were two things we would do. We'd either reinforce the trajectory that we were on or we would look about potentially retooling. But what Xi just shared that was always a concern was. If you're [00:08:00] on the bleeding edge and you have the money to do it, you get to go do it. If you're fighting for survival, you might get to say, well, guess what? We did hear these two things and this is where we might be able to lean in. And so often you feel like you're a parts department where you kinda get to go and just grab a few things off the shelf and. Hope that these other implementations work effectively. It's one thing to say, I'm gonna pick and choose these AI components of Epic and put 'em in my environment. It's the second piece to say, wow, if I optimize a workflow over here using these technologies, am I gonna get the ROI that I need? Are people gonna adopt it the way that I can and is it gonna integrate effectively? That's where you need help from someone like Z, because all the best ideas in the world still have to be financed. And as a CIO, even in the last few years. You don't get an unlimited bag of funds. Everything has to have a return on value. Otherwise, as long as you're comfortable doing it, you risk being the scapegoat for the things that don't work more than you get credit for.

The things that do work, and this isn't personal credit, it's credit for your [00:09:00] team so they feel safe enough that psychological safety and implementing advanced technology is a very delicate balance.

Bill Russell: You know what's interesting on that is the, different types of conferences. So the ones in the beginning of the year absolutely are more broad and you're, you know, doing your big product announcements, but like the egms and the gosh, I don't even know all the names of 'em, but the Workday conference and the whatever they're releasing stuff for tools that you already own.

That is a list, right? It's like, Hey, we're giving you these things. What are you going to do tho? Those are a little different. Those, you come back, you sit down with your team, you're going, all right our vendor just turned these things on. Are we gonna do 'em or not? These are more trends, right?

You could look at the trends of what's going on, what's being talked about, how are people viewing healthcare and where it's gonna go. And by the way, they have been wrong before. There have been whole seasons where people focused on the wrong thing. The tracks is smiling. Yeah. I mean, we've been in it at this long enough that you just remember, you know, seasons where we were talking about stuff and you look back down and go, yeah, that,

Drex DeFord | This Week Health: with that?[00:10:00]

Bill Russell: yeah, That's the big blockchain joke. Right.

Zahid Rathore: What was the vibe on the changing reimbursement in one big, beautiful Bill and what are they saying about, you know, the, well, I guess, let me, before I ask the question, you know, what we're seeing our clients is a lot of uncertainty. So is there some belt tightening going on? Yes. Is there some delaying of. Innovation deployment. Yes. So did they talk a little bit or allude to the circumstance or the temperature at the

Bill Russell: Well, it, it's important to note it's not one conference, right? So there's things going on all over the city. And yes that was a major theme at the event. I'm laughing because it was like it was on the surface. And to their credit you know, CMS and others they got up on stage, you know, with people sort of like ready to strangle 'em.

So, to their credit, they're not hiding. They're talking about it, but even the the presentations from the CFOs and CFOs, you could hear it as an undercurrent. It's like, yeah, we're, and the word you used is [00:11:00] perfect uncertainty, like.

Drex DeFord | This Week Health: UNC.

Bill Russell: We still don't know, like, what is our number gonna be for this year?

It's like, it's gonna be between this and this, and it's probably wider than any projection they've ever given. because it's just like, it could be really bad or it could be really good and like, and we don't, we like here are the factors, but it's a wide range.

Zahid Rathore: what do my clients perceive as they see these headlines? And I think it's protect the core. And if I adopt a new technology, what is the bankable ROI that I can incur from tool that has been used and proven to bring return.

. Has the timeline changed? Like it scrunched last year? Well, actually it scrunched over the last three years and I remember we were saying, Hey, you gotta have a, it used to be a three year ROI, then it was a two year ROI and last year people were saying no, it's a one year ROI, is it still a one year ROI that we're looking at?

I think it depends on like what problem is being solved, but yeah, when we look at value realization modeling for our clients. We do a typically a 10 year [00:12:00] cost model. But to your point, bill, there, there's some things that I think we, we prioritize The benefits and when can they be realistically achieved and people to see results, you know, tomorrow. Side note, there's an expression I've learned in my commissionership, you know, the best day to plant a tree was 20 years ago or tomorrow. So perhaps there's something there with benefits. You know, the best time to realize this benefit is. sometime in the past, but, or tomorrow. So I think there's a sense of urgency. and there's just so much spend. You know, we, I have one client, the CFO was looking at of the organization, and number one on the list was epic. Number two was Microsoft, and they were asking the questions. How can I rationalize these costs? And some of these things you can't rationalize away.

