Ed Caldwell of CarePayment: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System

An Interview With Luke Kervin

Give patients more flexibility when paying medical bills. People WANT to pay their bills, and when they have the ability, they will. Offering long-term payment plans without interest increases patient satisfaction and the likelihood they will get the care and services they need to be healthy. We know this to be true from a regular independent study that we conduct with our members. 89% of patients surveyed said they were more satisfied with their provider when CarePayment was offered.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the U.S. healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The U.S. Healthcare System,” we are interviewing healthcare leaders, doctors, hospital administrators, and nursing home administrators who can share lessons they learned from the pandemic about how we need to improve the U.S. Healthcare System.

As a part of this series, I had the pleasure to interview Ed Caldwell, CarePayment President and CEO.

Ed Caldwell joined CarePayment in 2015 as Chief Revenue Officer. Before joining CarePayment, Caldwell was senior vice president of sales and marketing for MediTract, a healthcare contract and document management solutions provider for one quarter of U.S. hospitals. He spent more than 20 years at Emdeon in senior sales management, business development and operations roles, including senior vice president of institutional provider solutions, where he was responsible for delivering revenue cycle management technology and service solutions to the provider market. Caldwell holds a Bachelor of Arts in Finance from the University of Alabama.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

It’s a funny story. I got into healthcare because the CFO of a healthcare company heard me talking to a colleague, and he told me I’d be a good salesman. That’s when I started working as a telemarketer selling Medicaid eligibility services. We sold a credit card device where providers could enter Medicare information and immediately get back coverage information.

From there, my passion for the healthcare industry kept growing, and I took a position with Emdeon (now Change Healthcare). What intrigues me is the combination of how complex healthcare is and how a simple solution can make a big difference.

Joining CarePayment has been the culmination of my career so far. I spent 23 years in revenue cycle but thought it was time to start doing something that more directly touched the lives of patients. At CarePayment, I feel my work is meaningful. We help make healthcare affordable by offering patients interest-free financing, so that they can get the care they need when they need it. At CarePayment, we genuinely believe that most patients are good Americans who want to pay their bill and can pay; they just can’t pay right now. We offer them a payment option that fits within their budget, relieving all sorts of daily stress in their lives. We also help providers by increasing cash flow and revenue which helps ensure health systems remain financially healthy to continue serving their communities.

Can you share the most interesting story that happened to you since you began your career?

When I was at Emdeon, we visited hospital patients who didn’t have insurance to help find a financial assistance solution that would work for them. On one of my first visits to work with a colleague who was onsite with a health system partner, my colleague and I visited a young man who had a self-inflicted gunshot wound. The young man was in poor condition, and we could see that his wife was very upset. My colleague sat down with the wife and explained how we could help. Within five minutes, the wife connected with my colleague and shared her struggles. It was clear that the wife needed more than financial help — she needed emotional support, and my colleague was able to sense that.

Watching this interaction, it reminded me how fragile we are in the moment of a medical event. I witnessed first-hand the emotional side of healthcare. And, in all aspects of healthcare, we have the ability to directly help folks even when it may not seem obvious.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

In one of my sales roles, I had a meeting with the CFO of a large health system in Texas. I gave myself what I thought was plenty of time to get to the meeting, but there was a wreck and traffic delayed me for 45 minutes. I jumped out of my car, pulled my coat on and ran for the meeting — arriving just on time. After the meeting, I went to the restroom and looked in the mirror. That’s when I realized that when I pulled on my coat, I inadvertently tucked my tie into my coat sleeve where it remained nicely tucked the entire meeting, and the CFO never said a word. To this day, I check my look prior to every meeting with a client or prospect. The lesson learned: Details matter in every aspect of what you do, and it always pays to double and triple check.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

As with many things in my life, my favorite quote comes from my Dad; he always told me two things: Do more than your fair share without being asked and act like somebody, because you are. Pretty straight forward but most things in life are at their core. The hard part is maintaining the discipline to consistently do the simple stuff.

Are you working on any exciting new projects now? How do you think that will help people?

We believe the financial experience in healthcare is a vital component of the overall patient experience. Consumers now expect long-term payment options for large bills and multiple options, including digital, that allow them to easily manage and pay, as well as set their communication preferences. It’s also important to remember that not all patients are the same. While digital options are the top preference for some patients, others want to talk to a trained professional or use postal mail to communicate and pay.

This is why we have invested in developing a robust omni-channel approach to engagement and member support that includes the integration of email, text, postal mail, portal, secure messaging, IVR and live agent interactions, as well as employer and community-based marketing programs to help patients pay their medical bills and do so in a way that is compassionate.

