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Jeff Lin
Host of Payment Matters
Payment Matters is a monthly radio show focusing on real issues happening in healthcare payments. Jeff chats with industry experts and thought leaders to bring fresh perspectives on how providers, payers and consumers are all tackling the evolving healthcare payments market. Join the conversation on Twitter with #PaymentMatters.

On this episode of Payment Matters, host Jeff Lin interviews Brandon Baldock, Director of Revenue Cycle Systems at Epic. Jeff and Brandon talk about the importance of the patient payment experience, and Brandon highlights new projects that he and his team are working on at Epic. Listen to the episode or read the full transcript below.

Jeff Lin: Welcome to Payment Matters. I’m your host, Jeff Lin. Thanks for tuning in. On this show, we talk about the ever-changing landscape of healthcare payments and the impacts to healthcare payers, providers and consumers. You can follow the conversation on Twitter at #paymentmatters and follow me, @JeffBLin

Really excited about today’s guest. He’s Brandon Baldock. Brandon is the Director of Revenue Cycle Systems at Epic.

Brandon, it’s great to have you as a guest today and thank you for being with us. Maybe just for our audience and our listeners here, tell us a little bit about your background and experience.

Brandon Baldock: Hi, it is great to be here. So, my background before being at Epic was in math. It’s funny, when our founder Judy Faulkner gives her introduction of Epic to groups that come to visit us, she often starts with her background and says, “I have a background in math,” and she’ll say, “Does anyone else have a background in math?” and I always have to raise my hand. I’m not actually sure she wants to keep hearing from me in those informal surveys.

But anyways, after doing graduate school in math, I started at Epic in 1998 doing implementations of our revenue cycle systems, and I’ve been here in the revenue cycle ever since. But, now I work in product management and I work with all our revenue cycle products and focus on the patient financial experience and brand.

Jeff: For listeners who may not know too much about Epic, could you describe a little bit about what Epic does?

Brandon: Yeah, so Epic is a platform for healthcare that focuses on everything that touches a patient. I think in some circles, Epic is probably most famous for MyChart, which is the patient’s access to their medical records for test results and revenue cycle things as well, like secure online payments and things like that.

In the healthcare community, I think Epic is most famous for its medical records software. But, in our space, we really focus on the revenue cycle and we’ve had the industry’s leading hospital billing and professional billing revenue cycle systems for many, many years now.

Jeff: You’ve been working in revenue cycle. What does that mean? What are you working on specifically today with respect to innovations that excite you right now?

Brandon: Yeah, well, as I mentioned, the thing I’m focused most on right now is the patient financial experience. I spend most of my time in that area and I’m really excited about what we’ve been developing. I’m super excited about what the community of users is doing with the stuff that we’re making. We had a big transformation in 2021. We went completely digital-first. We’re trying to eliminate the old statement cycle. We’ve been paperless for a long time. But now, this idea is to communicate digital-first to the patient via their preferred communication channel, such as text or email. We had our first organizations go live and launch this in November – New York-Presbyterian and Weill Cornell. In the first two months, they saw that with the digital notifications they sent out, 15% of them got paid in full within three days and they never had to send a statement. So, we’re excited about that.

I’m excited about our new visit auto pay. So, this is the idea that when I send a notification or when my patients start their visit, they can agree that they’ll pay automatically up to a certain amount. When we send our digital notification, we can say it’s all taken care of and you already agreed that your card is going to be charged for this amount. We want to be proactive and try to get that payment upfront and it just takes away all of the friction from it.

Jeff: Talking about the notifications aspect, that’s an amazing stat. Why do you think healthcare is so hard or different in terms of that patient experience? What makes it unique that people don’t understand?

Brandon: Yeah, well healthcare is way more complex than people outside of healthcare know, and it’s funny when we get people to come into it – and there is a lot of that right now, you know, people who have come from retail and other spaces that have their own challenges – but they now come in and say, well, “I’m going to be the Chief Digital Transformation Officer of this healthcare organization.” They pretty quickly realize there is a lot. Hospitals are like cities with all kinds of different ways that patients are interacting. I think one of the real complexities is that we’re always protecting their personal health information, so we can’t just text people and say, you know, pay for your colonoscopy, because then we just sent out a text about personal health information.

