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For decades, hospital employers have been squeezed by skyrocketing employee healthcare costs—now $15,000–$30,000 per person each year, quickly swelling into millions for larger corporations. Frontline staff—nurses, technicians, support personnel—are under pressure: a Forbes article finds 62% living paycheck to paycheck¹, and with high-deductible plans becoming the norm and out-of-pocket expenses of $4,000–$6,000 or more, families face significant financial strain. CFOs and HR leaders see renewal rates climb, budgets tighten, and employee morale affected. The status quo cannot continue. SIHRA® seizes the “low-hanging fruit” of duplicate-spouse coverage—identifying employees who qualify under a working spouse’s plan and incentivizing them to switch. Once enrolled in their spouse’s employer plan, qualified out-of-pocket costs for employees and their families is reimbursed at 100%, eliminating that cost burden entirely. “SIHRA® cuts employee healthcare spending by 15-50% without shifting any financial burden onto employees— eliminating all out-of-pocket costs to empower healthier, more financially secure staff while delivering predictable savings and stability to healthcare organizations,” says Craig Lack, CEO of Catilize Health®. SIHRA® redefines healthcare risk financing: predictable, sustainable, and compassionate—finally putting hospitals in control and ensuring employees get the care they deserve. SIHRA® not only arbitrages risk but generates meaningful cash flow from domestic utilization every year going forward. Perfected Over Decades, Unmatched Excellence Inspired by founder Kevin O’Kane’s vision in 2000, SIHRA® has been Catilize Health®’s singular focus. Through meticulous refinement, rigorous testing, and demonstrated success, Catilize has mastered the SIHRA® concept into the industry’s leading high-financial-cost-reduction solution for healthcare organizations—making Catilize the only U.S. company exclusively administering SIHRA® for more than 20 years. “Two decades of experience helped us perfect SIHRA®—cutting employer costs by 15–50% and delivering 100% benefits to employees.”— Craig Lack, CEO, Catilize Health® Over one hundred hospitals and systems have trusted SIHRA®, saving millions in healthcare spending. SIHRA® turns everyday care needs into financial wins. By optimizing duplicatespouse coverage, it empowers families to access essential care while providing hospitals with a sustainable cost-reduction and revenue-earning tool—reinvesting cost savings into patient care, infrastructure, and strategic priorities. “The critical edge SIHRA® holds over traditional plans is simple: increased profit and surplus—not hypothetical, but guaranteed.” — Craig Lack, CEO, Catilize Health®. • Domestic Claims: An employee’s surgery remains in-network but is billed to the spouse’s insurer at full commercial rates—converting an internal cost into new revenue. • 340B Pharmacy Program: Specialty medications dispensed through 340B follow the same path, generating additional income when covered and billed via the spouse’s plan. “SIHRA® changed my life—I can now afford prescriptions, avoid debt, and finally save for my family’s everyday healthcare needs.”— Licensed Vocational Nurse, California hospital.
A quiet crisis runs through the world of autism care—not from a lack of compassion or clinical expertise, but from administrative overload. Therapy providers, trained to guide children through critical developmental milestones, often spend hours each week fighting insurance denials, resubmitting claims, decoding ever-changing billing codes, and stressing over audits. This tug-of-war between caregiving and paperwork doesn’t just drain energy—it threatens sustainability. Providers face burnout. Clinics risk closure. Families, desperate for consistent therapy, are left vulnerable when the system meant to support them becomes a roadblock instead. That challenge is precisely what Comprehensive Billing Consultants (CBC) was founded to solve. CBC is a full-service revenue cycle management partner dedicated to supporting therapy providers who serve children on the autism spectrum. Instead of struggling through the red tape alone, providers turn to CBC to take on billing, credentialing, authorizations, appeals, audits, and training—freeing them to focus entirely on patient care. The story behind CBC is rooted in lived experience. Its founder, Sarah Schmitz, began her journey in medical billing before becoming a parent. She managed over 40 hours a week of therapies for her son with autism. When she discovered how few providers accepted insurance—largely due to the complex reimbursement process—she recognized a gap that desperately needed filling. She used her knowledge to help therapists get paid fairly and stay in business, eventually growing CBC into a national partner for behavioral health and therapy providers. CBC serves as both a shield and a support system for providers. It manages insurance claims from end to end, ensuring that billing is accurate, documentation aligns with payer expectations, and appeals are submitted when claims are denied. It doesn’t offer a rigid, one-size-fits-all package. Instead, its services are tailored to meet each provider’s needs. “We work with providers across the nation, handling their RCM services and fighting daily with insurance companies to get claims paid so families aren’t billed for services covered under state autism mandates,” says Schmitz, owner and president of CBC. Some clinics rely on CBC for complete billing services, while others need help only with training, authorizations, or audit preparation. Authorizations constitute a significant hurdle in autism therapy, and CBC actively manages this process—submitting requests, following up, and challenging denials when medically necessary services are rejected. Its team understands how to build strong clinical justifications that align with payer rules while remaining true to ethical, field-accepted practices.
