Healthcare providers debate ways to offer patients manageable payment options

Healthcare finance leaders today are faced with a critical challenge: how to effectively offer patients manageable payment options without tying up hospital cash flow or overwhelming staff.

“Consumers fear the pinch of high healthcare costs and their ability to pay for them — and this fear prevents many from seeking care,” according to the HFMA report Curing Payment Confusion.¹

While the report found that nearly 83% of healthcare finance and revenue cycle leaders surveyed by HFMA believe their organization does a good job of explaining financial matters to patients, it’s clear that concerns about healthcare costs weigh heavily on consumers. A recent Gallup poll found 29% of American adults believe costs of care are the most urgent problem the nation’s healthcare system faces.² This makes the availability of affordable payment options for patients increasingly important.

Several healthcare finance executives discussed their work in improving the patient financial experience and the growing role of patient financing as part of a recent roundtable titled, “The Financing Factor: How healthcare providers are balancing healthcare affordability and revenue integrity.” Here are their top insights.

What are your experiences with patient financing?

Gregory Arnold: Let me share our experience with integrating financing using Epic, aiming to keep patients within our system.

I oversee the revenue cycle for Endeavor Health, which is the combination of North Shore University HealthSystem, Edward-Elmhurst Health and Northwestern Community Healthcare [in Illinois]. We’ve been together for three years under the new name. Endeavor sought to bring three systems together, each of which did things differently.

Endeavor Health now offers payment plans for up to 12 months, with a fee to cover interest. We encourage patients to quickly pay off their balances. We don’t want them to have a balance that runs for two or three years. The new system has so far been a very good thing. Initial results show that we’ve seen about a 10% increase in yield in some of our previous plans, and I think we have about a 25% acceptance rate of people using the system.

Carla Neiman: My hospital is a small rural hospital in western Montana. We’ve worked with a third-party vendor on patient financing for about seven years, and it’s worked well for us. I actually had searched for a solution for patient financing for years before we put our program in place. Even before patient financing options became popular in the marketplace, I had spoken with our local banks about opportunities to put something in place. Then, as vendors started developing programs, I talked with two or three before we found the right fit. It was difficult to find a partner; what I found was that many didn’t really want to work with us because we didn’t have enough volume. We ended up selecting a program that has fairly limited options, but it works fine for us. It’s fairly prescriptive about the terms that we can offer based on the patient balance. Our program offers no-interest financing. It provides an option for those patients who just don’t have the resources to get that balance paid within our in-house time frame. We’ve been happy with it.

What are the challenges and benefits of patient financing?

David Lombardi: I am the CFO for Cecilia Health in New York. We are a virtual specialty medical practice focused on integrated cardiometabolic care, and we work with pharmacy benefit managers and insurers. We are not a hospital system, but we face a different version of the same challenge. The industry must determine how to keep patients engaged without encountering financial barriers that would cause them to walk away from care.

My group is in the throes of building out a full revenue cycle management [system] as we begin to expand into our next quarter’s market strategy. Patient financing is a key pillar to that plan. We’re evaluating partners that can potentially help us do installment options with minimal friction. What we don’t want to do is compromise cash flow. So the challenge here is finding a solution that integrates [with our system] and that supports us as we grow.

I think patient financing is going to shift from a nice-to-have option to a core infrastructure layer within healthcare. Providers will need tools that enable them to offer compassionate, flexible financing without burdening their staff and without sacrificing predictable revenue.

Arnold: With patients owing more, I think we’re going to have to focus more on self-pay collections, because it feels like more responsibility is falling on the patient. Right now, I’m having to collect a lot more from my patient population than I ever did before. We’ve had success with increased yield and acceptance rates through the financing model. I’m trying to think of what will make [payment] most convenient for them.

Neiman: Now that we have a patient financing program with a third party, it replaces the hospital as the creditor. I think sometimes, patients are more responsive to a bank [in paying their bill] than they are to their local hospital. Another obvious benefit is that we get paid up front for that balance by the vendor. Of course, our program is a full recourse program, so if the patient does default, we get the account back. That’s probably the only challenge we face with a program like this, but the positives outweigh the negatives. It’s a great option for us.

Would you please discuss your integration and reconciliation challenges?

Craig Nesta: I’m vice president for Emerson Health and COO for Emerson Practice Associates (EPA) in Concord, Massachusetts. EPA is a multi-disciplinary physician practice including primary care, medical and surgical sub-specialties, urgent care, anesthesia and inpatient medicine.

Emerson Health is deeply rooted in the community and patient experience is a priority. An issue that I heard come up during this roundtable is patient experience and how it relates to collecting patients’ outstanding balances. To optimize the patient experience regarding revenue cycle issues and patient balances, it is vital as an industry that patients have education on patient deductibles, co-insurance, balances, and more, as this is a key element to the overall patient experience. 