So that was the other huge transformation for us in 2021. We realized there is actually a lot more that we can do than we have been doing. So if you have a payment method on file with my health care organization because the last time you were in here and paid you said, “save my card for the next time,” Then I can send you a text and I can say you have a balance of $125 and click here to just pay it with the card ending in 1234. I haven’t actually sent you anything that would disclose any personal health information, but we can get that transaction done quickly and easily. So that’s been an evolution. I think the pandemic has really helped accelerate it. It’s really forced us all in this industry to maximize what we can do while still protecting personal health information. So that’s the obstacle. I think that’s the biggest one, besides just the complexity of all the different types of services that are encompassed in healthcare.

Jeff: How do you approach these problems here from a product lens? How do you know where to invest or where to focus on to really address your client needs?

Brandon: Yeah, it’s remarkably easy. Our customers really tell us where we need to go, and all we have to do is keep up with them, right? We have an incredible community. It’s a very tight-knit community and all we have to do is listen and we know where to go. Our founder, Judy Faulkner, says she compares it to the yellow brick road; all you have to do is follow the yellow brick road. I think it’s because it is laid out. It’s pretty clear. It’s a tight-knit group of people in this industry that know where we want to get to and know the challenges to get there.

Jeff: How do we overcome those challenges? Are the challenges that you’re seeing more for the macro healthcare or is it like challenges in terms of adoption, right? Like all the big technology companies are trying to get into healthcare, large acquisitions etc here. How come things aren’t magical like a ride-sharing app and I can step out of the rideshare and it pays automatically. Why are things moving slower? What do you see as the headwinds coming out of this?

Brandon: Yeah, I think it is a really complex industry and you have to be in it for a long time to know how to navigate it. When we look around at the vendors that have provided information technology in this space, it’s the ones that have been dedicated to healthcare the whole time that have been successful at providing solutions for groups. It just takes time and it takes knowledge. There’s a real barrier to entry just to understand the needs of the industry. It’s not an industry that lends itself to quick commercial, profit-oriented public companies, right? So I think that’s part of it.

Jeff: You highlighted a patient financial experience that encompasses a lot of things. How would you define the patient financial experience? What is that from a product journey from a customer journey? How do you view that?

Brandon: Yeah, it’s interesting because I lead a monthly webinar for our user community on the patient financial experience and the way we talk about it is the patient journey. It starts when you know maybe a person in the community isn’t even a patient yet, but they may be shopping for a knee replacement – how much is that going to cost? Now we’re into the patient financial experience and we don’t even have a patient yet. So we really say that the patient financial experience is woven into every step of the journey. There’s been a lot of focus on transparency and surprises, and that is a big part of the outside of the journey. So, we’ve tried to provide self-service tools that are easy to use. There’s a lot of regulation around this now too, so we need to comply with the regulation, but it’s for the right reasons, right? We want to provide patients with that knowledge of what their surgery is going to cost. Then, along the way that journey evolves into:

“Now I have a visit. So how do I arrive at that visit?”

“How are we checking my insurance? Can we do that online?”

“Can I upload my insurance card without having to do that at the front desk when I arrive?”

“How do I do that without having to go to the front desk?”

“If I can prepare ahead of time online, I can have a contactless arrival.”

“In the exam room, as we’re ordering that test that I’m talking about with my physician, can my physician tell me how much is that test going to cost me?”

And so, we provide tools at every step of the way. So we think that’s what we’re looking at when we describe the patient financial experience. It’s the journey from beginning to all the things in that after the fact that we think about. Readily, our bill pay experience and setting up payment plans and absolutely those are part of it as well. But it’s way beyond that.

Jeff: There’s a lot of paper in healthcare. From bills to check-in forms, there are reams of paper here. Sometimes it’s the same family history that was filled out a month ago, right?

You highlighted digital-first – is that a hard thing? How do you overcome potential patients or healthcare organizations not wanting to be digital-first? Has that been an issue at all?

