Cost Effectiveness of Health

3 ways the patient financial experience can improve health equity

April 25, 2022 2:07 pm
Mark Spinner is CEO and president of AccessOne, Charlotte, N.C.

COVID-19 shined a bright light on disparities in access to care and health outcomes that existed in the U.S. healthcare system long before the pandemic, but it also has exacerbated those disparities.a Now, health system revenue cycle departments have an opportunity to be part of the solution.

When healthcare leaders consider opportunities to close gaps in care, the patient financial experience may not immediately come to mind, but it should. That’s because lack of economic stability is a social determinant of health, and it affects the decisions people make around not only  whether to seek care, but also when and where they will do so.b As the percentage of people suffering from economic hardship increases, especially among people of color and families with children, bolstering financial communications and payment options can help ensure individuals receive the care they need while protecting organizations’ financial health.c For health systems, it’s a matter of both social responsibility and economics. 

Disparities in care lead to $93 billion in excess medical costs per year — costs that organizations may be forced to absorb when financial care doesn’t occur at the front end of the patient encounter.d

Protecting access to care through financial empathy and engagement

How can healthcare revenue cycle departments play a key role in improving access, affordability and equity? Leading organizations are exploring three innovative approaches.

1. Offering flexible and empathic patient  financing. Providing a variety of payment plan options and promoting them widely helps ease patients’ financial concerns prior to their care encounter. It also enables patients to pay with dignity, no matter their financial circumstance. Flexibility is key: 60% of consumers say affordable monthly payment options are important to them, while one out of four consumers says lack of an affordable monthly payment plan is one of their top frustrations with the patient financial experience, a fall 2021 consumer survey found.

Wake Forest Baptist Health, one of the largest academic health systems in North Carolina, exemplifies how a health system can best address this situation. It allows all of its patients to qualify for low- or no-interest payment plans that they can adjust based on their financial needs. This policy ensures that financial challenges — including those resulting from COVID-19 — do not prevent patients from seeking care. 

It also aligns with the health system’s mission of meeting the needs of underserved communities: In spring 2021, the health system announced a partnership with atrium Health, Urban League of Central Carolinas and Winston-Salem Urban League to co-host “Community Immunity for all” vaccination events designed to reach Black and Hispanic communities. 

Offering a variety of payment plan options also helps protect an organization’s financial health by ensuring patients keep up with their payments. For example, since the University of Kansas Health System in Kansas City, Kansas, began to offer no-interest payment options in 2017, 95% of its patients are current with payments, and the default rate totals less than 10%.

Meanwhile, at Cone Health in Greensboro, North Carolina, tailoring patient financing plans to patients’ needs has boosted account activation and significantly lowered recourse rates (less than 3%) and default rates (less than 7%).

Other organizations are finding value in a digital-first approach to communications. In these organizations, staff connect with patients via text or email within 24 hours of providing an estimate. Then, they walk the patient through the types of payment plans that may be available, from no-interest to low-interest plans, and offer to help enroll the patient. These steps give patients peace of mind that the hospital will work with them around payment.

Social media also has proven to be a powerful tool not only for informing patients of their payment options, but also for relieving the financial fears that hold them back from receiving care.

At Piedmont Augusta (previously University Health Care System) in Georgia, revenue cycle teams use Facebook to let patients know that every patient who receives care qualifies for manageable monthly payments, with amounts tailored to their financial needs.

The health system, which joined Piedmont on March 1, also offers patients the option of combining medical bills into a single monthly payment. It uses social media to inform them of this option, which simplifies tracking of patient financial obligations while providing a single point of reference for patient financial communications and account management.

2. Acknowledging the possibility that patients’ circumstances might change after financial estimates are delivered. Giving patients a choice of payment plans at the start is important, but so is offering patients flexibility to change their payment plans as circumstances change. Some patients may find themselves increasingly ill-prepared to cover the cost of more intensive care.

Moreover, that experience could become more widespread, given the amount of care that was postponed at the height of the pandemic, including cancer screenings. In scenarios like these, a compassionate approach to patient financial communications and payment arrangements can make all the difference. No one should be locked into a plan they cannot afford.

