Solution Perspective: Why program management is key to patient financing expansion.

Business challenge.

As patients shoulder a greater share of rising healthcare costs, health systems, hospitals and physician practices face mounting pressures to expand financial support. Helping patients financially also furthers the widely shared goal of fostering equitable healthcare access.

This Solution Perspective briefly explores the rationale for offering comprehensive financing. It details the CommerceHealthcare^® solution that is grounded in strong program management to smooth the path to success.

Key issues.

Four strong forces are influencing patient financing. First, affordability continues to be a significant problem as costs increase and self-pay obligations rise. Nearly one in three employees carries an annual individual deductible of $2,000 or more.^{1 footnote 1} The average Medicare beneficiary spends more than $6,600 out-of-pocket each year for health services, medications and supplemental insurance.^{2 footnote 2} A national poll estimated that cost influenced over 72 million people to avoid necessary treatment in the past three months.^{3 footnote 3}

A second factor is that many healthcare organizations have limited financial ability to extend credit broadly, accept greater credit risk, or incur added expenses. A leading rating agency believes healthcare has a ”fundamental disconnect between revenue generation and expense requirements that may be here for the long term.”^{4 footnote 4} Margins are tight, and improving them is a top-three mission for 78% of finance leaders.^{5 footnote 5}

Third, heightened attention to disparities in healthcare access is further fueling financing demand. With the expiration of the COVID-period Medicaid continuous enrollment, the number of lower-income beneficiaries is projected to decline by over 11 million in 2025.^{6 footnote 6} Government forecasts also see enrollment in health insurance plans via the Affordable Care Act (ACA) marketplace decreasing by 7.3 million people next year due to the removal of financial subsidies that are set to occur at the end of 2025.^{7 footnote 7} These outcomes pose serious risks to care access and use among those with economic challenges.

A final driver is the competitive market need to improve patient experience. Financing programs must increasingly be convenient and smoothly executed, a goal rendered problematic by chronic short staffing throughout revenue cycle management.

The program management need.

Organizations seek to help patients financially at increasing scope and scale, delivered with positive patient experience, and without a heavy investment in internal staff time and effort.

The CommerceHealthcare^® solution.

Health Services Financing (HSF^®) from CommerceHealthcare^® provides a ready and robust solution:

• Built upon financial strength. Commerce is one of the nation’s leading banks.
• Deep healthcare industry experience. Thorough understanding of the industry’s relevant regulations and unique demands.
• Dedicated healthcare bankers. Unlike many financial institutions, our relationship managers solely focus on healthcare.
• Single-vendor responsibility. No reliance on third parties for crucial processes.

Credit lines up to $50,000 and carrying zero or low interest rates can be extended to ensure appropriate coverage and flexibility for all patients needing assistance. Providers are not forced to screen and select patients in advance. Automatic approval with no credit check is the norm.

The centerpiece of the HSF^® approach is proficient program management. First, minimal technical effort is required by the organization during implementation. Additionally, the bank directly manages ongoing administration, interaction with patients, and issue resolution. Regular reporting keeps the client up-to-date. HSF^® combines the right technology integrated with revenue cycle systems, highly streamlined workflows, and trained customer service personnel. Should any patient account default, CommerceHealthcare^® refunds all transaction fees incurred by the provider.

Sustaining program excellence is vital. CommerceHealthcare^® maintains steady surveillance of processes and client strategies and proactively proposes course alterations.

How strong program management adds value.

The substantial benefits of HSF^® program management fall across five vectors:

• Consistency of program execution
• Flexibility to meet varied patient needs
• Scalability to support nearly all patients needing financing
• Productivity to reduce patient financing labor resource constraints
• Sustainability of value achieved

Conclusion.

Proven program management skills and infrastructure are essential to a successful patient financing program. HSF^® merits consideration as a readily available means to secure those capabilities. It is a timely solution with significant speed to value.

CommerceHealthcare^® solutions are provided by Commerce Bank.