Brandon: Yeah, so two things here. If you think about healthcare – another way of thinking about it is it’s all these different verticals, right? So, it’s hard to design a tool that says I’m going to get all this paperwork done in advance of a healthcare visit, because there isn’t one kind of healthcare visit. So some of it is on us as the suppliers of this technology to create these verticals that work in all these different settings. Like, if you’re going into the emergency department then we can’t talk to you about all the paperwork around your insurance digitally or otherwise until we make sure that we triage you and then you’re stable and we can have that conversation. That makes a lot of sense versus if you’re preparing for an elective surgery well, then we’ve got time and we can handle all this paperwork in advance, so that’s a different kind of way of going digital.

So I think some of it is on the vendors and some of it has been on healthcare itself to say we don’t need to have that signed on a piece of paper. It’s OK, we can sign things digitally. Unfortunately, it took a pandemic to some extent for everybody to say now we’ve got to try getting that signature electronically only. And lo and behold everything is still going well, better than ever in some respects from that perspective. So yeah, there were some hurdles as far as momentum and the pandemic helped us overcome some of that momentum and really accelerated the pace of change.

Jeff: If you’re just tuning in your listening to Payment Matters. I’m joined by Brandon Baldock of Epic, and we’re discussing healthcare payment experiences for patients.

I want to reference something you said earlier about some of the innovations that you’re working on. Can you describe Auto Pay in a little bit more detail and maybe the results you’ve seen with your clients when that’s been launched?

Brandon: Yeah, so we’re really excited about this one. So this is going to be exciting to see what customers do with it. It was just released in November of 2021 and we’re seeing a huge number of our organizations are going to upgrade to that release of Epic software in the April time frame, about 223 organizations across the country will be on that release. So, we’re going to see what they do with it and I’m really excited. I think they’re really excited. Healthcare is, you know, if you think about it, is a time and materials business, or at least a number of areas of healthcare are time and materials. I go in for my surgery and how long it takes is how long it takes. I might be in the ER longer or shorter. They’re going to find out more when they get in there. We are going to find out how long I stay in the hospital after my surgery based on how fast I’m recovering so it’s hard to say at the outset what it is all going to cost.

So the idea of Visit Auto Pay is to combine the desire to be proactive and take payments upfront, but still acknowledge that there’s this uncertainty in healthcare built so we don’t know exactly what I’m going to owe. In the past, the way this would work is I would pay my estimated balance and then at the actual time my balance is my responsibility is when I will know precisely what I owe. They might owe me a refund, or I might have a balance leftover that I need to pay, and so there’s all this stuff still to do. So, the idea of VIsit Auto Pay is it’s like the hotel flow. Nobody knows how hard I’m going to hit the minibar in my hotel room, but the hotel is authorized to charge my card up to X amount. They’ll say, “you’re putting your card on file for up to $500,” and then when all the paint is dry and they know, then I get a notification and it says it was actually this much and we’re charging your card. So this is healthcare working the way the hotel industry has handled this uncertainty for a long time. And yeah, we’re really excited. We think it’s going to take a lot of the friction out of it for patients and for staff as well.

Jeff: Yeah, it’s great innovation here addresses a lot of concerns that are out there about affordability in healthcare. You know we’re hearing more and more that these patient balances are growing and the general populace is not able to pay. Is there anything that you’ve explored with respect to those kinds of problems?

Brandon: Yeah, I mean it’s top of mind for all the groups that I talked to. Deductibles are higher and the ability to pay is lower. So yeah, absolutely, there’s a lot to talk about in this space. So I’ll tell you what I experienced when I talked to the groups that I work with. They’re very interested in automating as much as possible financial assistance because they know they’re going to be providing financial assistance. I think healthcare is really good about providing financial assistance, but it can be a time-consuming process to decide who’s eligible and get them signed up. So we’ve been working a lot in that space on automating presumptive charity. So that means, like, if it is obvious according to our policy that a patient warrants a discount, we’re going to do that automatically.

