By Scott Herbst, SVP at Availity

February 2018 – Healthcare consumerism has become an increasingly important focus for healthcare organizations as deductibles have risen in conventional health plans and as high-deductible health plans (HDHPs) have spread. Usually tied to health savings accounts, HDHPs incentivize consumers to make informed and judicious decisions about the healthcare services they purchase.

Nearly 40% of consumers purchased an HDHP in 2016, up from 26% in 2011, according to the National Center for Health Statistics.1 Yet consumers as a whole have not yet acquired the skills they need to become astute healthcare purchasers.

A 2017 report by the consumer credit reporting agency TransUnion found that 57% of Millennials, 50% of Gen X’ers and 42% of Baby Boomers have “little to no understanding of their health insurance benefits.”2 This has made it difficult for consumers to anticipate and plan for medical expenses. In many casesit’s made care seem unaffordable. In a 2016 survey3 by the Kaiser Family Foundation (KFF) and The New York Times, patients cited unexpected claims denials (26%), visits to out-of-network provider (32%) and high deductibles (26%) as primary reasons behind their inability to pay for healthcare services.

As a result of financial barriers, many patients are delaying care. According to a 2017 Gallup survey, 29% of patients have put off medical care because of costs; of that number, 63% say their conditions are serious.4


Consumerism represents a significant cultural challenge. Providers may complain about health insurers’ byzantine reimbursement requirements, but at least it’s a process defined by rules. Collecting from patients, in contrast, is a more nuanced process that requires an understanding of patient behavior and individual circumstances.

Once a patient leaves your office, your chances of collecting his or her payment drop by an average of 62%.5 Therefore, it’s crucial to capture as much revenue as possible at or before the point of service.

“Propensity to pay” software has been developed to predict which patients are most likely to pay. This information can help healthcare organizations fine-tune their approach to collecting from different patients.6  Nevertheless, inefficiencies and poor workflow can exacerbate problems in the collection process. It’s important to get it right early.

The technology, strategies, and human resources used to engender patient accountability are collectively known as “patient access.” Patient access’s main goals are to enhance the patient experience, increase the yield of collections and contain their cost.


Patient access is the front end of the revenue cycle, where front office staff initially engage with patients. In these discussions, they can help patients understand what they owe, make it easy to pay, and set patient expectations.

Patients have different expectations and preferences about paying their bills. By utilizing technology and building more flexibility into your approach to collections, you can reduce your reliance on paper statements and bill collectors, get paid more quickly and reduce your administrative costs.

Achieving these goals requires technology that can provide:

  • Quick and accurate estimates of the patient’s financial responsibility, after establishing insurance eligibility and authorization status
  • Forecasts of a patient’s capacity to pay
  • Multiple payment options and patient assistance plans
  • Proactive and consistent policies related to claims denial management.

Here’s how you can turn that idea into reality.

Pre-Appointment Checks. Before patients walk through your front door, they should know about their payment options and any financial assistance that may be available to them. Among the things they need to know are which services are covered by their insurance, what their total financial obligation is going to be, and what your organization expects to be paid for the appointment.

Clear and Concise Billing. Even if patients are willing and able to pay their bills, they may not understand the complex statements they receive from multiple hospitals, doctors, labs and/or specialists. To make this process easier for patients, providers should consider improving their billing statements. For example, is the bill’s language clear and concise, with excess industry jargon removed? If you have an older population, are your font sizes large enough for easy reading? Are costs itemized? Does the invoice have a section that details the insurance company’s obligation?

Make It Easy to Pay. Most practices, hospitals, and billing services already offer the option to pay by credit card. In addition, it’s worth considering online payments, which fit into the electronic lifestyles of today’s consumers.

Many vendors offer online payment portals, including those connected to the clearinghouses or practice management systems that you may already be using. Look for options that allow automated monthly debits for payment plans. These will reduce your reliance on a patient initiating a payment each month.

Communicate With Patients. Consistent communication with patients can also encourage them to keep current with payments. Text messaging and email, both of which are available in some financial clearance tools, may be the best way to communicate with some patients. Engaging patients from the beginning with accurate information will do more than most providers realize to establish and maintain a positive relationship with patients.

A healthy revenue cycle in the age of consumerism begins with patient access management. Flaws and inefficiencies in this critical first step will only exacerbate poor cash flow and collections and negatively impact patient satisfaction. With the right technology and human resources, hospitals and providers can side-step avoidable financial disasters and leverage innovative strategies to grow their bottom line.



Scott Herbst is Senior Vice President and General Manager of Provider Solutions for Availity.



  1. Cohen RA and Zammitti EP. High-deductible health plans and financial barriers to medical care: Early release of estimates from the National Health interview survey, 2016. National Center for Health Statistics. Available at:
  2. Decoding millennial financial health. Available at:
  3. Hamel L, Norton M, Pollitz K, Levitt L, Claxton G, Brodie M. The burden of medical debt: Results from the Kaiser Family Foundation/New York Times medical bills survey. January 5, 2016. Available at:
  4. U.S. women more likely than men to put off medical treatment. December 6, 2017. Available at:
  5. Method to the madness: 10 patient collection strategies that work. Available at:
  6. The impact of consumerism on provider revenues. Available at:

One Response to “The Dream of Healthcare Consumerism: How to Avoid It Being a Nightmare”

  1. Richard Carpe

    Excellent data-driven assessment of the marketplace. I have been working with providers for several years toward early identification of patient financial need and the provision of immediate options. Providers must manage AR More than ever. Richard Carpe


Leave a Reply