Beyond payer mix: Personalizing the patient financial experience captures revenue cycle focus

As patient financial responsibility continues to rise, healthcare organizations are rethinking how they engage patients around billing, affordability and collections. According to a West Health/Gallup poll, Americans’ ability to afford healthcare is steadily deteriorating.^a Traditional patient accounts receivable (AR) indicators — like payer mix, coverage type and aging balances — no longer provide a complete picture of which patients are likely to resolve balances, need financial assistance or require a more personalized engagement strategy.

At the same time, consumer expectations are shifting. Patients increasingly expect healthcare financial experiences to feel more digital, transparent, personalized and easy to navigate. That is pushing revenue cycle leaders to rethink everything from estimates and payment plans to communication strategies and financial counseling models.

In this HFMA Executive Roundtable, healthcare leaders discussed how their organizations are approaching patient financial engagement today, where traditional workflows are falling short and what it will take to create more connected, patient-centered financial experiences moving forward.

How are evolving patient financial responsibilities reshaping engagement and collections strategies?

Jacqueline Jordan: The earlier we can provide patients with clear estimates, explain their financial responsibility and offer payment or assistance options through the communication channel they actually prefer, the better the outcomes are for both the patient and the organization. Consumers expect the same personalized digital experience they receive in other industries. If we’re still relying primarily on paper statements or outbound phone calls, we’ve already missed one of our greatest opportunities to improve both the patient experience and revenue cycle performance.

Kyle Dunleavy: One of the most important areas we are focused on is estimates and increasing the volume of estimates we provide. It’s a bit easier on the self-pay side, but insured estimates are still challenging. We’re an Epic shop, and while estimate accuracy is great, where we need to improve is getting those estimates in front of patients early.

We still track traditional indicators like self-pay over 90 days, but even those metrics have become a bit clouded. About two-and-a-half years ago, we brought payment plans in-house from an external vendor, which has been positive for both patients and our workflow, but it also increased our self-pay over 90-day balances. We are trying to weigh how long to allow balances to remain in A/R and get comfortable with that timeline if patients are engaged in automated payment plans.

How are you personalizing the financial experience to better meet individual patient needs and circumstances?

Keri Whitehead: We use tools like ability-to-pay scoring and presumptive charity to help identify who we should contact first and who likely qualifies for financial assistance. We also work with early out vendors and payment plan partners. But I still think there’s a gap in identifying patients who may have the ability to pay but require a different engagement strategy.

Dunleavy: There are experiences I’ve had as a patient in private practice that worked really well from a financial perspective but are difficult to scale in organizations our size. My wife and I went through IVF, and the clinic assigned us a patient concierge who guided us through every step of the process, including billing, benefits and insurance. We always knew who to contact. That level of personalization often gets lost in large health systems, so we’ve been considering, as a system, whether we should focus more attention on higher balances and have someone either from our financial counseling or customer service team reach out and walk patients through their estimate, explain why they may owe what they owe and discuss options. I just don’t think there’s enough personalization today.

Jody Casey: Because our clinicians work in hospital systems all over the country, we’re often dealing with very different financial policies. Anesthesia can be especially difficult because patients often see it as a surprise bill. It was important for us to keep our entire team onshore and create multiple ways for patients to interact with us. Patients can text or call, and our technology routes repeat calls to the same representative whenever possible. It’s easy to get on a payment plan, and patients can even use Apple Pay via text. We try to put the patient at the center of everything we do from a revenue perspective, and that’s helped drive very high patient satisfaction scores.

Richard Schefke: We rely on a lot of communication tools because we serve the South Nashville suburbs and very rural communities, including Amish patients, and they all require different approaches. Some patients respond best to mail, others to text or phone calls. Different generations and communities want different experiences, so we tailor communication accordingly.

Yohana Tuguta: I think a big part of the challenge is understanding how we better segment patients. Maybe that means surveying patients and asking, “Did we make it easy for you to act?” Then, it’s about using that feedback to tailor how we solve some of those problems. As deductibles and out-of-pocket costs continue to rise, more commercially insured patients are taking on greater financial responsibility as well. The question becomes: Of my patient population, which patients are likely to pay, and which may struggle because of those added costs?

Darryn Lee: Payer mix tells you how a population is insured. It doesn’t tell you how a patient will experience their bill. As Keri pointed out, ability-to-pay scoring and presumptive charity can identify who likely qualifies for assistance. What’s harder to see is the patient who can pay but needs a specific type of engagement to get there. That patient’s preferences will not show up in a coverage category.

How are you helping patients find the right support earlier?

Jordan: We’ve recognized that different patient populations require different levels of financial navigation. For example, we’ve embedded financial counselors in areas such as oncology, where patients often face more complex financial circumstances. Those embedded models have demonstrated the value of bringing financial guidance closer to the point of care. As healthcare becomes increasingly complex, organizations should think beyond traditional financial counseling and toward proactive financial navigation — connecting patients with the right resources before financial concerns become barriers to receiving care.

