KLAS Report: Ensemble and Guidehouse Lead in Revenue Cycle Outsourcing

What You Should Know: 

– A new KLAS report, “End-to-End Revenue Cycle Outsourcing 2025,” examines client satisfaction with firms that handle all or key components of patient access, HIM, and business office departments for hospital-based organizations. 

– The report helps organizations identify the right firm for their needs by focusing on key revenue cycle outcomes, client satisfaction, and the impact of AI in the space.

The research found that many healthcare organizations are turning to end-to-end revenue cycle outsourcing (RCO) firms to overcome limitations in internal budgets, expertise, and technology. These engagements typically involve rebadging staff and last for at least five years.

Top Performers in End-to-End RCO

The report identifies Ensemble as the 2025 “Best in KLAS” winner for this segment. Ensemble primarily serves organizations with a net patient revenue (NPR) of less than $5B and has the highest client satisfaction across all metrics in the data sample.

Key highlights for Ensemble include:

Deep Partnerships: Clients credit Ensemble’s high satisfaction to deep partnerships, built on transparent expectations set during the sales process. This continues post-implementation with a structured governance process, collaborative leadership, and frequent communication.Strong Outcomes: Most clients are satisfied with key revenue cycle outcomes, particularly increased cash collections and reduced A/R days. They also praise the firm’s denials management, citing automation and detailed reviews that lead to lower denial rates and improved recovery.Optimism for the Future: No interviewed clients expressed pessimism about their future with Ensemble.Guidehouse also received high satisfaction scores, with clients highlighting the value of achieved outcomes and the firm’s strong partnership.

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R1 RCM & Opum Cash Collection Struggles

The report notes that clients of R1 RCM and Optum* struggle to meet expected cash collection targets and cite inconsistent quality from offshore teams. R1 RCM, which often works with large organizations with an NPR over $5B, received low satisfaction scores from clients who pointed to missed cash targets and slow execution. Similarly, Optum clients reported staff turnover, slow progress on key initiatives, and persistent back-end challenges like unmet cash-collection goals and poor denials management

The Role of AI in Revenue Cycle Management

While most firms are actively investing in AI, the report indicates that clients have yet to see significant operational or financial impacts from these investments. Ensemble has numerous ongoing and planned AI initiatives, including a proprietary machine learning tool called Ensemble IQ, with a focus on automation for denials management, coding, and patient engagement. Clients have noted some efficiency gains but have not yet seen specific financial outcomes from these efforts.

R1 RCM is in the early stages of AI development through a partnership with Palantir, but clients report a low impact so far, with one saying the efficiency gains have only benefited the firm itself.

Key Advice for Healthcare Executives

The report includes advice from healthcare executives on how to build a successful RCO engagement. Success goes beyond just quantifiable metrics like cash flow and A/R days. Clients also expect proactive issue identification, strategic alignment, and strong long-term partnerships

For more information about the report, visit here