We’re also making it easier for the financial counselors that are working with patients to do that in a digital way. So this goes back to that conversation about how we can get all this paperwork digitized. So we’ve made the online experience of applying for financial assistance and supplying the necessary forms for organizations that have that process, making that all digital and online and most recently making that available. So for any patient, regardless of their status in the past, we’ve made that available because we wanted to protect not only their health information, but now we’re talking about their financial information, so we have to be super careful with that. So in the past we would do that in our online financial assistance module in MyChart – that’s Epic’s online portal. So if I have a MyChart account with my organization, then I can use that. Well, we change strategy, and we say we want to make these experiences available to everybody regardless of their MyChart account status. We’ve looked at other ways to verify the patient’s identity using two-factor authentication, where a patient provides their date of birth or other demographics and then they can log in that way and get all of this stuff uploaded. I can do it with my phone and take a picture of my pay stub. So yeah, affordability is a hot topic.

The other thing that I’m really proud of our healthcare organizations for contemplating is how to be good stewards of our community.  How do we keep patients out of bad debt? So there’s several members of the Epic user group out there that have said they do not want to escalate the follow-up on a patient and end up sending them to bad debt. If they’re paying at least something on their balance then we’re just going to keep that balance going and we’re not going to end up with all these people in our community being placed in bad debt. It’s a really interesting time and a really interesting topic, and I am definitely proud of what our user community is doing in this area.

Jeff: That’s exciting. You know, sometimes when you say the word healthcare you forget the word “care” is in there, and in many ways, that’s kind of why all of us are in this business.

The last question here for you; you’ve been in healthcare such a long time. You’ve seen many aspects. If you had a magic pill that could address problems in healthcare, what would that be?

Brandon: Well, I’ll tell you. I’ll just base it on what I’m seeing right now, and it’s part of why I’m here doing this podcast, and I’ll explain that as I think about your question.

So, I think healthcare organizations right now know they want to modernize. They’re really concerned about staffing and at the same time, the patient experience is part of what they’re thinking about. They’re trying to innovate, and they’re trying to figure this out. They’re bringing in a Digital Transformation Officer and that Digital Transformation Officer is saying “I’m gonna figure this out,” right? We have to be allowing our patients to schedule online to have this easy access to our digital front door.

And in the meantime, I know the CIO, I know the folks in patient access at these organizations that have been trying for years to say, “We have these tools, we can schedule online. Can we implement them?”  And there have been these obstacles. You might have doctors concerned about patients wasting everybody’s time by making the wrong kind of visit and scheduling their own resource. And then in the meantime, there are those of us here in Product Development and on the vendor side who know, well, we just released a new tool that goes through a decision tree and makes sure that the patient is going to get to the right resource. So if there was a magic way to get us all in the same room despite distance and a pandemic and disparate angles that were coming from, and say “you’ve got the mandate to transform things digitally, you’ve got the knowledge of what the obstacles are, and we’ve got the solution to get over those hurdles,” we can put this all together. We can change healthcare.

So there’s going to be people out there who know Epic pretty well, and they’re going to say, “What the heck? Here’s a guy from Epic doing a podcast. That doesn’t seem very Epic.” But that’s why I’m here. Because I have this goal of getting everybody together, and we can do this. So I’m getting the word out.

Jeff:  Those are the Payment Matters we’re tackling today. Thank you to my guest Brandon from Epic for joining today.

Brandon, if they want to learn more about you or what you’re doing with respect to the patient financial experience, how should they reach out?

Brandon: Thank you. Yeah, so definitely visit our website epic.com if you’re not an epic customer. If you are an Epic customer out there, I’d love to hear from you on userweb.epic.com. We have links to our monthly financial experience webinar. So find us there. Contact your Epic person and they can lead you there.

Yeah, so that’s what I would love. I’d love to have everybody out there who is listening who already has an Epic User Web account and is interested in this area to attend a monthly webinar that we lead to give you all the road map and updates on a patient financial experience and for those of you out there who are not currently Epic customers, we will see you at HIMSS or you can find us on our website at Epic.com and love to hear from you in the future as well.

Jeff: Remember that you can listen to this episode on weekdays at 4:30 AM, 12:30 PM, and 8:30 PM ET. You can also listen to this on Apple Podcasts and Google Play Music, or just say “Alexa, play HealthcareNow Radio.” If you have a comment about the episode or the show, follow #paymentmatters or connect with me on Twitter @JeffBLin. You can learn more about my show at healthcarenowradio.com or instamed.com until next time, I’m Jeff Lin.

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