So then the question is, well, what benefits can I quickly derive from like, and to your point, it's like what can we go achieve in the next year? So I think it's all the above. I think there's so much pent up because of there's so much pent up uncertainty. people are [00:13:00] eager to start seeing return and so. Advice to all the new entrant vendors out there, or the long-term vendors that have a product. You better show bankable ROI, because I think that's what's gonna rule the sales cycle is it proven?

Drex DeFord | This Week Health: And sooner rather than later, right? I mean, it does change behavior. The uncertainty in the market the what used to feel very predictable. I know this is gonna happen this year at about this time, and so I can plan for that. All of that has just been dumped out onto the floor, and unpredictability has kind of replaced it.

And so as we do in healthcare, as many businesses do, we pull in our horns and like you said, protect the core and start to think about what is the challenge that is probably gonna happen tomorrow if I'm gonna implement a project that needs to pay off today because I need to think about the next 30 days in cash flow and all of that, As opposed to. Maybe two years ago or three years ago when it was much easier to say I'm willing to make this investment. Now, even though [00:14:00] it may not pay off for four or five years, because I know I've got predictability over the next four or five years about what's gonna happen in the city, what's gonna happen in the federal government, and that is, that is gone, it's really changed behavior.

So for new folks coming into the market and for folks who need advice and guidance, they're so busy. Focused on the work on a daily basis inside of operations that they often don't have time to sort of step back and think and plan and do the strategy because strategy is hard in this environment.

Zahid Rathore: One thing that we help our clients with that are, they're looking to adopt a technology, and it could be like a new EHR or a new bolt-on, or a new eer p what have you, like an enterprise system or a niche system is. What are the benefits that can be derived? So we establish the baseline, we establish the target goal, the stretch goal.

And then, you know, going back to Bill again, it's what is the realistic timeline to achieve? then there is as an assignment of accountability to a service line, director of manager, a vp. So it's not [00:15:00] just what the vendor's saying, how do we get, you know, you can buy all the technology in the world. not use it correctly.

You're never gonna realize that ROI get that benefit. So we try to call out. I feel like that's gonna be an emerging thing in 2026 is all about you're spending money, there are a lot of eyes on the spend, so how are we gonna bank the return? And the only way to do that is to assign accountability.

Drex DeFord | This Week Health: The plan, do, check, act cycle. a lot of ways in healthcare, we've not been great at sort of like finishing that circle. We plan and we do, but we don't necessarily come back and check and make sure that we got what we invested in. We got the ROI. Yeah, I guess I'm seeing that same thing, but it's interesting to see you're being asked for that in all the things that you're helping plan.

Zahid Rathore: you know, consultants have to remain relevant. So, you know, I think about a consulting project I did 10 years ago with a long-term client and, you know, it was eight years later, I came back reincarnated through Health Inc. Slash charts and we were looking at that analysis. [00:16:00] Eight years later to see if those benefits had been realized. And the issue of whether it was realized or not is sort of irrelevant is why do we wait eight years to revisit the analysis? There's something there about, there needs to be regular discipline about, okay, we spent this money on this tool. The vendors have techniques to. Kind of co cox you along to make sure you're realizing the benefit. But it comes back to is the manager, is the director or the VP using it, and were they bought into the goal at the beginning or not?

Bill Russell: I wanna bring up something that came up a couple times. It's the healthcare providers. Needing to be able to operationalize across not only their four walls, but also across partners in their community for care, in order to receive full reimbursement and those kinds of things.

So now not only do they have to have the data and the systems and the workflows defined within their health system, but as these people go to SNS and they go to other things [00:17:00] that are potentially outside of their control. They have to be able to coordinate not only, you know, that just coordinate the care, but the quality of care and make sure that there's not a readmission and those kinds of things.

because all those things d ding, the reimbursement. I'm gonna throw this to you guys and say, what's the complexity of this? I mean, on a scale of like one to 10 and, you know. Five being just coordinating your care within your health system. I mean, how complex is this to coordinate care across these other entities that you don't necessarily, they're not your employees, they're not your, you know how, I mean, how challenging is this and how do you approach it?

Drex DeFord | This Week Health: Z It feels like four dimensional chest to me in a lot of ways because, if you had one model in a health system and that's the way that you provided care for all your patients, there's a thing you could put into place. The analytics, the teams, the, all the stuff that you need for that model.

But the reality is. You see it out there, organizations are providing care using a [00:18:00] lot of different models. How they get paid, how their shared savings yeah, I, it's, it feels like multidimensional chest to me and not for the faint of heart.

Zahid Rathore: as you were all both asking this question, what came into my head was often the patient doesn't know like what their role and responsibility is, and if you're passive, you'll lose and you'll just get. from, From venue of care to venue of care. And you know, the only way we learn is like you go through it either yourself or through a family member.

