Transforming Billing Statements into Patient Engagement Tools


Learn three steps you can take to engage patients where they are—with language they can understand, and make it easy for them to pay you.


The future of patient financial communications starts with responding to patients’ needs


Perspective | Sally Love Connally

Senior Vice President and General Manager
Communication and Payment Solutions at Change Healthcare

Sally leads the communication business for both payers and providers. She has worked in the healthcare IT industry for more than 30 years, with leadership roles in sales, research & development, services, and support.

Healthcare billing in the U.S. is big business—an estimated $500 billion per year.1 Based on a 2018 analysis of a large academic medical center, the cost to collect ranges from $20 for a typical primary-care visit to more than $200 for inpatient surgery.2 And as patients with high deductible health plans (HDHPs) shoulder more of the burden for payments, you should expect those costs to rise, especially since collecting payments from patients costs three to four times more than collecting from payers.3

It’s time to take a different approach to patient billing, one that recognizes patients are not insurers, but rather customers—who often have financial challenges and who rarely possess a firm knowledge of industry practices and jargon. Viewing billing from a patient’s perspective is the key to driving both revenue as well as patient satisfaction. By using intelligent, data-driven communication, you can build trust and guide consumer behavior toward desired outcomes at a lower cost.

Challenges to Transforming Patient Financial Communications

When it comes to pre- and post-service financial communications and payment experiences, we need to assess consumer attributes, behaviors, and desires. Patients have different preferences regarding how they receive information, from texts to emails to printed statements. Additionally, some patients need a high level of detail on statements, while others want to see only actionable information, such as payment amount and due date. (For example, if insured, patients want to clearly see the amount due so they can confirm it reconciles with their explanation of benefits.)

Consumers also expect to have several payment options, from writing a check to paying online with a credit card, to paying over the phone or via text-to-pay. Offering a multitude of options to address this wide range of preferences won’t happen overnight, but you can begin to incorporate changes one step at a time.

Customizing Patient Statements to Consumer Preferences and Needs

The first step is to obtain a better understanding of what motivates consumers to respond to patient statements, and, conversely, what makes them set a bill aside. Change Healthcare uses a ‘design-thinking’ approach to obtain this information. Design thinking refers to a process that incorporates end-users’ input at the outset, and then continually leverages their feedback to refine and improve the user experience and/or product. This differs from stand-alone A/B testing or focus groups because it brings consumers into the process from the very beginning. It starts with empathy—making sure we understand the challenges, obstacles, and desires of the user, and from there moves to defining the problem(s) to be solved, ideating around solutions, creating prototypes, and only then using testing to gather data on the most effective solution.


We’ve learned that ‘trust’ is one of healthcare consumers’ most essential needs. Consumers equate trustworthiness with statements that are easy to understand, accurate, and actionable.


At Change Healthcare, the consumer-research process begins with observing consumers as they review statements, often in their own homes. This enables us to authenticate responses and actions, which has led to unique insights. For example, we’ve learned that ‘trust’ is one of healthcare consumers’ most essential needs. Consumers equate trustworthiness with statements that are easy to understand, accurate, and actionable. Service-level details, placement of amount due, and clearly visible payment options are key components in driving both comprehension and payments.


Offering a plethora of payment options helps engage each demographic, drive a personalized experience (and thus, patient satisfaction), and also facilitates collections.


Of course, as communication modes and the healthcare environment evolve, consumer preferences will also change. Another benefit of the design-thinking process is that it is iterative; designers and testers are always refining patient statements based on consumer input to help ensure the most effective solution is deployed. At Change Healthcare, we use machine-learning technology to scale and drive this iterative process.

Step Two

Customizing the delivery of financial communications and offering multiple payment options is the next step to creating a personalized experience. To address the growing number of consumers who want to receive and pay bills electronically, you can adopt a hybrid communications strategy. This entails sending a printed statement to all patients with directions for how to opt-in to email/text communications and notifications if one of those delivery channels is preferred. And regardless of which channel is chosen, patients should have multiple, modern options to make payments. For example, Change Healthcare’s SmartPayTM is an integrated, omni-channel solution that enables patients to pay online or via mail, text, over-thephone or automated voice-pay. Offering a plethora of options helps engage each demographic, drive a personalized experience (and thus, patient satisfaction), and also facilitates payments.

Step Three
You can elevate the patient experience a notch higher in two ways: (1) by choosing to deliver consolidated patient statements, and (2) by sharing helpful information, including personalized health and wellness tips.

    Consolidated Communication

 Statements can be aggregated by guarantor (the insured individual in the household receives one statement for all services delivered to members on his/her plan), and/or by event. The latter entails encapsulating all services received for an episode of care. For example, a patient undergoing inpatient  surgery would receive one bill covering all services: laboratory, radiology, the surgeon, anesthesiology,  the hospital stay, etc. This approach precludes a patient receiving numerous bills from multiple sources for one hospital stay.

    Wellness and Support Communications
 Statements can also be customized to specific populations; for example, by  including mammography-screening reminders for females (age 45-plus) during National Breast Cancer Awareness Month, or by including an annual
retinopathy-screening reminder for patients with  diabetes. Or, more generally, you can share information on how to leverage a health-savings account. This strategy both positions you as the patient’s health partner, and it also supports your population- health initiatives. Ultimately, it serves to nurture your relationship with the patient.

A Comprehensive Patient-Engagement Financial Strategy

In addition to improving patient statements, there are also opportunities to make significant improvements upstream in the process, both at pre-service and point-of-service. For example, many providers are:

  • leveraging real-time eligibility to provide patients with estimates of their out-of-pocket costs to drive satisfaction and upfront collections
  • using solutions that can uncover reimbursement sources to assist in covering the cost of care
  • setting up payment plans to better engage and motivate patients to pay.

Reaping a Return on Your Investment

Adopting communication strategies that support patients’ preferences and meet their needs can help you achieve three key benefits:

1. Reduced Administrative Costs
So many resources go into patient collections, including the cost of paper, printing, and postage for mailed statements; staff resources dedicated to tracking bill status; customer service for patient inquiries, and more. Patient statements designed to prompt a fast payment response, consolidated statements, and electronic delivery all help to reduce the number of statements mailed, as well as patient inquiries.

2. Accelerated Collections
Providing transparency via upfront estimates on out-of-pocket costs, combined with payment plans, easy-to-understand patient statements, and convenient payment options, all work together to help facilitate faster payments.

3. Increased Patient Satisfaction
Creating a financial experience that meets or exceeds patients’ expectations not only helps drive revenue, it also helps to cement a positive relationship with your organization. When patients sense you are partnering to support them in understanding their costs, in making it convenient for them to pay, and in offering helpful information, it helps to drive satisfaction and loyalty.

1. Jiwani A, Himmelstein D, Woolhandler S, Kahn JG. Billing and insurance-related administrative costs in United States’ health care: synthesis of micro costing evidence. BMC Health Serv Res. 2014;14:556.

2. Phillip Tseng et al. “Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care System.” JAMA Feb. 20, 2018.

3 Prince, Beth. “Improving Self-Pay Collections: One Proactive Approach.” Change Healthcare. Jan. 26, 2018.

To download this Insight, please fill out your information below

Like this Perspective or need to read it later?

Related Insights

View all Insights