Joey Wahler (Host): It's a key part of healthcare leadership, so we're discussing how leaders turn insight into action. Our guests, Bill Rutherford, Former Executive VP and CFO of HCA Healthcare, and Matthew Ennen, he's Senior VP of Finance for Ensemble Health Partners. Ensemble is one of ACHE's premier corporate partners. Our premier corporate partners supporting ACHE's vision and mission to enhance healthcare leadership excellence. For more information on Ensemble, please visit the corporate partners page at ache.org. This is the Healthcare Executive podcast from the American College of Healthcare Executives. Thanks so much for joining us. I'm Joey Wahler. Bill, Matthew, welcome.

Bill Rutherford: Welcome, Joey. Good to see you.

Matthew Ennen: Hi, Joey.

Host: Yeah, same here. We appreciate the time from both of you. First, in terms of background, in a nutshell, Bill, how would you describe your tenure leading finance at HCA Healthcare? What stands out most to you?

Bill Rutherford: Well, I was fortunate. I spent 35 years as a financial executive within HCA Healthcare, playing in a variety of roles, both from corporate support as well as operational finance. I was over a group of hospitals for 10 years as roughly half the company. And then, I got the opportunity to be the CFO of the entire organization. So really, what stands out to me is the ability to help our organization navigate strategically and really focus on accomplishing our mission, which I think is why most people are in healthcare, which is try to impact people's lives. So, that's what's most memorable for me during my career.

Host: Sounds great. And Matt, what perspective most of all do you provide at Ensemble working alongside health systems today?

Matthew Ennen: What makes my perspective somewhat unique is I get to see dozens of health systems operate under different circumstances, but they're all facing the same challenges: margin pressure, labor constraints, reimbursement uncertainty, and increasing complexity. And what I've found is while every organization is different, the patterns of what drives success and what holds organizations back are remarkably consistent.

Host: Interesting. So, you see a common thread there for sure. So, let's jump into it. As you both know, the CFO role, for instance, now spans things like strategy, operations, technology, change management, and mastering that complete business transformation is the new baseline for survival. So Bill, what actually separates the CFOs that are adapting to that mandate from the ones that are falling behind?

Bill Rutherford: Well, the way I think about it, I think most CFOs today of any reasonably sized health system has evolved to really be a strategic leader for their organization. And they're at the table helping set strategic direction, allocating capital resources, and responding to various market dynamics within their institution.

And so, I think simply the ones that are doing well are the ones that are creating capacity for their organization and creating capacity for themselves professionally to be able to have the ability to respond to an ever-changing and dynamic environment that they find themselves in.

Host: Right. Creating capacity, certainly a clear way to think about that. And Matt, how is that expanded role showing up across the health systems you partner with? And how would you say leaders can bridge the gap between traditional financial oversight and frontline reality, if you will?

Matthew Ennen: Yeah. What I'm seeing is separating successful organization is their ability to connect the financial outcomes back to operational behaviors. You know, margins don't just deteriorate because of a spreadsheet problem, right? They deteriorate because something is happening operationally. Maybe length of stay has increased, patient access has become constrained, denial rates are climbing, or even labor productivity has drifted.

The bridge between finance and frontline reality is visibility. The best CFOs aren't just reviewing the financial results at month-end. They're creating systems that allow operational leaders to understand performance drivers in real time and take action before those issues show up in the financials.

Host: All right. Now, Bill, these numbers are eye-popping. When you're responsible for one 184 hospitals across 21 states, as you've been, whew, every decision must be grounded in a clear understanding of what's driving results, right? So, what did your experience at HCA teach you about the difference between the factors genuinely improving performance and those that only appear to be? And how would you say CFOs bring that same discipline to their organizations today?

Bill Rutherford: Well, I think we prided ourselves in being a data-driven organization, and I think most CFOs just by their nature are data-driven. The key to me is making sure that data drives and correlates to really key business objectives you're in pursuit of. So, you're always trying to draw the correlation between activity and results.

And obviously, decisions based on data are going to be, I think, much more grounded. But you got to make sure that the areas that you're focusing your time and attention in, the resources that you're applying, are really driving the key objectives for your organization. So, it's a combination of not only having the data that guides your decision-making, but make sure the areas that you're focusing your time and attention on are truly those that move the needle in terms of your strategic direction for your organization.

Host: And so following up on that, Bill, from what I understand at HCA, clinical and financial performance were never separate conversations. When outcomes slipped, margins followed. So with that being said, what's an example you can think of where a clinical signal showed up in the financials first or maybe vice versa? And why do you think so many systems still run these as parallel tracks versus real alignment at the leadership table?

Bill Rutherford: We were always looking to integrate our clinical, operational, and financial teams together. We actually had an initiative we titled Clinical Excellence, which was to bring our clinical teams, our financial teams, and our operating teams together to tackle opportunities or challenges. It may have been bringing clinical and evidence-based protocols to a certain process, may have been around certain supply utilization or pharmacology use. And its focus always was centered around what's best for the patient. Are there ways you can reduce variation? And oftentimes, those had a direct benefit financially.

