The Exec: Building Patient Trust and ROI Through Bill Pay Tech

Drew Smith, director of revenue cycle at MainStreet Family Care, talks implementing text-based bill pay and creating a positive patient financial experience.

Digital payment options are becoming increasingly important for revenue cycle leaders as they seek to bolster their technology and better secure revenue. Perfecting and expanding these options should be a priority, especially since the same challenges that made 2022 the worst financial year since the start of the pandemic haven’t abated.

With patients increasingly demanding convenient, digital payment methods, healthcare providers must adapt to meet changing expectations to stay ahead of the competition, and this is what Drew Smith, director of revenue cycle, at MainStreet Family Care is trying to achieve with its new, text-based bill pay.

“We reduced the volume of paper statements mailed to patients by 11%—and this represents significant savings for our 46-facility system. We’ve also saved five hours in manual work per week for our revenue cycle team, or 260 hours a year,” Smith said.

During his conversation with HealthLeaders, Smith touch more on this and chatted about implementing this new technology, what it means for the systems’ patients, and how it significantly decreased accounts receivable days.

HealthLeaders: Why was it imperative to improve the patient billing experience?

Drew Smith: MainStreet Family Care serves a primarily rural population in Alabama, North Carolina, Georgia, and Florida, and often, we are patients’ only option for care. Even though we’re an urgent care center, people in our communities often turn to us for primary care because of the lack of providers available locally. Some of the areas we serve have a county hospital people can turn to for care, but many do not. Without access to care for conditions like diabetes, which impacts people in rural areas more severely than those in urban areas, the health of these communities would severely decline.

So, it’s vital that we have a healthy balance sheet. This means we depend on patients to pay their out-of-pocket costs of care in a timely manner. But research shows 40% of patients are often confused by their bills. Moreover, consumers believe healthcare providers can make it difficult for them to pay their bills. And in rural areas in particular, we’re finding that inflation is affecting residents’ decisions on whether to seek care or delay treatment. This makes clear communication around how much patients owe for their care after insurance and their options for payment crucial.

Pictured: Drew Smith, director of revenue cycle at MainStreet Family Care. Photo courtesy of LinkedIn.

HealthLeaders: How did you determine there was a need for text-based pay?

Smith: We chose text-based bill pay because we wanted to make it easy for patients to understand their financial responsibility for care and simple to pay their bill. Our goal was not only to speed payment but also reduce cost to collect. Paper statements cost $6 per statement for our organization based on paper and postage costs, the time it takes to post physical checks and respond to returned mail and the need for a lockbox. When we improve cash flow and reduce our cost to collect, we strengthen our ability to open new facilities and extend care to underserved areas—and that promotes better health.

One of the things that was attractive to us about text-based bill payment is that we could reach patients through the device they use most: their cell phone. In the rural communities we serve, most adults own a smartphone. We also don’t get charged when we have an inaccurate mobile number for the patient or the text hasn’t been successfully delivered. And the experiences of AccessOne, the vendor we work with, indicated patients pay their medical bills faster when they receive text notifications for payment. We estimated we could save thousands of dollars a week just by avoiding paper statements for a portion of our population while speeding cash flow. 

HealthLeaders: How did your patient population respond to the change?

Smith: We saw an immediate impact on our ability to collect payment sooner through text-to-pay. Since rolling out mobile pay in 2019, 14% of our patients pay their medical bill using our secure text payment feature. Among patients who use mobile pay, 95% pay their balances within two weeks. More than 80% of this bucket make a payment before a paper statement is ever printed. We also offer patients the opportunity to self-enroll in a payment plan using their mobile phone. This makes the process of payment plan enrollment much more convenient. It also adds an element of privacy by enabling patients to take this step from the comfort of home.

Initially, there was some skepticism among our staff about how patients would respond to text-based payment. However, for us, the initial response to text-based medical bill payment was strong. We’ve found that by branding text-based communications to have the same look and feel as other MainStreet Family Care communications, patients more readily accept mobile pay as a valid vehicle for payment.

But that doesn’t mean we haven’t had to modify aspects of our approach. Even as mobile pay exceeded our expectations, when we reached out to patients for feedback, we discovered some people felt the language used in our communications was a little aggressive. In some instances, patients thought the messages were spam. We took a second look at our messaging to soften communication, and the response has been pretty positive. We plan to take another look at our messaging to make sure it still resonates with those we serve in a high-inflation environment.

Of course, some patients still desire paper statements—and that’s OK. Today, we wait a week after a text-based notification is sent before mailing a paper statement. This gives us time to capture payments from those who prefer to pay us electronically while respecting the preferences of those who still want a paper statement. We also allow patients to opt out of mobile notifications.

HealthLeaders: What other benefits has this change created for your organization?

Smith: Text-based payment significantly decreased our cost to collect and our days in accounts receivable. We reduced the volume of paper statements mailed to patients by 11%—and this represents significant savings for our 46-facility system. We’ve also saved five hours in manual work per week for our revenue cycle team, or 260 hours a year. That’s time that can be directed to more value-added tasks, like patient financial counseling.

HealthLeaders: How has the implementation of digital patient payment options improved the patient experience for your organization?

Smith: Digital payment options give us another way of creating better patient financial experiences—and not just around payment. For instance, when patients receive a text from our mobile pay system, they can easily call us with questions right from the payment screen. Many patients who view their statement via text end up calling to make a payment over the phone or update their insurance information. This is a return on investment that may not be reflected on our performance dashboard, but it’s made our call center a better-performing channel while creating stronger connections with patients. We’ve found that the benefit of taking an omnichannel approach to payment is that it builds trust with patients by meeting them where they are. By creating a seamless, consistent financial experience, we can leave a positive impression that carries over to their next encounter with our facility.

Are you interested in sharing your expertise on this topic? Join one of our panels for the upcoming Patient Financial Experience NOW Summit on April 19. E-mail revenue cycle editor Amanda Norris at anorris@hcpro.com for more information on joining the conversation.