For example, at Moffitt Cancer Center — home of the largest clinical cancer research unit in Florida, with more than 450 clinical trials — patient financial services staff work with 22% of cancer patients across the state. They find that patients often arrive at a point when they are least able to pay the very time when they start needing more aggressive treatment. They may have exhausted their insurance maximums or depleted their financial resources during earlier rounds of treatment, for example. Or they may have lost coverage and been unable to qualify for Medicaid. as a result, 35% of customer service calls were inquiries from patients asking to change the terms of Moffitt’s long-term internal payment plan.

In 2019, Moffitt Cancer Center expanded the flexibility of its patient payment plan approach, not only adding low-interest or no-interest payment plans, with adjusted monthly payments that best suit patients’ financial need, but also giving patients the ability to switch plans as circumstances change.

The approach has significantly reduced bad debt while enhancing the patient financial experience. Today, Moffitt’s recapture rate is 15%, and its recourse rate on payment plans is just 1.2%.

3. Working with primary care providers to reach out to consumers who have delayed needed care. Under value-based payment models, providers and health plans often must ensure specific populations receive health screenings such as mammograms and colonoscopies. But fears about contracting COVID-19 aren’t the only thing holding members back from getting recommended care. as the surveys referenced earlier demonstrate, financial concerns also play a big role in members’ decisions to delay care.

Today, an increasing number of hospital revenue cycle teams are working in tandem with primary care offices to help patients understand the extent to which care is covered by their health plan. That’s a critical move for eliminating gaps in care, given that some screenings are covered in full. Staff then outline payment options that best meet individuals’ financial needs.

A more equitable approach to financial care

As these organizations’ experiences demonstrate, developing proactive and collaborative approaches to patient financial communications enables healthcare revenue cycle teams to take a lead role in eliminating disparities in care. The impact: improved health outcomes and a more positive patient financial experience for all.

How COVID-19 impacts patients’ decisions about their healthcare

Consumer data captured throughout the pandemic testify to the impact of financial concerns on patients’ healthcare decision-making:

  • A March 2021 survey found 40% of consumers would delay paying medical bills because of the pandemic’s impact on their finances.a This finding included 44% of Gen Xers, many of whom make healthcare decisions for themselves, their children and their parents. At that time, 38% of respondents reported a decrease in household income due to COVID-19.
  • By fall 2021, more than half of consumers (58%) responding to another survey reported they had delayed medical care to avoid a healthcare bill — and one-in-three said they had done so in the past year.b Half of the consumers reported being concerned about their ability to pay medical costs in the next 12 months, including 57% of families with children. Meanwhile, medical bills rank low on the list of individuals’ payment priorities.
  • In spring 2022, three out of four American adults reported feeling anxious about their financial situation.c And fewer than half of American adults say they would be able to cover an unplanned expense of $1,000, a January 2022 survey found.d

It’s also important to note that the COVID-19 recession was the first recession to see a decrease in healthcare spending. Although health services spending in 2020 rebounded as in-person care and lab services became more widely available, total expenditures still fell 1% year over year, according to a Kaiser Family Foundation analysis.e


a. TransUnion, The COVID-19 pandemic’s financial impact on U.S. consumers: Consumer pulse, 2021. 

b. “AccessOne survey finds consumers want more from their providers when it comes  to paying for healthcare,” News release,  Oct. 13, 2021.

c. White, A., “77% of Americans are anxious about their financial situation—here’s how to take control,” NBC Select, March 22, 2022.

d. Bennet, K., “Survey: Less than half of Americans have savings to cover a $1,000 surprise expense,” Bankrate, Jan. 19, 2021.

e. Cox, C., Amin, K., and Kamal, R., “How have health spending and utilization changed during the coronavirus pandemic?” Kaiser Family Foundation, March 22, 2021.


a. “Dr Anthony Fauci on health disparities affecting people of color,” The American Journal for Managed Care, Aug. 26, 2020.

b. Benach, J., et al., “Precarious employment: Understanding an emerging social determinant of health,” Annual Review of Public Health, March 2014.

c. Orgera, K., Garfield, R., and Rudowitz, R., “Tracking social determinants of health during the COVID-19 pandemic,” Kaiser Family Foundation (KFF), Dec. 15, 2021; and Ndugga, N., and Artiga, S., “Disparities in health and health care: 5 key questions and answers,” KFF, May 11, 2021.

d. Turner, A., “The business case for racial equity: A strategy for growth,” Altarum, April 24, 2018.


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