So, I think just bringing the teams together in kind of what's, today, a cross-functional area, and putting them in the same room, having common objectives, always, I think, is a positive movement. And we were very fortunate to have strong partnerships with our clinical teams and financial teams.

Host: Well, as you two well know, organizations seem to often get used to working around broken systems by adding people and stacking fixes until it feels "normal." Complexity quietly erodes margin and slows decisions. So Matt, where would you say health systems are overbuilding internally, especially in a revenue cycle, and how should CFOs pitch the trade-off of building versus outsourcing to the board?

Matthew Ennen: I think many health systems today are unintentionally overbuilding around complexity. When a process breaks, you know, the natural response is to often add people. Another issue appears and another team gets added over time. Organizations create layers of manual work, workarounds, specialized teams, and disconnected technology.

And revenue cycle is probably one of the clearest examples of that in the healthcare space. Many organizations are attempting to solve increasing complex reimbursement challenges by continuing to add internal resources, but that approach eventually reaches a point of diminishing returns. The conversation shouldn't be framed as insourcing versus outsourcing.

I believe it should be framed as how the organization gains access to scale, expertise, technology, and best practices in the most efficient way possible. When speaking with boards, I encourage CFOs to focus on outcomes rather than organizational charts. The question shouldn't be who performs the work. The question is whether the organization is achieving lower cost to collect, stronger cash flow, reduced denials, improved patient experience, and substantial financial performance.

Host: Picking up on that, Bill, where would you say that pattern Matt discussed there is showing up most today? And what guidance would you give healthcare organizations about investing early in operating model changes needed to avoid greater costs and disruption down the road.

Bill Rutherford: I think healthcare systems have always searched to do that. I mean, when I step back and think about healthcare, you're in an area where you've got a reimbursement system largely government-supported through Medicare and Medicaid. You've got cost elevating. So, health systems are looking for ways to garner efficiency and continue to deliver strong patient outcomes on there.

And so, you're going back to my original conversation. They're looking to create capacity.. And oftentimes some of that capacity is how do you partner with trusted organizations that can help address an opportunity or challenge that you may have that you may not be able to do at the same scale, same timing, same capability inside your own organization. And we see health systems now more willing to partner with others, especially around the revenue cycle area, which is complex, it's heavily regulated. And when you think about the need of technology investment and the pace of play around that, that helps create capacity for an organization and respond to an ever-changing marketplace that's out there.

So, the way I see organizations responding to the opportunities now may be a little different than where they may have been five, six, seven years ago. And I think that's all in recognition that there's an opportunity for them to expand their capacity by partnering with other organizations.

Host: All right. Well, strategy is the "easy part" here, right? But execution is a system built on clear ownership and a rhythm where issues surface early on. So, Bill, what would you say that operating discipline looks like for a CFO here in 2026?

Bill Rutherford: Well, when I think about it, and you step up and think about this broad concept of operating discipline and all that entails for a healthcare system, as we would think about a basic kind of flywheel your operating model was to grow your presence in your market, expand your capacity in terms of services, make sure you're paid fairly for the services you provide, manage the costs that you have within your system, both labor, supply, and operating costs, make sure you're deploying resources appropriately, both capital and operating. And lastly, make sure you got the right people, the right leaders in the right place.

So, it's a very complex operating environment and operating model for leaders to navigate. And so, when I think about the discipline that it takes to manage that and navigate it is to make sure you got clear business objectives, that you know the resource capability of your organization, where your strengths are that you can play to, and where you have opportunities.

And don't be shy about finding others that you can partner with to fill in some of those gaps, either internally or externally on there. So, I think the discipline really becomes from a full scale looking at your operating agenda and looking at the business objectives you're trying to accomplish, know where you have some opportunity, and know where those resources might lie that can help your organization navigate those successfully.

Host: And Matt, how does embedded finance leadership help systems build that rhythm without running on heroics, so to speak?

Matthew Ennen: One of the biggest challenges I have seen is that many organizations are running on exceptional effort rather than repeatable processes. People work nights and weekends to close gaps. They solve problems through relationships and individual expertise. While that's admirable, it's difficult to scale and nearly impossible to sustain. Embedded finance leadership creates a connection between strategy and execution. Instead of finance operating as a reporting function, finance becomes an active partner, helping operational leaders understand performance drivers, prioritize actions, measure results, and maintain accountability.

The goal is to create a performance management rhythm where issues are identified early, ownership is clear. And progress is measured consistently. When that happens, organizations become less dependent on heroics and more dependent on the systems. That's where sustainable improvement comes from.

