As financial pressure intensifies across healthcare, ambulatory organizations are being forced to rethink how they operate. Rising labor costs, staffing shortages, reimbursement complexity and growing patient expectations have made efficiency no longer optional—but foundational to sustainability. In a recent Becker’s Healthcare podcast, Sri Velamoor, president and chief operating officer of NextGen Healthcare, spoke about what operational excellence looks like in practice and the seven levers that can meaningfully improve performance across ambulatory care settings.
Velamoor, who brings decades of experience across healthcare, technology and financial services, framed the challenge simply: practices are being asked to do more with less. In response, NextGen developed a seven-lever efficiency playbook designed to help organizations drive measurable gains in revenue and margins while improving care delivery.
The Seven Levers of Operational Excellence
When executed effectively, these levers can drive 3% to 5% revenue improvement and 12% to 15% EBITDA gains for ambulatory practices, Velamoor said.
1. Clinical efficiency. Documentation burden remains one of the largest friction points for clinicians, contributing to burnout and delayed revenue capture. Ambient AI and automation tools can shorten the time from encounter to cash posting by streamlining coding, charge capture and claims submission.
2. Access and volume optimization. No-shows remain a costly challenge, with just one missed appointment per physician per day equating to roughly $15,000 in lost annual revenue. Improving scheduling workflows, reminders and patient engagement can directly improve visit volume.
3. Payer and contract optimization. Practices must ensure they are paid according to contract terms and understand how their reimbursement compares with peers in their market. Even modest improvements in payer mix or contract performance can unlock meaningful financial gains.
4. Patient acquisition and retention. In competitive local markets, retaining existing patients and attracting new ones is critical. Optimizing the patient experience—from scheduling through follow-up—plays a central role in sustaining volume.
5. Revenue expansion. Many organizations are looking beyond traditional fee-for-service care into opportunities such as clinical research, data syndication and adjacent services to diversify revenue streams.
6. Site and staffing optimization. For multi-site organizations, analytics can help align staffing levels with demand patterns, reducing labor costs while improving productivity and access.
7. Purchasing efficiencies. Practices have historically underutilized financial tools to manage procurement and payments. Greater sophistication in this area can improve cash flow and reduce unnecessary spending.
Why Behavioral Health Faces Unique Pressures
Behavioral health organizations experience many of these challenges more acutely due to fragmented provider networks, complex reimbursement models and persistent workforce shortages. Velamoor highlighted staffing and site optimization as especially critical in this sector, noting that data-driven scheduling tools can reduce payroll costs by 8% to 14% while cutting scheduling management time nearly in half.
Referral leakage is another major issue. Many behavioral health organizations lose 10% to 20% of revenue due to poorly managed referrals between outpatient clinics and higher-acuity settings. Strengthening referral workflows can both protect revenue and improve patient access to needed services.
Technology also plays a key role in addressing workforce constraints. According to Velamoor, as much as 90% to 95% of required post-encounter documentation can now be supported through AI-enabled tools, allowing a broader range of care team members—not just physicians—to deliver care efficiently.
Keeping Innovation, Patients and Policy in Focus
Velamoor emphasized that sustainable improvement requires more than deploying new tools. Strong data foundations, a portfolio-based approach to improvement and hands-on change management are essential to drive adoption and long-term results.
He also urged organizations to maintain a patient-centered lens and stay aligned with evolving regulatory requirements. Efficiency gains must be paired with patient-facing tools that support scheduling, communication and engagement.
Ultimately, scaling operational excellence requires balancing financial discipline with thoughtful care design. By focusing on the right combination of efficiency levers, ambulatory organizations can improve performance today while building a more resilient foundation for the future.
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
