Mind the Gap: Connecting Community Benefit and Patient Billing Leaders to Improve Health and Financial Outcomes

Rarely do staff in the revenue cycle intersect with staff in community benefit or population health departments. However, these departments are responsible for shared goals such as improving patient health outcomes, ensuring financial sustainability, and advancing patient-centered care. This gap gave rise to this learning cohort and its name. Though it might seem simple, the cohort began simply with introductions to others in their own institutions. When staff take the time to review terminology and understand each other’s roles, it creates more space to build trust and connection andprompts interest in being more collaborative. 

One Patient Experience leader, after learning more about revenue cycle, volunteered to be part of a hiring team for a new revenue cycle leader, positioning her to share her goals and the need for cross-departmental partnership. Another cohort participant said they can’t imagine going back to not being closely involved with each other’s work. 

Even within health systems, there are data silos that can prevent practice changes that would benefit both patients and hospitals overall. This can be made more complicated by third party contracts that hospitals utilize to bring efficiency to their medical billing process. Once data is shared, however, there is opportunity to better understand patient utilization patterns and rates of unpaid bills (down to ZIP code level). This can trigger deeper investigations into why patients are unable to pay bills and what other factors are driving affordability barriers. This is where community benefit staff can use new data findings to drive investment decision making. 

Upon sharing data, one group mapped zip codes of hospitalizations and where financial assistance was granted. This spatial data was overlaid with other demographic data and used by community benefit staff to identify areas for investment in programs such as health insurance enrollment. 

Financial assistance policies (FAP) may be out of date on websites and/or unclear to staff outside of revenue cycle. Typically, community benefit staff are not part of the FAP process and unaware how patients interface with the application process. Reviewing these policies together with revenue cycle staff increases awareness and raises questions about why some practices exist. This fosters conversations and innovation around how patients experience medical debt that would not occur otherwise. 

Partners did a deep dive into when and why they screen patients for financial assistance. One system shared that they screen all patients before moving them to debt collection, but after bills are released. The group had a robust discussion about the value (and cost) of moving screening higher up in the workflow (before bills are released) – prompting staff to review their policies. Another system shared that their community benefit team largely manages financial assistance applications, leading to a robust discussion about workflow and organizational structure.

Community benefit staff have a unique perspective of community needs as a result of their work to document challenges communities face through community health needs assessments (CHNAs). Revenue cycle staff may be unfamiliar with this process and the data it provides. Sharing data and community experiences can help inform investments in initiatives such as health insurance enrollment and local service providers. A shared goal for both revenue cycle and community benefit is to convert uninsured individuals into insured patients. 

One system shared that they are engaging a new set of contractors to support patients in accessing health coverage, including Marketplace plans. This is an extension of their internal enrollment efforts. In addition, this system amended their financial assistance policy to include both insured and uninsured patients. 

In large health systems, departments like revenue cycle, patient billing, community benefit, population health and patient experience often operate in silos. To break down these barriers and turn insights into action, you need to cultivate relationships both within and outside your organization. Sharing data across teams is crucial, but it’s the internal partnerships that enable you to actually implement better practices. Relationship-building contextualizes all of the aforementioned learnings into actual change.

Through a presentation from a HAN member CEO and a community benefit leader from a national health association, participants were reminded of how significant clinicians are as an internal stakeholder to advance their shared goals. Clinicians are a key messenger in practice change efforts.  

During the cohort, critical shifts occurred both internally and externally, with changes to federal policies directly impacting financially vulnerable populations and organizational changes impacting team leadership. Managing change requires adaptability, communication, and strategic awareness, and that is especially true now. This means aligning people, processes, and culture to new directions—often through leadership shifts or strategy changes—while ensuring transparency, trust, and consistent support for teams, which is particularly so for collaborative efforts such as between revenue cycle and community benefit teams.

Success comes from striking a balance between vigilance and empathy, and viewing change not as disruption but as an opportunity to further support populations that are most vulnerable to medical debt or may avoid care due to concern about cost, and to do so in collaboration with others within your organization.