Whitehead: Building on Jacqueline’s point, we do some of this through our Moores Cancer Center. When a patient receives a cancer diagnosis, they are connected to a navigator who helps guide them through the process, and we have a team focused on identifying assistance for high-cost drugs. At the same time, these grants and support programs introduce a lot of complexity. For example, with some high-cost HIV infusion drugs, manufacturer assistance programs still require financial screening, approval processes and complicated billing workflows. Most people outside revenue cycle don’t realize how complicated those processes can become.

As patient responsibility grows, how are you measuring whether personalization and engagement strategies are actually improving financial outcomes?

Jordan: Patients want the same transparency and ease of comparison they experience in other industries, such as travel, but healthcare pricing is still overwhelming for most people. We talk about shoppable services, but patients often don’t know what they’re looking at. The challenge is figuring out how to simplify things so patients understand what a service will cost, can make decisions more confidently and feel like the organization is helping guide the rest of the process. That’s what patients are looking for.

Lee: The best patient financial communications take patient preferences into account. Using what the organization already knows about how to handle routine cases is what frees people to focus on the patients who need one-to-one human contact. That makes the financial experience easier to navigate — and gives health systems a better opportunity to get paid.

The through line is that the information needed to make these decisions often already exists inside the organization. It just isn’t driving decisions regarding when outreach is made, which channel is used or what support is offered for payment.

Dunleavy: I think price estimates are still where we need to focus right now. We see it clearly in our patient experience feedback. Patients either say they had no idea what they were going to owe, or they specifically mention appreciating that they received an accurate estimate before service and had the ability to pay through MyChart. With the tools available today, estimates remain one of our biggest opportunities. Longer term, I think the industry needs to move toward much faster adjudication — ideally almost immediately after service. There’s infrastructure being built around that, but there are still obstacles. Ultimately, we need to move away from a long, drawn-out billing process that can feel like a mystery to patients.

Whitehead: We’ve invested a significant amount of effort this year focused on reducing avoidable denials and controllable loss adjustments, and we’re projecting roughly $48 million in improvement from that work. But it also uncovered just how much payer behavior impacts both financial outcomes and the patient experience. Patients often only see the provider side of the process, but behind the scenes organizations spend enormous effort navigating denials, prior authorization issues and inconsistent payer requirements.

Nikki Harper: I think it comes back to mutual purpose. Patients can now see more of what care costs and make more conscious choices, but there is still misalignment in how we’re incentivized. We have to keep coming back to serving our patients — balancing quality outcomes with financial sustainability. At the end of the day, we want to help patients understand how they’re going to pay and how they can afford care, so they don’t come away with a great clinical outcome and then feel burdened by medical debt. That’s never the goal.

Conclusion

Healthcare organizations are moving away from one-size-fits-all financial engagement strategies and toward more personalized, patient-centered approaches. In this executive roundtable, leaders stress the importance of engaging patients earlier, simplifying financial communication and connecting individuals with the right affordability resources before balances become unmanageable.

For example, Jordan of UC San Diego Health emphasizes engaging patients before the final statement is sent, through the channel they actually use. Dunleavy of UConn Health pointed out that estimates may be accurate, but they aren’t always reaching patients early enough to act. And Tuguta of Sutter Health frames the underlying question: Which patients are likely to pay, and which may struggle as out-of-pocket costs rise?

Success will likely depend on combining better data, digital engagement tools and human support to create financial experiences that feel more transparent, connected and easier for patients to navigate.

PANELISTS

JODY CASEY
is chief growth officer at North American Partners in Anesthesia (NAPA) in Sunrise, Fla.

KYLE DUNLEAVY
is director of single billing office at UConn Health in Farmington, Conn.

RYAN FRANK
is vice president of partnerships at Cedar in Atlanta.

NIKKI HARPER,
FHFMA, EHRC, CRCR, is chair of revenue cycle — analytics, automation and diversified revenue at Mayo Clinic in Rochester, Minn.

JACQUELINE JORDAN,
CHFP, CRCR, MBA, is director of patient access at UC San Diego Health in San Diego.

DARRYN LEE,
MBA, is vice president of sales at Cedar in Boston.

RICHARD SCHEFKE,
FHFMA, CPA, is associate CFO at Maury Regional Health in Columbia, Tenn.

YOHANA TUGUTA,
CHFP, CRCR, CPA, is director of finance at Sutter Health in Santa Rosa, Calif.

KERI WHITEHEAD
is system director of patient financial services at UC San Diego Health in San Diego.

About Cedar

Patients are healthcare’s fastest-growing payer class, but most billing infrastructure was built to collect from insurers, not individuals. Cedar closes that gap. Powered by more than 1.5 billion patient interactions, Cedar’s AI-driven technology meets patients where they are, across billing, payments, and financial assistance, with outreach and payment options built around how people pay today. Cedar has processed over $13.6 billion in payments and supported more than 63 million patients nationwide. Health systems collect more, at lower cost, from a payer class legacy systems were never built for. To learn more, visit www.cedar.com. 

_{This published piece is provided solely for informational purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions by participants are those of the participants and not those of HFMA. References to commercial manufacturers, vendors, products, or services that may appear do not constitute endorsements by HFMA.}

Footnotes

a. Witters, D., and Maese, E., “In U.S., inability to pay for care, medicine hits new high,” Gallup, April 2, 2025.