And those that know me, you know, my, my parents were physicians, but I also lost my father to cancer. And watching him navigate that and with all the horsepower that we knew about healthcare, there still were cracks. And, you know, looking back at it. And upon reflection, and if I meet someone who's about to go on this healthcare journey, it's, you know, the role of advocacy and, you know, it's almost like [00:19:00] we as consumers, we as patients need to know like, what is our role in all this?

And probably a lot of it is, you know, you need to self-advocate, but I think drex hit it outta the park with four dimensional chest. But wouldn't it be helpful if we knew that it was four dimensional chest as a patient or as a consumer? Maybe a modicum of understanding how to play four dimensional chess. But yeah, it's super complicated and you know, even just the portability of your data. you know, I have a family member who's currently trying to navigate healthcare and. You know, it's my family member is young. He's in his twenties, and he has really no understanding of the complexity of this. And I think he assumes given his experiences with other technologies and under in other industries, that everyone should know everything. And that is way not the case. That absolutely not the case.

Sarah Richardson: And there's that archer too, where advocacy is not like reimbursed or covered. And so I've got friends who are either taking [00:20:00] a sabbatical or a pause, and they are serving truly as advocates in their neighborhood. Or for their communities, like what you've done with the commissioner role, because they happen to live in a population with a lot of elderly patients and helping them get to their appointments, helping them understand their prescriptions, helping 'em understand the aggregation of their medical records.

This person's like, it's a job,

Drex DeFord | This Week Health: People do it.

Sarah Richardson: job

Drex DeFord | This Week Health: People deal with their family members too. When their family members get sick they leave the workforce so they can help them. You know, when you're sick, it's the last thing you wanna do is to try to figure out this complicated system. E even a healthy person who's well connected into healthcare like we are, struggle with the other problems of like, well. You know that internist doesn't have my information yet from my general practitioner, and since they don't, they won't make the appointment, and so my care is being delayed and I'm getting more and more sick. It frustrating to

Bill Russell: since we have some security folks on the line with Z and Direct, I do wanna head in that direction before I [00:21:00] do. I, you know, it's, there's. There's a couple ways people can approach this, and I'm seeing 'em approach it differently. There's the let's call the easy. Route, which is you get your providers to agree to go on your EHR and then all of a sudden you can bake in your workflows and your data and whatever across a single platform.

In a lot of cases, that's not even available to you in this world. So you do have to figure out, okay, how are we going to create that data layer and how are we gonna create that workflow layer? And then how are we gonna if you did the data layer and the workflow LA layer correctly, you're going to be able to do the analytics, which are gonna be required in order to get that reimbursement, which is no small feat either.

And some of the billing has to be done across those multiple entities as well. So, there's a lot of different ways to approach this. I think the old way of, oh, we'll just get 'em on our EHR and call it a day. I think that that is gonna be the thing that alludes many health systems and they're gonna have to, flex that [00:22:00] data muscle and that workflow muscle and really operationalize is the right word, the operations muscle across another entity. I wanna close with security because I'd be remiss with Z and Drex on the line. You know, what, what's happening in the world of security? What should we be thinking about right now?

Zahid Rathore: the,

The horse has been beaten to death in, in healthcare that it's, you know, you've heard the expression, it's not a matter of, of if, but when in terms of, of a healthcare provider organization getting disrupted from a cyber attack.

So I'm not gonna repeat that. you know, when I think about 2026 for my clients, it's all about getting. Accelerating posture. So accelerating your cyber readiness posture, accelerating your downtime, resiliency posture. a lot of our clients have established the work groups, you know, the CISOs in place calling the shots, but just given even what we talked about, the need to bring people together from RevCycle and from the various disciplines of healthcare, that takes time. Organizations, you know, they say, I have a [00:23:00] working group. And then you say, well, how's progress going? And it's, I think the word is slow,

Bill Russell: Okay.

Zahid Rathore: an external partner help accelerate that? But I think in 2026, it's all about accelerating progress. You know, you were all at JP Morgan. The A, you know, we continue to clinging to see how AI can be effective.

And what are the, like effective use cases, perhaps there's. The lightning rod in 2026 is AI can be helpful to accelerate downtime, resiliency, or your cybersecurity posture. Those are two great use cases.

Bill Russell: Well, I'm getting tired of drex writing about how AI is going to you know, take my health system down.