In today’s healthcare landscape, accurate coding, clear documentation, and streamlined billing are critical—but most consultants only offer quick audits and surface-level fixes. These temporary solutions leave organizations trapped in a cycle of recurring issues and ongoing reliance. KZA takes a different approach. With a philosophy rooted in education and empowerment, KZA helps healthcare providers build the internal capabilities they need to manage coding, compliance, and operations independently. For over four decades, the firm has partnered with hospitals, private practices, attorneys, and academic medical centers to turn complexity into clarity—offering solutions that last well beyond the engagement. “We don’t audit just to catch mistakes— we audit to educate,” says Cathy McDowell, President and CEO. “Our goal is to build confidence and capability inside the business so they can thrive long after we’re gone.” A Practical, Education-Driven Approach When a client approaches KZA, the team doesn’t settle for surface-level insights. Instead, they dig deep into systemic issues. They analyze CPT frequency reports, denial data, and documentation across the entire patient encounter. The team evaluates each phase of care—from preoperative planning through postoperative documentation—to identify breakdowns and areas for improvement. After the audit, KZA delivers findings in a detailed written report and follows up with a live, one-on-one education session led by an expert consultant, ensuring nothing is lost in translation. This session allows providers and staff to ask in-depth questions, gain clarity, and walk away with actionable next steps—not just a generic report. This education-first approach goes beyond correcting documentation or coding errors. Often, audits are the entry point into more strategic engagements involving practice operations, revenue cycle management, EMR optimization, and front-end workflow redesign. This evolution reflects a broader trend KZA has observed: healthcare providers are no longer satisfied with compliance alone—they are seeking operational excellence.
Every healthcare breakthrough needs more than a great product; it requires a force behind the scenes to ensure it doesn’t just launch but reaches the people who need it most. That’s the role Sales Focus Inc. plays. Based in South Carolina, the company does more than build sales teams. It embeds within client organizations to navigate the complexities of commercialization, launch, and scale-up with speed, precision, and purpose. At the helm is CEO Tony Horwath, whose 26 years of experience have transformed Sales Focus into a full-lifecycle sales execution firm known for its agility, discipline, and brand integrity. “We don’t just assist our clients; we become part of their team. Our ability to stand up a fully operational, brand-aligned sales team in less than 45 days, anywhere in the U.S. or abroad, changes what’s possible for healthcare companies under pressure to deliver,” says Horwath. A Full-Lifecycle Solution, Not Just Outsourcing Unlike traditional outsourcing models focusing on transactional sales or staffing, Sales Focus offers an end-to-end system, from strategic planning and recruitment to onboarding, field management, and ongoing optimization. The firm recruits W-2 employees who carry the client’s business card and act as brand ambassadors. Each representative is carefully screened, trained, and coached for performance in highly regulated healthcare environments. This ensures compliance and a deep alignment with the client’s values and messaging, which is critical in an industry where trust and credibility drive success. Designed for adaptability, Sales Focus supports a wide range of commercialization needs. Whether launching a new product, entering a new market, or improving an underperforming strategy, clients benefit from a scalable model: they can start small, scale up or down as needed, or even transition the sales team into their internal operations. This built-in flexibility is especially vital in healthcare, where product cycles, reimbursement structures, and regulatory demands are in constant flux. The S.O.L.D.™ Process: Precision in Execution At the heart of Sales Focus’s success is its proprietary S.O.L.D.™ methodology, a trademarked four-phase system that ensures speed, alignment, and accountability at every stage.
