Cost Effectiveness of Health

Bruce Haupt: How the revenue cycle can help patients make healthy choices

August 31, 2022 4:08 pm
Bruce Haupt

Can the way a healthcare organization approaches the revenue cycle actually promote improved cost effectiveness of health (CEoH)? If one assumes the revenue cycle’s purpose is to simply secure payment for healthcare services delivered, one could argue that the answer is “no.”

But there’s more to the revenue cycle than just being focused on obtaining payment. Bruce Haupt, president and CEO of San Diego-based ClearBalance HealthCare, says the way healthcare organizations approach self-pay collections can make a huge difference in helping to keep people healthy.


Our nation faces a significant challenge in transforming our healthcare system to embody true CEoH. Clearly, sweeping societal changes are required to meet this challenge. How can our nation’s progress toward these goals best be reflected in the revenue cycle?


First, it’s important to understand the revenue cycle will almost always follow what the industry is doing. But when you are talking about cost effectiveness of health, that implies the nation overall is getting value for the quality of outcomes it’s paying for around both healthcare and health.

Bruce Haupt suggests the revenue cycle ultimately will evolve to reflect changes in our nation’s healthcare system that promote improved cost effectiveness of health.

At face value, focusing solely on the revenue cycle is not going to address cost effectiveness, given that it is primarily concerned with how we collect on the cost side.

But how an organization’s culture affects the way Revenue Cycle addresses the cost concern makes a difference. The fundamental goal for the revenue cycle should be to make all consumers aware of their costs for their proposed care before that care is received and the financial obligation is incurred, and to present them with options to pay for that care in a manner that’s convenient, affordable and dignified.

I’m using the word consumers purposely because I think that’s important. Given the complexity of our health system, we need to provide people with the incentive to act like consumers, and we can do that by giving them the information they need to be good consumers.

Of course, there are situations where making a consumer choice is not possible — say, in the case of emergency care for an accident. But it’s important even in those situations to foster awareness of costs and payment options as soon as practicable.


Can you elaborate on what you mean by offering payment options?


This is where the organization’s culture applies. In some cases, there is a concern that by communicating payment options equally and fairly to everyone, even consumers who can afford to pay their out-of-pocket costs immediately will take advantage of other options. The trade-off is that when you don’t communicate available options you lose many more consumers who would be willing to pay their costs if they’re given affordable options.

Also, rising inflation is putting more stress on consumers. It’s all about looking for ways to help patients ultimately to pay their balance in full, but to pay what they can afford now, with flexibility in terms of payment methods — check, cash, ACH debt, debit, credit card, PayPal, HSA, FSA, Google Pay, all those different things.

Another key area is payment channel: How am I engaging that consumer to pay? It could be through a portal, could be text-to-pay, could be a voice-response unit, could be mail, could be in person or could be by talking to somebody live on the phone. The fact is, health systems deal with all the population, so they need to have all the methods and make it easy for people to use.

And they need to become better at putting all those pieces together to make them work by communicating broadly and clearly to the community – using the power of all their consumer social outlets, not just their website – that these options exist. They need to send the message, “We are here to help you pay for the care you need in a way that fits your circumstances and budget.”

The ultimate goal should be that nobody will go to bad debt. You either give patients charity care or you give them an easy way to pay through all of these options.

One thing we know from our consumerism study is that 38% of the people who used financing said they would’ve delayed care if they didn’t know they had an option for financing. That statistic has held steady for more than five years.


So that implies letting people know from the start that they have payment options is really an essential step to helping ensure they stay healthy, which is the goal of CEoH.


Yes. By alleviating their concern up front about whether they can afford the care, it enables consumers to be more receptive to receiving the care they need before it’s no longer a matter of choice.


What kinds of organizations are doing this well? And what are some of the challenges they must contend with, even beyond getting paid?


Clearly, very large health systems that have a lot of capital, many employees and big IT departments are in the best position to do what’s necessary. But there are many challenges even for them to making it work seamlessly: Many organizations have a wide range of consumers in terms of their economics, social circumstances and state of health. And they offer a huge range of services. So while it may seem clear what’s needed to address consumers’ needs and concerns, many organizations have a lot of work to do to create a seamless, holistic experience.

Let’s take population health as an example. Healthcare organizations want to encourage consumers to have preventive tests to make sure they don’t have some problem that, left unchecked, could escalate to a more serious, higher cost medical issue. But things are complicated by all the different ways organizations are paid today — some fee-for-service, some value-based care, some bundled payment, and then there’s self-pay. So getting paid for all the things you could do to keep patients healthy is not a straightforward proposition.


If you think of patient access as being part of the revenue cycle, is that perhaps the place where you could begin to address some of these challenges?  


Yes, and fortunately, many healthcare organizations now are focused on improving patient financial engagement at the front end. From a purely revenue cycle standpoint, they’re focused on increasing their point-of-service collections. But they also are doing more to meet consumer expectations for convenience..

Baylor Scott & White Health in Texas, for example, has an app that enables consumers to self-select to schedule a procedure, among other things. And from the revenue cycle standpoint, consumers can use it for cost estimates.

People also can use it to stay on top of clinical requirements, such as getting a reminder to take prescribed a pill the night before service. So the app tells you what you need to know on the clinical side, while on revenue cycle side, you could get the price estimate about how much you might expect to pay.


What are other things healthcare organizations are doing to ensure patients have a positive financial experience, regardless of their ability to pay?


Analytics play an important role in patient financial engagement. For example, before my procedure, an organization can use analytics to determine if I am likely to be someone who will need financial assistance. If so, they can be prepared to discuss it with me.

There are other things organizations can do not directly related to the patient financial experience but that can create goodwill toward the organization communities A lot of organizations are providing community outreach, providing education about clinical issues and about health and how to access services. And then they might provide free services. They might go into an underserved neighborhood and say, we’re here to give COVID or flu vaccinations, and we’re also here to tell you how we can help you stay healthy.


What should finance leaders focus on now to promote CEoH and improve access for patients?


The best thing they can do now is to make sure their organizations are providing communication — and counseling if necessary — early and often so  consumers really understand the options for their care treatment as well as the cost of their care. As a provider, I want you to know that you can come to us and get the care you need, and one way or another we are going take care of you from a financial perspective.  If I  don’t do that well, the consumer might just say, “I can’t go to this organization, because I just can’t afford it.”

Steps for helping patients over the out-of-pocket payment hurdle

Healthcare organizations require a number of capabilities if they are to give patients all the options they need to pay for their care in a way that’s convenient and affordable , said Bruce Haupt, president and CEO of ClearBalance HealthCare®. Here are soem key requirements he cited:

  • You need access to the person’s insurance information. You need to know whether they are insured or uninsured. And if they are insured, what is the plan, what’s the latest status of their insurance and how much deductible do they have?
  • You need to be able to provide a good price estimate — one that’s close to what it’s going to be.
  • You have to have a very clear, well-thought-out charity and financial-assistance policies, which all not-for-profits must have, of course. But it is imperative that it be presented simply and clearly to ensure the patient fully understands it.
  • You have to have a broad range of affordable payment options so patients can have confidence in their ability to pay for their care.




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