Tuesday, February 17th, 2026
Every day, your health system makes thousands of operational decisions—referrals, scheduling, site of care, discharge planning. What if each decision could simultaneously optimize for quality, patient experience, and margin across every one of your payment contracts?
This isn’t just a future vision. Leading health systems are transforming payment complexity into a competitive advantage with Clarify Meridian™—a tech-enabled outcomes solution that solves the multi-variable optimization problem that health system executives face every day: determining the optimal referral destinations that deliver both the best clinical outcomes and the best financial performance across their contract portfolio.
How Multi-Variable Optimization Works in Practice
Multi-variable referral optimization means every operational decision, from initial referral through post-acute care, is informed by real-time intelligence about its quality, access and financial impact across all payment models.
Here’s what it looks like in practice: When your primary care physician refers a Medicare patient for joint replacement, Clarify Meridian recognizes that this patient triggers a CMS TEAM bundle and surfaces insights — such as which orthopedic surgeon consistently delivers the best outcomes at the lowest episode cost, the optimal site of service, and post-acute pathways most likely to reduce readmissions while supporting margin goals.
The same intelligence works across your entire book of business. That commercial patient? Clarify Meridian accounts for narrow network requirements and steers to in-network specialists who meet quality thresholds. That Medicare Advantage patient? It optimizes for HCC capture opportunities and shared savings arrangements.
What’s Possible: Three Illustrative Use Cases
Three potential use cases illustrate how this optimization transforms operations:
Referral Optimization: A health system with a 400-bed flagship hospital using contract-aware referral routing. By directing patients to high-performing, in-network specialists, the system could reduce specialist leakage by 18%, protecting revenue under fee-for-service contracts and improve bundle performance by $3,100 per episode for value-based arrangements. The key is giving referral coordinators visibility into how each decision affects both network integrity and contract economics.
Surgical Scheduling: Consider a system that shifts appropriate cases from its main hospital to an ambulatory surgery center when clinically appropriate and contractually advantageous. This approach could generate $4.2M in additional margin annually—without new volume or service cuts.
Post-Acute Navigation: Under CMS TEAM, a single readmission can erase an entire episode’s margin. A system using predictive analytics to match patients with optimal post-acute settings could reduce 30-day readmissions by 22%, based on historical performance data.
Why Traditional Approaches Fall Short
Most health systems still operate with fundamental blind spots. Your managed care team optimizes commercial contracts. Population health manages risk arrangements. Service lines chase volume. Finance tries to reconcile it all in retrospective reports.
But today’s reality demands real-time, unified intelligence. Consider that the same knee replacement might be profitable under your Blue Cross contract, marginal under Medicare Advantage, and a significant loss under TEAM, depending entirely on your operational choices.
Manual tracking can’t keep pace. By the time your teams identify optimization opportunities in monthly reports, you’ve already lost millions.
The fundamental truth: mission and margin are inseparable – health systems must excel across all payment models to sustain both.
“Health systems face unprecedented complexity—policy shifts, intensifying competition, and rapidly evolving payment models,” says Todd Gottula, Founder of Clarify Health. “Success requires real-time intelligence across every contract and patient journey. That took us ten years to build: 300 million patient journeys with AI-powered optimization that coordinates care quality and financial performance. We make the opportunity visible in the complexity, and partner with you to capture it.”
Why This Approach Can’t Wait
Starting in 2026, CMS TEAM becomes mandatory for five surgical episodes in 741 acute care hospitals across 188 markets with no opt-out. At the same time, CMS will hold Medicare, Medicare Advantage, and Managed Medicaid reimbursement increases to just 1% annually while costs rise 5-7%.
Government-sponsored encounters represent 40-60% of most health systems’ volume but are becoming less profitable daily. Traditional strategies (better commercial rates or cost reduction) can’t close this gap. Health systems must rethink how they capture profitable volume across their entire contract portfolio.
What It Takes to Optimize Across All Payment Models
Successfully optimizing quality and financial performance across your contract portfolio requires three integrated capabilities:
Unified Intelligence Across Your Portfolio – You need comprehensive visibility into referral patterns, contract economics, and provider performance across all payment models. This means aggregating claims, clinical outcomes, and contract terms to identify where quality improvements and financial opportunities intersect. Multi-contract prioritization ranks opportunities by quality outcomes and financial impact across FFS, APM, and hybrid models—something point solutions cannot deliver.
Scenario Modeling That Accounts for Contract Interactions – With thousands of variables affecting each patient journey, you need to model how referral changes impact performance under different payment structures. Multi-contract scenario modeling shows which changes maximize value under each payment model while avoiding situations where improving one contract degrades another.
Intelligence Embedded in Daily Workflows – Insights are worthless if they don’t reach decision-makers. Intelligence must integrate into existing workflows—referral coordinators’ screens, schedulers’ queues, business development liaisons’ plans—translating complex analytics into actionable guidance with tracking that connects recommendations to outcomes.
The Path Forward Starts Now
Health systems face a choice: continue managing payment complexity through spreadsheets and siloed teams—losing millions to suboptimal decisions—or embrace multi-variable optimization as your strategic advantage.
The winners won’t be those with the most favorable contracts or the highest volumes. They’ll be the systems that make every operational decision with full visibility into its quality and financial implications.
How much are you leaving on the table? Most health systems are unknowingly losing $50-85M annually in referral leakage and missed optimization opportunities across their contract portfolio. Clarify’s complimentary opportunity assessment quantifies exactly what’s at stake for your organization—showing you where the money is going and how to capture it. Get your opportunity assessment →
About Clarify Health
Clarify Health delivers a complete, tech-enabled enterprise intelligence, optimization, and outcomes solution, processing over 300 million patient journeys to deliver actionable intelligence for health systems nationwide. Our platform turns payment complexity into competitive advantage.
Learn more about Clarify Meridian™ →
For more information, contact us at info@clarifyhealth.com.
The post Making the Invisible Visible: How Leading Health Systems Are Turning Payment Complexity into a Competitive Advantage appeared first on Becker's Hospital Review | Healthcare News & Analysis.
Source: Read Original Article