Host: Well, you've both done such a great job of comprehensively breaking this all down for us so far. But before we wrap up with a question I'm going to ask both of you about offering a real timely key piece of advice for those joining us going forward, I just want to backtrack for a moment or two and ask you both a little bit more about your backgrounds in this.

Bill, what would you say first piqued your interest in doing this kind of work? What was it that made you say, "This is what I want to do with my professional life"?

Bill Rutherford: Well, I think anybody who's working in healthcare in the pursuit of impacting people's lives, you know, that provides you or at least provided me the energy to get up every day and try to make a small difference.

When I think about the opportunities to make a change in the healthcare finance areas, really where I started getting really, really engaged probably 20 years ago when we started launching our shared services initiatives, where we could take what was historically distributed routine administrative aspects of healthcare and how could we bring best practices, bring technology, and the best management teams together, and almost take those processes and support them in a different way than historically underneath the umbrella of a hospital.

And that had such benefit to our organization. We were always trying to find ways to replicate that. We had benefit in not just standardizing processes, bringing best practices to the table, bringing best technology. But as I said before, it freed up our leaders to be able to focus on strategic initiatives within their organization that could help the company grow and help their organization grow.

So, that really just fueled a passion for me to find where are there other ways to bring efficiencies to the healthcare system that would derive benefit, derive benefit for systems, derive benefit for our patients, derive benefit for our employees, and so forth. So, as I progressed through my career, that was one of the things that I was always in search of is how can we use, in our space, our knowledge, our expertise, our capabilities to try to bring substantive value to our organization.

And it's really exciting when you think about it, because I believe there still remains a lot of opportunity in healthcare. When you think about the administrative aspects and the complexity that we have, there are a lot of opportunities remaining, and it's going to take scale, it's going to take resources, it's going to take capital investment, it's going to take trial and error, and it's going to take management expertise to navigate those. But that's where I think the opportunity is, and that's where some of the fun is as well.

Host: All right. Well, Bill, you say that's what fueled your passion. Matt, how about you?

Matthew Ennen: Very similar to Bill, I started out my career in consumer products, mainly in manufacturing, and was lucky enough to befriend a former HCA executive, and he spoke with such passion about healthcare. Healthcare was never on my radar coming up early in my career, and I made the leap of faith based upon this one man's passion and I haven't looked back since.

And it's been the greatest career change I've ever made. I've been in healthcare now, 15 plus years, and the mission is what keeps driving me and the patient care and providing, services to our clients to perform that care in their communities is what gets me out of bed every day.

Host: Yeah, it's always interesting to me talking with people from the industry, leaders like yourselves, how some get that healthcare bug very early in life, and others make a switch later on and make the transition just as smoothly and just as passionately as the two of you.

To wrap things up here, in summary, gentlemen, the best time to invest in your operating model is, of course, before you need it. So for both of you, what's the one move that CEOs and CFOs joining us right now should make in the next 90 days, let's say, to build the resilience their organization will need, let's say, 18 months from now? Bill, what are your thoughts there?

Bill Rutherford: Well, I go back to some of the basics. You know, as I think about it, I'd say take an honest assessment of your organization's capabilities. Know where your strengths are, identify where your opportunities are. Ensure you kind of an understanding of what's going on in your marketplace in terms of the changing dynamics.

And where you believe there's opportunities, explore where some of the solutions for the opportunities are. It may be around people resources, it may be around technology, it may be around who do you partner with or who do you have the opportunity to partner with. And there's a range of opportunities for organizations where they believe if they have some opportunities. It may be around service line development, it may be around payer contracting, it may be around supply chain management. It could be around labor management. It could be around revenue cycle. But some of those organizations, you have strength and play to those strengths, but where you believe there's an opportunity for you to do better or to navigate or respond to a changing environment, explore what options are there for you.

Host: And Matt, your thoughts on that?

Matthew Ennen: My advice would be to identify, you know, two to three operational capabilities that will really most determine your organization's future performance and honestly assess whether they're built to scale or not. For many health systems, that's revenue cycle, workforce productivity, data analytic capabilities.

I think the organizations that will be strongest 18 months from now are the ones that are making those investments today. They're simplifying processes, creating better visibility into performance, strengthening accountability, and building operating models that can absorb future disruptions.

The main takeaways I took from my time at HCA is that resiliency isn't built during a crisis, it's built before the crisis arrives, and I think that's a key for any healthcare organization today.

Host: And very well said there at the end. Well, the two of you certainly make all of this sound so relatively simple and doable. I'm sure that's just one of many reasons why you're both so good at what you do. Folks, we trust you're now more familiar with healthcare leaders turning insight into action. Bill, Matt, congrats on all your great work up until this point, and thanks so much again

Bill Rutherford: Great. Thank you, Joey. Appreciate you.

Matthew Ennen: Thank you, Joey.

Host: Same here. And for more information, please do visit healthcareexecutive.org. And if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of the Healthcare Executive podcast from the American College of Healthcare Executives.