When Ligare Capital Funding was founded seven years ago, it wasn’t part of a grand plan to disrupt an industry. It began with a simple conversation between three longtime friends who recognized a flaw in how capital flowed through the medical reimbursement and personal injury ecosystem. Financing arrangements were often ad hoc, poorly documented and lacked transparency. In many cases, medical providers relied on lenders who acted more like opportunistic intermediaries than institutional partners. “No one was thinking long-term and very few were treating it like the regulated financial service it should be,” says Rob Cagno, CEO. Ligare was built to fill that gap. From the start, it focused on structure, compliance and long-term lending, avoiding high-risk models in favor of predictable, relationship-driven capital. Rather than chasing volume or complex deals, Ligare emerged as a partner that could grow with a practice, not just fund it in the short term. That disciplined approach quickly gained traction. Within two years, Ligare expanded beyond its original footprint. Today, it operates in 15 U.S. markets, has deployed over $100 million in capital and partnered with more than 50 medical practices nationwide. While scale has evolved, the foundational approach remains to deliver timely, transparent financing grounded in accountability. Ligare’s model is intentionally dual-faced. On one side, it provides working capital to medical offices, especially those with delayed reimbursements from no-fault personal injury or workers’ comp claims. These practices often face cash flow issues from slow insurance cycles. Ligare’s funding helps them stay operational, support growth and avoid care delays. On the other side, Ligare has built a track record of disciplined capital management for over 100 investors. With an underwriting approach centered on operational and legal predictability, it has consistently delivered stable returns while protecting downside risk. Much of that consistency comes from where Ligare operates. It focuses on no-fault and letter of protection personal injury markets with legal frameworks that support faster claims resolution. This enables quicker repayments, lower default exposure and efficient collections, creating a stable system that supports providers and investors alike.
James Bryant, Vice President of Emergency Services, Centra Health
Candace Omija, Manager, Professional Billing and Coding, The Queen’s Medical Center
Jerald M Archibeque, Director, Hospital Billing, Presbyterian Healthcare Services
Donovan Cooper, Senior Director of Ambulatory Care Services, Holland Bloorview Kids Rehabilitation Hospital
Daniel Mather, MSN, RN, PPMC, Director of Clinic Operations, Salina Regional Health Center and Consultant for Mather Leadership and Consulting
Cesar A. Román, Director of Strategic Sourcing and Procurement Operations, University Health
Reimagining Support in the Business of Healthcare
The healthcare landscape is being transformed—not just in treatment delivery, but in the systems that sustain it. Behind every clinical breakthrough is a maze of billing codes, reimbursement models, credentialing requirements, and regulatory frameworks. Today, organizations across the sector are turning to specialized partners to help them navigate this complexity with agility, humanity, and purpose. From revenue cycle consulting to outsourced sales execution and specialized autism billing support, these services are evolving from tactical necessities to strategic enablers. The most effective among them bring together deep industry knowledge, adaptive systems, and mission-aligned execution to empower providers—not just serve them. Technology is reshaping the field, particularly in revenue cycle management. Automation and AI are streamlining billing, coding, and audit functions. But as Marina Hayden, sr manager, revenue cycle business partner at UofL Health, notes, “Adaptability to evolving circumstances” is just as critical as technical sophistication. That adaptability includes aligning with value-based care models, enabling telehealth billing, and mitigating compliance risks in real time. Yet amid this digital transformation, leaders are calling for a renewed focus on the human element. Olivia Wolf, director of business development strategy at Southcentral Foundation, emphasizes that, “Behind every claim, visit note, diagnosis, and CPT code is a patient who is enduring hardship.” The systems that support healthcare must reflect the same empathy, mission, and integrity as those delivering care on the front lines. This edition’s cover story features Catilize Health®, a company leading the charge in reimagining prior authorization as a strategic enabler of timely, patientcentered care. By combining automation with clinical insight, Catilize Health® is helping payers reduce delays, improve member experience, and deliver more efficient authorization workflows—proving that operational reform can go handin-hand with compassion and clarity. This issue also features insights from James Bryant, vice president of emergency services at Centra Health, who led the launch of an innovative behavioral health initiative grounded in trauma-informed care and systemwide collaboration, as well as Cesar A. Román, director of strategic sourcing and procurement operations at University Health, who emphasizes on the importance of how effective communication between clinicians and patients is essential in tailoring treatment to individual needs and ensuring the best possible outcomes. Together, these perspectives underscore a new standard—where agility, ethics, and empathy must co-exist. We spotlight the providers helping organizations meet that standard.