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Improving Patient Financing at Bryan Health System

Bryan Health System | Lincoln, Nebraska

The Client

Bryan Health System (BHS) serves the Lincoln, Nebraska region with four medical centers, including two critical access hospitals, totaling 528 staffed beds. BHS admits over 30,000 patients annually, supported by almost 1,000 medical professionals and 5,425 employees. The health system also maintains a statewide physician network, Bryan Heart cardiac and vascular services, with more than 40 outreach clinics, and Bryan College of Health Sciences. BHS has attained top hospital designation in several national rankings.

Strategic Objectives and Directions

Like all providers, the recent focus at BHS has been on COVID-19 recovery. But the organization’s forward-looking leadership is also prioritizing delivery of convenience and value in care experience that meets fast-rising patient consumerism.

A strong patient financial experience is vital to the effort. Valarie Johnston, Director of Patient Financial Services, described the strategy as resting on three pillars: comprehensive coverage of the entire patient journey, personalized options to “meet patients where they are at,” and ongoing dialog to help patients understand their payment obligations.

"Johnston’s mantra is 'communicate, communicate, communicate.'"

The Challenge

Patient financing was a key concern for BHS, with three chief issues:

  • High rates limiting adoption by patients. BHS’s previous bank was going to nearly double its interest loan rate to 8%, when it had been at 4.5%.
  • Cumbersome credit analysis and loan processing. Johnston described the prior financing as “almost totally a paper process, with minimal online input and numerous forms sent to the patient.”
  • Overreliance on BHS internal funding plans. Patient loan growth exceeded a comfortable range and added to staff administrative burdens.

Finding the Right Financial Partner in CommerceHealthcare®

BHS leadership concluded that significant change would benefit patients and staff alike. Fortunately, a strong alternative emerged from within. CommerceHealthcare® had recently helped the BHS payables department address deficiencies in the virtual AP credit card program. The primary card supplier was unable to grow and adapt to BHS's requirements. CommerceHealthcare® rapidly ramped up its program to meet the demands. The AP card program now replaces manual paper-based supplier payments with a highly efficient electronic process, and its transaction revenue-sharing feature allows BHS to earn extra income. 

Given this success, CommerceHealthcare® was a logical option for patient financing.

The Solution

BHS adopted the Health Services Financing (HSF®) solution by CommerceHealthcare®. HSF® is a highly flexible patient lending program whose centerpiece is a low- or zero-interest line of credit with no credit approval for up to $50,000 and for multi-year durations. All encounter charges can be consolidated into one convenient monthly payment. The line of credit can also cover subsequent medical charges, eliminating an additional loan process. HSF® pays the provider 100% of the patient charges up front.

BHS educates patients about the program through robust multichannel communications that encompass the website, brochures, MyChart® and other electronic modes. The enrollment process is streamlined with no paperwork. Increasingly, patients are using online self-enrollment. Commerce Bank likewise takes an omnichannel approach to delivering high-convenience payment options, including conventional and emailed statements, online quick pay, a smartphone app, auto-pay choices, interactive voice response and live customer service.

BHS offers an internal six-month payment option as a supplement to HSF®, targeting a $40 – $50 per month minimum payment. This choice appeals to patients preferring to manage a short-term repayment schedule.

Johnston draws an important distinction between “a formal payment plan versus monthly installment payments to the hospital.” The latter often leaves patients unclear as to where they stand in their obligation, while a bank financing plan such as HSF® “removes ambiguity, looks similar to a mortgage or other bank loan, and tends to achieve high payment compliance,” notes Johnston. “The fact that CommerceHealthcare® tailors the financing to individual needs only strengthens the compliance factor.”

Smooth Implementation Paves the Way

System change typically hinges on successful implementation. Johnston gives CommerceHealthcare® high marks in this regard. “Implementation was the smoothest we’ve ever had,” she observed, crediting a structured approach involving “weekly meetings to review tasks and milestones, which everyone hit.” HSF® implementation requires minimal technical setup. The solution can be integrated with a provider’s patient management or revenue cycle systems.

Johnston highlighted staff communication development:

"The solid scripting and great training made it easy for everyone to offer the program in a patient-friendly and consistent fashion."

Results & Benefits

The HSF® program has attained the health system’s principal objectives and generated substantial benefits:

  • Patient choice. The flexible credit lines satisfy varied patient needs, fostering customer satisfaction.
  • Program growth. Patient acceptance can be seen in the numbers. Total 2021 funding of $10.2 million far eclipsed the $1.6 million annually under the previous program.
  • Reduction of internal financing. Johnston noted that the CommerceHealthcare® program has enabled BHS to halve its monthly in-house financing from $3.5 million to $1.7 million.
  • Staff productivity. Program administration by CommerceHealthcare® has reduced workload in the patient financial services department. “We are doing 300 lines of credit per month,” said Johnston, “so staff time and diversion would add up quickly.”
  • Improved cash flow. CommerceHealthcare® issues payment to the provider for 100% of the patient charges.
  • Partner coordination. Program management by CommerceHealthcare® has improved the working relationship with BHS’s collection agency and other financial parties.
  • Strategic asset. CommerceHealthcare® has forged a banking relationship with BHS that can support future strategic and operational needs.

Recommendations for Success

Valarie Johnston identified two key success factors:

  • Gain staff buy-in. “Results are maximized when all staff are committed to offering the HSF® program in a consistent and positive fashion.”
  • Educate other departments. Adoption is further bolstered by training staff working in patient entry points such as patient access, financial assistance, and customer service to engage the financing conversation.

Future Directions

BHS anticipates further integration of the CommerceHealthcare® solution with its electronic health records (EHR), as well as offering the program’s pre-service enrollment feature that extends financing based on estimated charges. More broadly, BHS continues to take advantage of expansion opportunities. The proven ability of CommerceHealthcare® to scale its patient financing rapidly will help meet these growth demands.