Valued Voice

On Dec. 9, Wisconsin Health News (WHN) hosted a panel discussion in Madison featuring four Wisconsin hospital and health system CEOs: Dr. Alan Kaplan, CEO of UW Health; David Hartberg, CEO of Vernon Health; Dr. Scott Rathgaber, CEO of Emplify Health; and Daniel Jackson, CEO of Ascension Wisconsin. Moderated by WHN Editor Tim Stumm, the discussion explored the top challenges facing Wisconsin hospitals, including access, affordability, administrative burden and the future of care delivery. The Wisconsin Hospital Association (WHA) served as the featured sponsor of the event. 

WHA President and CEO Kyle O’Brien (left) opens the WHN panel discussion on Dec. 9. Panelists (left to right were Moderator and WHN Editor Tim Stumm; Dr. Alan Kaplan, CEO of UW Health; David Hartberg, CEO of Vernon Health; Dr. Scott Rathgaber, CEO of Emplify Health; and Daniel Jackson, CEO of Ascension Wisconsin. 

WHA President and CEO Kyle O’Brien opened the program by reflecting on the mission-driven nature of hospital leadership. “Our jobs are not easy. They’re stressful because what we do is important. If what we did was irrelevant, it would be easy,” he said in remarks to attendees. Noting the admiration patients often express for caregivers, O’Brien added that the CEOs on stage “are leading the organizational infrastructure that makes those miracles possible through the hands of the saints.” He reaffirmed WHA’s commitment to supporting Wisconsin’s hospitals, saying WHA is “honored to be their advocates here in Madison and in Washington.” 

Administrative Burden and the Role of Middlemen 

A significant portion of the discussion centered on administrative burden and insurer practices, particularly prior authorization. 

Kaplan highlighted the national scale of the issue. “Administrative cost in the United States is $1.2 trillion… that’s 4% of America’s GDP,” he said, noting that those costs do not reflect patient care, but rather the complexity of navigating coverage rules, documentation requirements and insurer processes.”

The panelists said much of that burden is driven by insurer denials and prior authorization requirements that divert time and resources away from patient care. Kaplan shared UW Health’s experience, noting that $592 million in services were denied over a three-year period, requiring 100 staff members to manage appeals—yet only 2.4% of those denials resulted in actual payment adjustments. 

The impact extends well beyond hospital balance sheets. According to the American Medical Association, physicians and their staff spend nearly two full days each week completing prior authorization requests for insurance companies—time that would otherwise be spent caring for patients. Panelists emphasized that these administrative demands contribute to workforce burnout, delayed care and growing frustration for patients trying to navigate the system. 

Hartberg encouraged attendees to visit the Healthy Wisconsin Alliance’s “Stuck in the Middle” campaign site, which highlights how middlemen practices drive up costs and leave both providers and patients caught between insurers and care delivery. 

Rathgaber questioned whether prior authorization meaningfully controls costs. “When… they say [prior authorizations] are the cost controller, the first thing I’d say is, can I see the data on that?” he said. Comparing Emplify’s provider-sponsored plan with traditional commercial plans, Rathgaber noted that prior authorization is required for only about 2% of cases in their own plan, compared to 15% to 40% in other plans—even though the health system has “much more skin in that game.” 

Despite these challenges, panelists emphasized that Wisconsin hospitals continue to deliver high-quality care and strong outcomes. Rathgaber noted that “we have great outcomes in Wisconsin” and that hospitals and health systems across the state “are serving people very well from a quality standpoint.” That experience is reflected in statewide performance with nearly two-thirds of Wisconsin hospitals earning 4- or 5-star ratings from the Centers for Medicare & Medicaid Services in 2025.  

Access, Affordability and Uncertainty 

When asked more broadly about the biggest issues facing hospitals, panelists cited access pressures, rising costs and a challenging policy environment. 

Kaplan noted that demand for care continues to grow. “We can hardly accommodate the amount of care that’s required in our communities,” he said. UW Health is expanding inpatient capacity and specialty services, yet access challenges persist. 

Rathgaber pointed to affordability as a growing concern for both families and employers, driven in large part by double-digit increases in workforce expenses, supplies and pharmaceuticals that continue to outpace revenue growth.

“Expenses are rising faster than our revenue,” Rathgaber said. “How do we make the ends meet when that’s happening?” With roughly two-thirds of Emplify Health’s revenue now tied to government payers, he warned that hospitals can no longer “put that on the backs…of our businesses.” 

Jackson highlighted uncertainty as the defining challenge for both providers and patients. “I would sum it up in one word, uncertainty,” he said, citing fluctuating reimbursement, workforce constraints and policy shifts. For patients, uncertainty around premiums and ACA subsidies compounds the strain. “How do you bring stability [and] sustainability to those circumstances?” 

Innovation, AI and the Road Ahead 

Despite these challenges, panelists pointed to innovation and collaboration as essential tools moving forward. Rathgaber shared examples of AI tools that reduce clinician documentation burden, emphasizing that they are designed “to enhance the human” rather than replace staff. Kaplan noted ongoing payer–provider collaboration to use AI to streamline prior authorization and reduce unnecessary denials. 

In closing, panelists reflected on what lies ahead. Jackson predicted more customized care models tailored to community needs. Rathgaber anticipated increased automation and personalized care alongside a collaborative effort with payers to drive the cost of health care down for patients and employers. Hartberg pointed to the passion of emerging health care students as a promising sign for rebuilding the workforce.  

Kaplan closed by highlighting continued advancements in medical care, including new therapies that are transforming once-fatal diseases into chronic conditions. While those breakthroughs offer hope, he noted, they will also create new access and cost pressures that Wisconsin hospitals must be prepared to navigate.