Our recent partnership with an independent marketing cloud drives intelligence-based communication with our patients. Using the data based on preferences and behaviors, we can now meet patients where they are to make paying off their medical bills even easier. By offering a convenient and personalized financial experience, we see increased patient satisfaction and provider revenue.

We also redesigned the CarePayment website and member portal to create a more user-friendly experience for providers and patients. The updated look and feel offers a cleaner, simpler user experience with new layouts, modern navigation and a responsive design to fit all devices. It also features expanded, easier-to-manage digital payment options for members, including text-to-pay and secure online messaging with CarePayment customer service.

How would you define an “excellent healthcare provider”?

As a patient financing company, our definition of “excellent” is a provider who cares about the whole patient and believes in the importance of the patience experience. An excellent provider cares for not only the physical health, but also the financial health of patients. This means offering financing solutions to help patients afford care and communicating with them about finances in a manner that is both convenient and compassionate.

The best of the best understands the value of the investment of a dollar — the expense and the reward. Many providers only look at the expense and don’t think ahead to the returns they might see on those dollars invested. Services like ours require an investment upfront but also have a high yield. It’s a very direct cost-benefit relationship.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

Well, that’s clearly a very broad question with far reaching implications, so let me be specific in answering through the lens of CarePayment and the impact we have seen in our segment of healthcare. The rising amount of financial responsibility put on patients for their medical care became even more detrimental to patient care during the pandemic. Healthcare premiums, deductibles and out-of-pocket costs are skyrocketing, and as a result, so is medical debt. With patients out of work throughout the shutdowns, many delayed care because they were unable to pay or were still trying to pay for the care they had already received. In situations like these, they are essentially having to choose between being clinically healthy OR financially healthy.

In turn, healthcare providers are struggling due to decreased patient volume. A health system that is not financially stable cannot effectively serve the community.

The U.S. healthcare system is also struggling within the current regulatory environment. Unethical lending practices in medical care often put vulnerable patients in an impossible position. A company may promise zero percent interest, but once the introductory period concludes, or a patient violates the terms of the agreement, they are charged an interest rate, often 30% or more. These lending practices are so harmful that states and the federal government are working on (or have passed) legislation to increase access to compassionate payment options in healthcare.

I firmly believe that there are ways to mitigate the rising medical debt that many consumers are facing, while also maintaining financial stability for health providers — all while staying within the scope that these new regulations are establishing.

One of those solutions is offering flexible payment plans without interest for which every patient qualifies. Patients want to pay their bills and when given a fair solution, they will. As a result, providers are able to collect payment and generate more revenue, which they can then reinvest in their communities.

Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

The front-line workers were true heroes. COVID was one of the worst global health crises we’ve seen, and the healthcare system worked tirelessly to keep people healthy and safe by creating pop-up clinics, innovative testing and vaccination programs and much more.

For example, Vanderbilt Medical Center here in Nashville invested in an extension of the hospital, converting a parking lot into more treatment space to make sure they could accommodate the potential influx of COVID patients.

Non-medical staff also stepped up, helping the medial staff with patients and day-to-day operations. And, vendors were also doing what they could to make the lives of providers and patients easier.

At CarePayment, to mitigate any financial hardships that our members were facing due to COVID, we offered programs that began with much longer payment terms, as well as deferred payments for 30–90 days. The pandemic caused an unprecedented mass hardship, so many in the industry were putting forth efforts like these to give consumers the leeway they needed to stay afloat financially.

Of all the industries, I would never have thought that healthcare, and hospital revenue cycle more specifically, could flourish as it has in a remote work environment because of its complexity and the interconnectedness of it. What surprised me was the speed at which it was able to adapt, even with all the infrastructure in place that needed to be shifted. It’s been incredible to see.

Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

While there are many problems to solve in healthcare, within our area of expertise the healthcare system needs to:

1. Improve the Patient experience. Patients are also consumers. They expect their healthcare experience to function much like their interactions with the brands they trust. In this era of consumerism, many patients will select (or leave) a provider based on the patient experience. A large part of this experience includes the financial journey.
   What providers need is a strategic and consumer-based approach to patient financial engagement. This approach will provide compassionate care for patients and deliver cash for providers. The approach starts by broadening the definition of care to include revenue cycle operations, which have a profound role to play in patient satisfaction and health outcomes, as well as increased patient collections
   Just as providers are transforming the clinical experience through Telehealth and other innovative approaches to care to continue to achieve key health goals, expanding financial services and support will clear the way for more patients to proceed with necessary treatment and to pay for that care.
2. Give patients more flexibility when paying medical bills. People WANT to pay their bills, and when they have the ability, they will. Offering long-term payment plans without interest increases patient satisfaction and the likelihood they will get the care and services they need to be healthy. We know this to be true from a regular independent study that we conduct with our members. 89% of patients surveyed said they were more satisfied with their provider when CarePayment was offered.
3. Engage patients earlier and more often. This is a strategy we have found to be effective to make sure patients are on the right financial track from the moment they schedule their first appointment to when they receive their bill. Patients who are engaged early and often, in a compassionate manner, are more likely to pay their bills, which increases provider revenue. When providers have the financial conversation with patients prior to treatment or discharge, we know from our own portfolio that those patients are over 90% likely to pay off their bill in full, even when that bill reaches $5,000 — $7,000.
4. Invest in affordable healthcare for patients so providers get paid for their services and can then invest in their communities. Health care providers, especially hospitals and health systems, tend to be “anchors” for communities as huge employers and care providers. When providers are healthy, they reinvest in their communities and improve the quality of care.
   Unfortunately, healthcare providers often believe that they will be unable to really get more patients to pay their bills, so they focus on cost to collect, rather than yield. When affordable zero interest payment options are made available to all patients who need help (not just those who ask), patients will pay, leading to a significant cash increase for providers to put back into their communities. While investing in affordable healthcare requires just that — an investment — it is important to consider the return for both patients and providers. For example, the CarePayment solution drove an extra $10 million in cash to one of our large health system partners, and they reinvested the money to support the growing population they serve.
5. Champion health equity. COVID-19 has underscored inequities and financial barriers to care that already existed within this system. While health systems throughout the country have been working to address equitable patient access to quality healthcare, the challenges have been highlighted by the pandemic. The patient financial experience is often overlooked and can inadvertently propel inequities. Through a combination of a robust financial assistance program and no-application, zero-interest patient financing, health systems can make positive strides towards improving health equity. When offered in a fair and compassionate manner (without credit checks), patient financing can help vulnerable populations get the care they need.

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages? How do you think we can address the issue of physician diversity? How do you think we can address the issue of physician burnout?

One of my strengths is my ability to recognize my weaknesses; I will certainly acknowledge that there are folks considerably more qualified than I am to answer this question. Having said that, I do believe our program can help improve the clinical and financial experience for patients and providers, creating a less stressful environment which, in turn, will make providers more effective clinicians.

While workforce and physician management is not something we are a part of, we do know that our healthcare partners are very focused on providing the very best environment for physicians to perform their very best. One of the great ancillary benefits of our program is it relieves the clinical and office staff from having to have detailed financial conversations or manage payment plans for patients. When physicians and office staff can focus on the clinical care of patients, everyone benefits.

What concrete steps would have to be done to actually manifest all of the changes you mentioned?

From the financial standpoint, the way to manifest these changes is to address the stigma around affordable payment plans in healthcare. Most other industries offer ways to pay over time — the healthcare industry is pretty far behind in that regard.

Providers need to be connected with programs that offer flexible payment options with zero interest that everyone qualifies for. With these programs, providers are then given the necessary tools to better reach patients to let them know that these options exist, and that they don’t need to delay care due to financial worries. This not only helps more patients afford crucial medical services, improving patient experience and addressing health inequity, but also it produces returns for the provider that they can then reinvest in their communities.

Legislation regarding financing in the medical industry is also a key part of the equation to prevent predatory lending. Not all payment options are good options, and the bad options only inhibit positive change in the industry.

In our experience, the system works best when providers are able to give patients what they need — medically and financially — without having to overextend their own resources and without causing patients to overextend theirs. And, we truly believe that this is possible across the industry with just a few shifts in thinking.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger!

Our biggest mission is to ensure that every American is financially AND clinically healthy. Because of the current state of the U.S. healthcare system, many people are having to choose one option or the other. We want to transform communities through financial services that truly help patients afford care, to in turn help providers increase revenue, so they can reinvest in their communities.

We’re working to make affordable payments for patients less taboo in the healthcare space. Many patients are delaying or deferring crucial preventative care because they think they won’t be able to afford the price tag. But if providers would proactively say “you can afford it,” then it would help so many patients, and providers would see those returns, too.

How can our readers further follow your work online?

They can visit our website at carepayment.com or find us on LinkedIn at www.linkedin.com/company/carepayment.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.