Patients cared for by Leading Health Systems (LHS) across the country are facing a number of external pressures related to the financing of their care. Evolving legislative and regulatory requirements, changing consumer expectations, and the increase in patient financial obligation have all contributed to a challenging patient financial experience. The patient financial experience is made up of many factors, including access to pricing information, scheduling services, time between services and billing, understanding payment options, and countless other challenges. It is essential for LHS to cater to patients as consumers in order to alleviate these financial hurdles and capture the additional revenue stemming from patient out-of-pocket costs. Providing additional opportunities for patient financing and multiple bill-pay channels are just a few ways LHS are improving the financial experience for their patients today. However, LHS still vary in the extent to which they prioritize consumer-focused initiatives to improve the patient financial experience, with some health systems more proactive than others.
In the Fall of 2021, The Health Management Academy (The Academy) surveyed various LHS financial executives to provide them with a baseline understanding of how their peers are tactically approaching and developing strategy related to improving the patient financial experience.
- VPs of Revenue Expect Revenue from Patient Obligations to Increase Significantly in the Next Five Years
- While 24% of financial executives surveyed believe that patient obligation will increase by over 10% in the next five years, 71% believe that it will increase more modestly by only 1-10%. However, of the 24% that anticipate growth of greater than 10%, half held the title of Vice President (VP) of Revenue.
- Of Those LHS that are Improving the Patient Financial Experience, Many are Focused on Patient Financing Plans and Bill Pay Options
- Nearly two thirds of LHS (65%) offer in-house patient financing plans, with the average plan adoption rate at 19%.
- All LHS surveyed offer an online bill pay portal, with 53% offering it through their Electronic Health Record (EHR) and 47% offering it through a vendor partnership.
- LHS Find it Difficult to Focus on Improving the Patient Financial Experience Given Competing Priorities
- Most LHS executives (76%) agree that “competing priorities” is the most common barrier to improving the patient financial experience at their health system
VPs of Revenue Expect Revenue from Patient Obligations to Increase Significantly in the Next Five Years
Across the country, patients are facing a significant increase in out-of-pocket expenses as high deductible health plans (HDHP) increase in popularity. From the LHS perspective, part of improving the patient financial experience includes being prepared to accept payments in multiple forms. However, only a small number of health systems seem to have developed a sense of urgency around preparing for the anticipated increase in revenue from patient obligation. For example, the majority of LHS executives sampled in this study (71%) expect revenue coming from patient obligation to only “increase somewhat (1%-10%)” in the next five years (Figure 1). Conversely, 24% of financial executives surveyed believe that patient obligation will increase “significantly (>10%)” in the next five years. Of the health systems that believe patient obligation will increase ‘significantly (>10%),’ 75% are from the southern region of the US, none are academic medical centers, and there is no significant distinction in health system size. However, of the health system executives that anticipate patient obligation will increase significantly, 50% held the title of VP of Revenue. Given that VPs of Revenue made up a smaller percentage of the total study sample than other executives, this finding is significant in that it indicates that VPs of Revenue may be more likely to prioritize consumer-focused initiatives to account for the impending increase in patient-generated revenue than other finance executives. Additionally, when asked which executive is typically in charge of leading efforts to improve the patient financial experience, 59% of all study participants indicated that it is the VP of Revenue Cycle (Figure 2). In order to be successful, LHS executives of varying roles will need to share responsibility for the patient financial experience and other consumer-focused strategies.
View PDF of Figure 1 Chart[PDF]
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Of Those LHS that are Improving the Patient Financial Experience, Many are Focused on Patient Financing Plans and Bill Pay Options
With patient obligation increasing, some LHS are beginning to offer flexible financing options. Roughly two thirds of LHS currently offer “in-house, interest-free patient financing,” while another quarter offer “financing through partnerships” (Figure 3). Very few LHS offer “financing with interest” or nothing at all.
"One of the items our health system doesn’t have today is a formal loan program for our patients. We have historically managed that in-house, but inconsistently, so we are currently looking at partnering with an external loan vendor for 2-3 year loan agreements with zero interest."-VP of Revenue Cycle
"Our system offers in-house, short-term payment plans (6 months or less) and long term with low annual interest depending on the terms (7 months or longer)."-Sr. Director, Revenue Cycle
View PDF of Figure 3 Chart[PDF]
Today, the majority of patients are able to enroll in payment plans offered by LHS either online (47%) or over the phone (53%) (Figure 4). LHS have seen differing rates of adoption of the payment plans they offer. Across LHS, the average payment plan adoption rate is 19%, however LHS seem to be split, with one group having a high payment plan adoption rate (40%+) and the other group having a much lower payment plan adoption rate (5% or less) (Figure 5). Of those who have above average plan adoption, 80% allow patients to enroll online and 60% work with a vendor to offer their payment plan to patients. Further, qualitative insight from financial executives surveyed suggests that the financing terms for payment plans seem to have an impact on adoption rates.
View PDF of Figure 4 Chart[PDF]
As LHS continue to develop their virtual presence, executives sampled indicate an increase in the different ways patients can pay for the care they receive. All LHS surveyed offer an online bill pay portal, with 53% offering it through their EHR and 47% offering it through a vendor partnership (Figure 6).
