Peter Dinella
Customer Strategy Manager
Challenging Times, Up Close
This past April, I got the chance to attend the Hospital Association of Southern California’s (HASC) annual conference.
Situated in the almost offensively scenic coastal town of Carlsbad, the event gathered hospital and health system leaders from across the region for three delightful days of panel discussions, keynote speakers, and a somewhat questionably themed Mardi Gras dinner party.
It was marketed as “An Essential Conference for Challenging Times”.
As someone who’s only recently become better acquainted with California’s healthcare ecosystem, the why behind this choice slogan didn’t immediately register with me. Sure – being on the business side of the industry has given me a certain level of visibility into what's relevant across the nation in healthcare. Workforce shortages, AI arms races, federal policy changes. The list goes on and on.
These same core topics were unsurprisingly on the docket at HASC. But hearing first-hand about how leaders and their teams were actually experiencing these obstacles afforded me an entirely new vantage point.
What resonated most deeply with me was learning that at least three of the hospitals represented at the conference were operating under such immense financial pressures to where they only had three days of funds left in the bank to keep their doors open. One bad week of denied claims, aging machinery/infrastructure, or low patient volumes could be the difference between staying afloat and closing up shop.
As the literal lifelines of their communities, I found it both shocking and terrifying that so many of these hospitals were left in such a precarious position. Among the contributing factors, there was undeniably one main culprit set to make things more difficult : House Resolution 1.
What H.R. 1 Means for Hospitals
For those who haven’t been following H.R. 1, or its impact on healthcare, a quick preamble is probably warranted.
Signed into law in July 2025, H.R. 1, also known as the One Big Beautiful Bill Act, is a sweeping piece of federal legislation that carries significant consequences for Medicaid programs. The law placed new restrictions on the mechanisms states have historically relied on to fund Medicaid, while also introducing stricter eligibility requirements that have already reduced overall Medicaid enrollment.
The consequences are particularly notable in California, where Medi-Cal covers a large share of the population and hospitals have historically relied heavily on the supplemental funding mechanisms associated with it. A high-end estimate suggests that up to $128 billion of revenue could be drained from CA hospitals over the next decade as a result of the law.
But for these organizations already operating with razor-thin margins, this isn't simply a question of lower reimbursement several years from now. It means taking an already challenging financial calculus and making it considerably harder in the immediate term.
The reality is frustratingly bleak: hospitals have almost no control over this existential threat to their institutions, and consequently, the communities they care for. They cannot rewrite federal Medicaid policy, increase Medi-Cal reimbursement, or eliminate many of the underlying costs needed to keep a hospital running.
What they can control, however, is how effectively they manage and protect the revenue they are contractually entitled to receive.
Managed Care, Protector of the Realm
That makes the role of managed care teams especially important, now more than ever.
Traditionally, managed care has been viewed primarily through the lens of negotiation: securing favorable rates, protecting key contract terms, and determining the economics that will govern a payor relationship for the next several years. Yet once the agreement is signed, the contract itself can become operationally disconnected from the very claims it governs.
The teams negotiating those agreements are often siloed and separate from the revenue cycle teams responsible for billing, collecting, and identifying payment discrepancies. In between sits an extraordinarily complicated set of reimbursement methodologies, payor policies, contract terms, and unruly claims data.
As a result, a health system can negotiate a strong contract without necessarily having a reliable way to track performance and determine whether the thousands of claims ultimately paid under that agreement are actually honoring its terms.
In today's environment, managed care therefore cannot be thought of only as the function responsible for negotiating the next contract. Increasingly, it also has to be about protecting the economics of the contracts already in place. For hospitals operating with increasingly little room for error, protecting existing contracts is becoming a fundamental means of financial resilience.
This relies on a tighter connection between the agreement that was negotiated, the claims being adjudicated under it, and the revenue cycle teams ultimately responsible for collecting that revenue.
Closing the Gap Between Contracts and Claims
That is where Kubera comes in.
At its core, our platform is designed to provide the connective tissue between managed care and revenue cycle. We give teams a common infrastructure for translating negotiated agreements into operational workflows, modeling the rates and terms that govern payment, and validating that claims are ultimately reimbursed the way the contract intended.
Kubera’s repertoire spans traditional fee-for-service contracts, capitation and value-based care arrangements, payor fee schedules and payment policies, and broader payment integrity workflows. The goal is the same across each of them: close the gap between the teams negotiating the economics and the teams responsible for realizing them.
In other words, make your agreements work for you, rather than you having to work around them.
At Kubera, I think we can all agree that it has been a genuine privilege to partner with some of the innovative hospital leaders across Southern California and beyond on this work. If there was one thing I took away from HASC, it was not pessimism, but quite the opposite.
The financial challenges facing hospitals are real, and in many cases severe. But the prevailing attitude I encountered was one of perseverance and optimism. Leaders were not ignoring the obstacles in front of them. They were confronting them directly, looking for new ways to operate more effectively, protect their organizations financially, and continue serving the communities that depend on them.
The environment may be getting harder, but this only makes the work of ensuring every negotiated dollar actually reaches the hospital more important.