Home

Successful risk mitigation for one of the largest healthcare providers in the USA

Published: Sep 2025
Treasury Today Adam Smith Awards 2025

Best Risk Management Solution

Overall Winner

Baylor Scott & White Health

Photo of James Green, Kaufman Hall and Boriana Farias, Baylor Scott & White Health.

Boriana Farias

VP Treasurer
Baylor Scott & White Health logo

USA

Baylor Scott & White Health (BSWH) is a healthcare system based in Dallas, Texas, United States. Formed in 2013 from the merger of Scott & White Health with Baylor Healthcare System, it became the largest non-profit healthcare system in Texas and one of the largest in the country.

in partnership with

KaufmanHall a Vizient company logo

The challenge

The healthcare industry has faced significant disruption due to cyber-attacks and after decades of consolidating vendors and processes in the pursuit of efficiency, some of these industry cyber events revealed a new risk associated with counterparty concentration. Baylor Scott & White Health’s (BSWH’s) finance leadership team identified the need to complete a comprehensive analysis of business processes and associated vendor relationships connected with cash flows to:

  • Identify counterparty concentration risk exposures and measure the potential impacts to cash flow.

  • Develop a point of view on acceptable concentration risk limits.

  • Create a framework for the ongoing monitoring and mitigation of counterparty risk.

Given the complexities of the US healthcare landscape, this was a monumental task that would require treasury department leadership, cross functional alignment, substantial internal resource commitments, and an external partner to challenge the organisation to view risk with a new perspective. Boriana Farias, VP Treasurer says, “Our CFO challenged us to think about counterparty concentration risk in a different way. We needed a new perspective beyond traditional business continuity planning to assess risk across the enterprise and think of new ways of doing business to protect the organisation’s cash flow from potential single points of failure and disruptions.”

The solution

Kaufman Hall and BSWH jointly embarked on an eight‑month journey to deep-dive all the underlying workflows, systems and vendor relationships that directly and indirectly impact cash flows (both inbound and outbound). This comprehensive analysis involved cataloguing the operational and technical elements of each facet of the cash flow cycle and challenged senior leaders across the organisation to rethink how they approach their core competencies. Through tabletop exercises and outlining the practical implications of potential disruptions, the organisation was able to effectively measure bottom-line cash flow impacts to 100+ vendors, systems and workflows.

90 team members participated in interactive workshop sessions to develop the outputs of this exercise. A key outcome of this phase was detailing the ‘gross risk’ associated with workflows, systems and vendors to then further quantify the impact of contingency planning and business resiliency. This allowed the group to discount the gross risk figure, giving a true ‘net risk’ value that required action. BSWH documented a go-forward Counterparty Risk Framework and thresholds were established to group risks into tiers to assist with the prioritisation of the required remediation efforts. BSWH established a Bank Counterparty Risk Dashboard to be reviewed quarterly to confirm alignment to the organisation’s overall risk framework. Lastly, a roadmap was established for executing tactical activities to further enhance business continuity and mitigate risk.

This process captured the vulnerabilities that the organisation faced in its operations and enabled BSWH to ensure the ongoing success of the business through potential disruption.

“Receiving the prestigious Adam Smith Award for Best Risk Management Solution is a testament to the hard work of Baylor Scott & White’s Finance team and our ongoing commitment to advancing the organisation’s risk management capabilities. Collaborating with internal and external partners, treasury plays a crucial role in safeguarding the financial stability of the organisation. With strong support from executive leadership, we continue to innovate, ensuring our practices remain effective and proactive as we support our mission to promote the health and well-being of the communities we serve.”

Boriana Farias, VP Treasurer

Best practice and innovation

The measurement and modelling process for evaluating vendor/counterparty risk took an innovative approach for contextualising underlying risk in terms of gross and net cash flow disruption. This approach required customised models for individual vendor categories and challenged the team to think through a multitude of eventualities in various scenarios. The framework for ongoing management through an enterprise-wide, cross-functional steering committee placed this initiative as a key finance priority for the organisation. Support and engagement with the C-suite highlighted the importance of this task and promoted an environment of collaboration and accountability. The roadmap of tactical activities was developed for the deployment of best practices around how to effectively manage redundant vendor relationships, how to strategically align banking partners, and how to promote best in class continuity planning. An additional outcome of this process was also the creation of a comprehensive bank counterparty risk evaluation tool to help the organisation systematically manage operating liquidity across the complex enterprise account structure. Supplemental banking and technology solutions are being evaluated to harness the full benefit of new functionality in the marketplace with a primary focus on mitigating risk.

Key benefits

  • Process efficiencies.

  • Increased automation.

  • Risk mitigated.

  • Manual intervention reduced.

  • Future-proof solution.

  • Improved key performance indicator (KPI) metrics.

James Green

Senior Vice President, Consulting, Kaufman Hall

Kaufman Hall is honoured to have partnered with Baylor Scott & White Health in the tremendous undertaking. This recognition reflects the organisation’s commitment to proactive, data-informed treasury practices and its forward‑looking approach to enterprise risk management. We were privileged to support the development and execution of this strategy, which not only addressed complex financial risks but also strengthened long-term resiliency. Baylor Scott & White Health exemplifies excellence in healthcare treasury leadership, and we congratulate their team on this well-deserved achievement.

in partnership with

KaufmanHall a Vizient company logo
Adam Smith Awards sail

The Adam Smith Awards are the industry benchmark for best practice and innovation in corporate treasury. The 2025 awards attracted 454 nominations. To find out more please visit treasurytoday.com/adam-smith-awards

All our content is free, just register below

Already have an account? Sign In

Already a member? Sign In

This website uses cookies and asks for your personal data to enhance your browsing experience. We are committed to protecting your privacy and ensuring your data is handled in compliance with the General Data Protection Regulation (GDPR).