Drex DeFord | This Week Health: You look. So in the two minute drill yesterday I actually talked about you know, AI agents and 2026 is gonna be the year of the AI agents. I've been very vocal about this idea that we have to lean hard into artificial intelligence in cybersecurity because the bad guys are already leaning hard into artificial intelligence and trying to figure out how to break [00:24:00] us. we've gotta lean into that. But AI agents can also kind of create this situation of like a whole new group of kind of virtual employees who have access to tools and could make a lot of serious mistakes. And not only open us up to breaches, but just as an insider threat. So there's that whole challenge of. What goes on with ai and now's the time to talk about it because we're just starting to use agents and do things with agents and identity access manages management has always been hard, but it just gets compounded now, with AI agents. Are you guys thinking about that or starting to talk to, to, to your clients about what they're doing with AI agents and managing what those capabilities are and how they'll work?

Zahid Rathore: You know, Drex, I think it goes back to my earlier comment about it. Depends on the maturity of the organization. You know, how sophisticated is the experience of the CISO to lean into those emerging things versus a whole, you know, is the IT function. More just trying to [00:25:00] focus to keep the lights on.

The other thing, I, as you were all talking. You know, is the commoditization of it and the outsourcing of it to third parties, and the extra layer of complexity that would bring. So if a bad actor comes in, if If you had it in your shop, you could go down the hall and chat with your colleague, but now your colleague is across the ocean, different time zone.

You don't know actually who you're talking to. and could the threat be from there? know, this the period of where there's the smoke before the fire is declared that there could be some serious damage. And we're seeing more and more clients thinking about outsourcing bits and pieces or the whole.

Component of it outside of the four walls, outside of their control. So that brings in the question, like what is your vendor doing? How are, how is your vendor adopting this and using a AI agents. And as we do our IT outsourcing analysis, that's an emerging area is how we ask the vendors, what is your use of [00:26:00] AI to enhance cyber, your cyber posture?

Drex DeFord | This Week Health: it's really almost for all of the third parties that are involved, right? So when you talk about resiliency, you think about this resilience path a big. Painful thing that we learned with change Healthcare, but we've learned it over and over again since, is that there's some hidden party in our third party supply chain that if that. Organization breaks, and maybe it's because they're using AI and they have a problem, but no matter what it is, if they break, we go down, we we can't provide great care. And so third party risk management has become much more than just like, are my third parties secure? Are they doing a good job of securing themselves?

It's also this whole conversation about happens when one of them gets taken out for some reason. Can I continue to operate and survive without that? Part of my utility that I've been paying for. So if you outsource all of it, you've got that kind of a problem. Even if it's just a software [00:27:00] as a service component, it can be a disaster for you too.

Bill Russell: You remember the show? That's incredible. Some of us who are old enough can remember the show. That's incredible. It's where people did like crazy things and whatever, and there was this guy who caught a bullet in his teeth.

Okay. And that was the shtick. Somebody shot a bullet, he caught it in his teeth. I don't know how you practice for that. You know, somebody like throws you one soft toss and then all of a sudden it's like, okay, but the line is, you know, how do you practice for that soft toss? And then you go, okay, this one's gonna be coming a little faster.

And I feel like that's the time we're in right now. It's like 2026 is. This one's gonna be coming at you a little faster. For CIOs, for CISOs, for CTOs. There's an awful lot of moving parts right now. The foundation under the whole thing from a financial standpoint and others is uncertain. And it's gonna require all the leadership and creativity and teamwork and community to uh, to navigate this.

It's gonna be, it's gonna be a [00:28:00] wild 2026. Hey, Drex, what does that say behind you?

Drex DeFord | This Week Health: It says, you don't need to Google to know which way the wind blows. I think that's probably really appropriate for the conversation today. Right? It's, we know which way the wind's blowing. It's blowing in all directions at the same time right now.

Bill Russell: I've been there. I, you know, living in southwest Florida, you know, I've been there when the wind's blowing in every direction and you're like, I'm not gonna go outside today. I think it's.

Drex DeFord | This Week Health: how it feels. Yeah.

Zahid Rathore: I wanna end on something, bill. I just wanna say that I appreciate what you all have built and what you're building for our industry. You know, the power of your convening the power of bringing the conversation locally, and having these types of conversations and your city tours and all that. I just encourage you, it is awesome. It's so great.

Sarah Richardson: It's always like, just when we get to spend time with you, we are so grateful for what our partners bring to the table too. And, it's fun to catch up on our lives as much as it is what we provide to others professionally. So

Zahid Rathore: Yeah, but I, you know, I want to go in and [00:29:00] like, you guys are disrupting the con, you know, you're actively pro in a positive way, disruption. You're changing how this, how we can connect and share information

Bill Russell: All right. Well, Z, we expect the same thing from you in on the DC streets.

We appreciate you being here and thanks. Uh, Thanks team. Look forward to uh, meeting you with you in the next five minutes. Take care.

Zahid Rathore: All right guys. Have fun.

Sarah Richardson: Be well,

Zahid Rathore: We'll see ya. Bye now.

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