"We integrated the statement and an online portal where patients can research and pay their bill. We have a vendor for that."-VP, Finance
"We have grown organically over the years. We never had a standard set of contact software, which means we had different standards and reporting networks used to track patients and hand-offs. We would have to gather patient information a number of times when we transferred patients. We now have a single database that saves patient information. This was an organizational initiative in which revenue cycle was a large part, and we think this will be a significant benefit to our patients' experience, given that they will now only have to provide their information one time."-VP of Revenue Cycle
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LHS Find it Difficult to Focus on Improving the Patient Financial Experience Given Competing Priorities
LHS executives rate their patient education efforts in billing and financial obligation as either “good” (53%) or “very good” (29%), while only 18% of LHS rate their efforts as “fair” (Figure 7). However, challenges still exist to the improvement of the patient financial experience across LHS. “Competing priorities” is cited as the most common barrier, as indicated by 76% of executives sampled (Figure 8). Other common barriers include “inability to estimate out-of-pocket costs” (29%), “insufficient IT capabilities” (29%), and “payer relations.” Other barriers captured across a handful of qualitative interviews include prior authorizations, patient engagement, and fragmentation across the system.
"We would like to be further along, but it's been hard to prioritize what is going to have the greatest impact. We want to do so many consumer-focused things, but we can barely get bills out the door."-VP, Finance
"Our greatest challenge today is with prior authorizations. Prior authorizations are challenging because the patient is stuck in the middle, and it is not their fault. That is a growing concern for us and something we are trying to partner with some of our larger payers to help us with."-VP of Revenue Cycle
View PDF of Figure 7 Chart[PDF]
View PDF of Figure 8 Chart[PDF]
Informed Practices for LHS
As LHS continue to face challenges with improving the patient financial experience, finance and consumer executives must seek out opportunities to improve all aspects of the patient financial journey.
Key Informed Practices for LHS:
- Due to the acceleration of consumer culture and patient financial obligation, some LHS are prioritizing the patient financial experience as a revenue strategy, with revenue cycle leaders at the forefront. As LHS consider plans to improve the patient financial experience, finance and consumer executives must prioritize opportunities to improve both individual aspects of the patient financial journey, as well as the experience as a whole.
- A key area of focus for LHS executives today is on enhancing the patient financial experience after care has been delivered through expanded billing and payment options. To continue to be successful in this arena, LHS should aim to improve patient awareness and understanding of their financial obligation, which is often achieved through streamlining billing processes and the development of a single, understandable bill for patients. This involves early communication and education for patients to ensure they are engaged in the billing process and aware of their obligation before receiving their bill. If patients understand their expected charges before receiving care where possible and receive comprehensive billing information post-care, LHS can help to cut down on surprise billing. Overall, LHS should focus on discussing payment options with patients throughout the patient financial journey to make it as easy as possible for patients to fulfill their financial obligation.
- The continued increase in patient obligations needs to be shared by both the patient and provider. As patient financial obligations grow with high-deductible health plans, consumer budgets will increasingly become strained. LHS will need to increase adoption of payment plans and consider offering longer-term monthly payment options for larger obligations to keep the patient obligation affordable. LHS should weigh options and costs of offering extended repayment terms with payment plans managed in-house or through an external partnership. Additionally, LHS should consider keeping shorter-term payment plans in-house and extended-term payment plans through external partnerships, as many executives have identified this as a key strategic priority moving forward.
- Above all, LHS will need to achieve alignment across finance and consumer executives in order to develop a system-level strategy for improving the patient financial experience. Today, VPs of Revenue seem to be leading patient financial experience strategies, which is why some health systems are changing the organizational structure of their revenue cycle departments to include more personnel with consumer experience. For these health systems, both revenue cycle and consumer teams can work more closely together to better integrate consumer strategies across the health system and across all aspects of the patient financial experience.
The 17 responding executives included Vice President (VP) of Revenue Cycle, Senior Vice President (SVP) of Finance, Vice President of Finance, Senior Director, Revenue Cycle Customer Service, and System Director, Budget & Revenue Integrity. The 13 unique health systems own or operate 196 hospitals, have 1.6 million inpatient admissions annually, 32 million outpatient admissions annually, and have an average total operating revenue (TOR) of $5.7 billion. For the purposes of this research, health system size is based on TOR, with large health systems defined as those with greater than $6B TOR, medium defined as $6B-$4B TOR, and small defined as less than $4B TOR. The survey sample consisted of 38% large, 15% medium, and 46% small health systems. The survey sample also consisted of health systems from the following regions: 8% Northeast, 53% South, 31% Midwest, and 8% West.
In the Fall of 2021, The Academy conducted a quantitative survey as well as in-depth telephone interviews with LHS executives around the patient financial experience. None of the participants derived any personal profit or gain through participation in this study.
The Health Management Academy
The Health Management Academy (The Academy) is a membership organization exclusively for executives from the country’s Top-100 Health Systems and most innovative healthcare companies. The Academy’s learning model identifies top priorities of health system leaders; develops rich content based on those priorities; and addresses them by convening members to exchange ideas, best practices, and information. The Academy is the definitive trusted source for peer-to-peer learning in healthcare delivery with a material record of research and policy analysis. Offerings include C-suite executive peer forums, issues-based collaboratives, leadership development programs, research, advisory, and media services. The Academy is an accredited CE provider. More information is available at www.hmacademy.com.
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The information and opinions in this report were prepared by The Academy. The information herein is believed to be reliable and has been obtained from public and proprietary sources believed to be reliable. All survey data and responses are collected in good faith from sources with established expertise and are believed to be reliable. Opinions, estimates, and projections in this report constitute the current judgement of the authors as of the date of this report. They do not necessarily reflect the opinions of The Academy and are subject to change without notice. Any products referenced within this report have not been independently evaluated. The Academy neither recommends nor endorses any of the products identified by research participants. All registered names or brands referenced in this document remain the property of their respective owners and are included for identification purposes only. This report is provided for informational purposes only. Any reproduction by any person for any purpose without The Academy’s written consent is prohibited.