This is Part 3 of a three-part series on the healthcare trilemma: rising patient demand, shrinking clinical capacity, and mounting financial pressure.
A perfect storm of revenue strain is building for health systems.
The expiration of the Affordable Care Act’s enhanced premium tax credits for 2026 could cost healthcare providers more than $32 billion in revenue and force them to absorb nearly $8 billion more in uncompensated care. An estimated 7.3 million people are expected to lose subsidized coverage, leaving 4.8 million uninsured.
To protect their margins, health systems must compete smarter and more aggressively for high-value, commercially insured patients. Failing to do so could intensify existing financial stress — labor expenses are climbing faster than income, and more than 750 rural hospitals in the U.S. are at risk of closing due to financial pressures in 2026.
These financial pressures, combined with surging patient demand and shrinking clinical capacity, create what DexCare calls the healthcare trilemma. In the first two parts of this series, we covered rising demand and capacity constraints. This final installment focuses on financial pressures and why better patient navigation is the path toward capturing commercially insured patients.
Problem: You’re losing high-value patients before they reach you
Financial pressure makes a health system’s patient mix critical. Commercially insured patients generate margins that sustain operations, yet health systems are losing these patients to their competitors before care even begins.
Accenture’s recent patient loyalty survey explains why. Nearly 9 in 10 respondents (89%) said they would switch providers if care were easier to navigate. Top reasons for discontent include:
- The practice was difficult to do business with
- A bad experience with front desk or administrative staff
- Digital/online services and support that didn’t meet expectations
Navigation isn’t the only deciding factor. Access matters almost as much, cited by 70% of patients, including access to:
- Convenient location and hours, even weekends and evenings
- Quickly being able to get an appointment, with online options
- Digital, mobile, or social media interaction
- Telehealth and virtual care appointment offerings
- Customer service
Put simply, poor navigation and access drive patient leakage. High-value patients won’t wait weeks for care or struggle through clunky search and scheduling systems. When a competing health system can offer a next-day appointment and yours can’t, patients book elsewhere.
Patients also consider provider ratings when choosing where to seek care. If they can’t quickly find trusted providers or authentic reviews, they abandon your system and book with competitors who make this information easy to access. Over time, volumes decline, margins erode, and payer mix shifts in the wrong direction.
Solution: Improve navigation and boost your bottom line
Patient navigation addresses patient leakage by matching patients to the right providers no matter where they begin their care journey. Platforms like DexCare enable this by adding an intelligent data layer, connecting scheduling data across EMRs, workflows, and access points. This capability lets health system leaders view open capacity and guide patients to the most appropriate and convenient care setting.
Organizations also retain control, applying business rules and clinical criteria such as insurance coverage to choose how their capacity is presented and allocated. The result is improved patient flow that makes optimal use of existing clinical resources. With DexCare, systems can direct lower-acuity visits to cost-effective, appropriate care settings such as virtual care, preserving in-person capacity for higher-acuity — and potentially higher-margin — patients.
Intelligent routing further reduces leakage by steering patients toward the most appropriate, cost-effective care setting based on availability, clinical needs, and organizational priorities. Commercially insured patients see open appointment slots in real time. They can also choose alternative care settings — such as virtual visits, clinics, or nurse practitioners instead of physicians — based on what’s available, your variable business rules, and what the patient needs.
This does three things: Health systems can balance their resources more efficiently; Patients get more options and faster access; And systems can treat more patients with the staff they already have, creating a sustainable growth without adding headcount.
Smart navigation begins before scheduling
Better patient navigation doesn’t just start on a hospital website. Many commercially insured patients made the decision earlier, at the point of search, where they compare options and read provider reviews. Hospitals that fail to engage patients at this stage risk losing them before they even find the organization’s website.
Navigation tools like DexCare take this into account by understanding the intent of a patient’s plain-language search, then surfacing providers who match that intent. Hospitals get fast-loading pages and content optimized for search and AI engines, while patients see the most relevant providers who have access now.
With DexCare, search engine results pages can also include links to verified ratings — a key search engine trust ranking — from a health system’s website and RatingsMD. This gives patients the information they need to choose the right provider before they even arrive on your website — or your competitor’s.
Proven success with leading health systems
DexCare’s patient navigation solution already serves more than 57 million patients across 50 states and partners with leading systems, including Providence, SSM Health, and Piedmont. Our clients experience a 1.5% to 3% average increase in commercial payer mix.
To see how, consider the example of Texas Health Resources (THR), a system in the competitive Dallas-Fort Worth Market, where patients have multiple choices for care. THR balanced its provider resources to meet surging demand. After implementing DexCare’s navigation platform, THR saw a 56% increase in appointments booked online, with 88% of those patients carrying commercial insurance.
Capture commercially insured patients before competitors do
When patients are directed to the right modality and provider at the right time, health systems can attract more commercially insured patients and protect their margins. Organizations using DexCare’s patient navigation platform can treat up to 40% more patients with the same clinical resources simply by reducing misrouting and patient leakage.
Ready to see how patient navigation could help your health system weather the financial storm? Request a demo of DexCare today.