Neiman: We are on Epic, and we took time on the front end to make sure that we had the patient financing piece integrated in our system and that the workflows aligned. It’s not a lot different than transferring an account to bad debt within our system, but we’re transferring it to this third party. We have had a couple reconciliation issues when we’ve had a recourse account returned to us, simply because it doesn’t happen very often.

What does an integrated financing solution that could work with EHR systems like Epic look like?

John Talaga: We’ve worked with several large customers over the past five-plus years, specifically talking about how they want to deliver a positive financing experience to patients. Many weren’t satisfied with what you might consider the traditional ways of doing that — providing a link, sending a request out to a third party and then essentially getting a loan from a third party, which you would create terms with, and having patients sign up for a plan there wasn’t an optimal solution, in their view.

Instead, clients want to have a fully integrated experience, where that financing trigger could live inside the experience where patients would otherwise make a payment or would set up a provider-based plan. Not everything should be financed. It gets too expensive, and it’s unnecessary. So we’ve worked with clients on delivering models that offer greater flexibility.

Neiman: Ours is pretty straightforward. We love it. Everything is electronic. We have accounts transferring electronically, and that has all worked well.

What future investments do you expect in patient financing?

Lombardi: In the future, I don’t see these types of payment options as nice-to-haves, but as must-haves. Whether it’s due to economic uncertainty, inflation, pricing pressure or co-pays, at the end of the day, the burden is going to be placed onto the consumer. I predict the industry will invest more in patient financing as part of the revenue cycle management strategy, offering flexible payment options and alleviating staff burden.

Sheldon Pink:  I am the vice president of the central business office at Methodist Health System in Dallas. One of the things that Methodist does very well is their pre-collections. That’s probably the strongest I’ve seen in many other health systems. They’re collecting anywhere between 3% and 4% upfront. Most of the patient responsibility is identified upfront.

Our community hospital will never adopt the strategy of not seeing a patient over payment issues, because our reputation in the community is more important than the dollar and cents of whatever the co-pay is. We focus on improving the patient financial experience, education, accuracy and flexibility in our financial model.

We try everything in our power to communicate to patients: “Hey, can we put you on a payment plan?  Can we do this? Here’s what you’re going to owe.” We do everything in our power, but I don’t think healthcare would ever get to the point where we stopped seeing patients that we do now.

Ryan Klein: I am the senior director patient access and financial experience at UW Health [University of Wisconsin Health] in Madison, and I agree with the importance of self-service and integrated patient financial options. With the growth of high-deductible plans and increased patient liability, the industry needs to be more consumer centric and provide patients with payment options.

UW Health allows patients to create payment plans prior to the date of service when an estimate is proactively provided; however, we always ask for payment in full first. Although we would like patients to proactively create payment plans, pre-service payment plan adoption has not taken off as we had hoped, but we will continue to offer this to patients with expected out-of-pocket costs.

Conclusion

Roundtable participants stressed the importance of integrated financing solutions within EHR and the benefits of self-service options for consumers to manage their patient financing accounts.

The conversation also emphasized the need for accurate patient estimates and the potential for patient financing to become a core infrastructure layer in healthcare.

Several action items were also suggested for organizations seeking to take a proactive approach to patient payment. They included:

• Evaluating the cost and benefits of honoring patient estimates and the potential risks involved
• Exploring opportunities to increase self-service patient financing options, such as allowing patients to enroll in payment plans or apply for financial assistance through online portals
• Assessing the projected increase in self-pay accounts receivable over the next three to five years

By developing strategies to meet the growing demand for patient financial options, providers can strengthen patient financial care while protecting their bottom line.

Panelists

GREGORY ARNOLD
is a senior vice president, revenue cycle with Endeavor Health in Chicago

RYAN KLEIN
is senior director, patient access and financial experience with UW Health in Madison, Wis.

DAVID LOMBARDI
is CFO with Cecelia Health in New York

CARLA A. NEIMAN
FHFMA, CPHRM, is CFO for Clark Fork Valley Hospital and Family Medicine Network in Plains, Mont.

CRAIG NESTA
JD, FHFMA, MBA, is vice president with Emerson Health, and COO at Emerson Practice Associates in Concord, Mass.

SHELDON PINK
FHFMA, MBA, LSSBB, is vice president, central billing office, with Methodist Health System in Dallas

JOHN TALAGA
is executive vice president and general manager of healthcare at Flywire in Boston

CHARLOTTE VIGIL
moderator, is senior consultant at Eliciting Insights in St. Louis

About Flywire

Flywire simplifies payment processing, capturing payments more efficiently, cutting excessive transaction fees, and optimizing the financial health of your healthcare system. Our responsive billing and payments platform leverages deep analytics and machine learning to understand your patients capacity to pay, their preferred method of engagement, and where on their healthcare journey we need to meet them. We’re delivering on your patients most important payments and maximizing collections for you and financial peace for your patients.

Footnotes

1. Williams, J., “Curing patient confusion,” hfm, May 24, 2024.
2. Saad, L., and Brenan, M., “Cost leads Americans’ top-of-mind healthcare concerns, Gallup, Dec. 15, 2025.