Moving to integrated payments: A roadmap for health leaders

Every year, hospitals are unable to collect the majority of balances owed by patients with private insurance or Medicare Advantage. Research shows that before the COVID-19 era, repayment rates averaged 54%; more recently, they’ve sharply declined. When patient balances exceed $7,500, collection rates can fall as low as 17%. These unpaid balances, along with other inefficiencies in revenue cycle management, have contributed to more than $36 billion in uncompensated care each year for the past three fiscal years.

While fixing these challenges require system-level change, modernizing payment solutions to meet patient demand and industry best practices is a good place to start. Yet the decision to modernize isn’t as simple as it sounds. It requires organizations to weigh system compatibility, consumer preference, and scalability, and ensure compliance to security and privacy standards.

Why change is still hard in health care payments

Change in health care technology rarely happens quickly. Even as patient expectations evolve, many organizations remain tied to older systems and processes. For example, in 2022, around 73% of health care organizations were still operating on legacy information/operating systems that are no longer supported. Likewise, around 75% of providers still use manual collections processes, despite 77% of patients believe digital payments would be beneficial. This gap underscores why modernization isn’t just a convenience, it’s essential for meeting patient expectations and improving operational performance.

Staying with the status quo is always easier over the short term, but it comes with significant costs across the board. Outdated payment systems drive up administrative costs, delay collections sometimes indefinitely, and erode patient trust. In fact, 56% of patients would switch providers for a better payment experience and the number increases to 74% for patients under age 27. Health systems may believe that by avoiding modernization they’re minimizing their risks, but it may leave them less prepared for new demands.

Building a roadmap you can follow

Every journey requires a good map. Moving toward integrated payments is no exception. It’s essential to start with a candid assessment of your health system’s current situation: what systems are already in place, what integration gaps exist and where, and how much revenue is being lost to inefficient collections and write-offs.

From here, the early engagement of stakeholders, including treasury, revenue cycle management, IT, compliance teams, providers, and even the board, can help ensure alignment around high-level technical requirements, strategic goals, and end-user needs. Pairing all this with a partner that already possesses robust integration credentials and a track record of supporting scalable, secure implementations in health care delivers the kind of value that truly makes a difference.

Key considerations for successful integrated health care payments

When evaluating integrated payment options, health leaders must weigh several key considerations. Each one directly shapes patient experience, organizational performance, and system sustainability.

• Compatibility with existing EHRs. Payment solutions must work seamlessly with existing EHRs to ensure accuracy, efficiency, and a consistent user experience for both providers and their patients alike.
• Omnichannel payment options. Patients today need and expect payment flexibility. Mobile wallet payments overall have increased by more than 105% since 2019, showing that consumers want the ability to use a variety of digital payment platforms, like Venmo, PayPal, Apple Pay® and Google Pay™.
• Compliance and security. Health care providers must maintain PCI DSS compliance to protect cardholder data. Implementing technologies such as validated point to point encryption and tokenization is essential to secure payment information and reduce the overall PCI compliance burden. Choosing payment partners that are HITRUST certified demonstrates a clear commitment to data security and risk management. With cyber threats continuing to rise, health systems are on track with 85% stating that preparing for and mitigating cyberattacks is a high priority.
• Scalability and support. Expanding care locations and payment channels (for example, online, mobile, or kiosk) shouldn’t mean added complexity. A scalable, integrated payment solution within the existing EHR simplifies training needs and ensures consistent support from knowledgeable, responsive partners with expertise in both payments and health care workflows.
• Rising costs and expectations mean payment systems can’t be an afterthought. Integrated payments empower health care organizations to develop and maintain stronger revenue cycles, improve patient experiences, and reduce administrative costs across the board. While change requires effort, the roadmap to success is clear: evaluate carefully, involve stakeholders early and often, and select partners that understand the unique and pressing needs of health payments.

By prioritizing system and patient needs, organizations can build secure, sustainable payment solutions that support long-term growth.

Ryne Natzke is Chief Revenue Officer at TrustCommerce, a Sphere Company.