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How St. Luke’s University Health Network boosted collections by 22% – despite staffing shortages

Published: January 4, 2024 by Experian Health

Between November 2022 and September 2023, St. Luke’s University Health Network (SLUHN) saw a 22% uplift in self-pay collections, amounting to an additional $1.2 million in average monthly collections. What makes this particularly noteworthy is that they achieved this during ongoing staffing shortages. It’s an encouraging result for providers facing similar challenges, so how did they do it?

On a recent webinar with Experian Health, Cindy Samuels, Senior Manager of Patient Revenue Services at St. Luke’s, and Rich Wade, Strategic Product Consulting Director at Experian Health (and the Patient Revenue Services team’s designated consultant), share how Collections Optimization Manager and PatientDial allowed St. Luke’s to automate and optimize their collections efforts.

How staffing shortages wreak havoc on the collections process

Revenue cycle managers are all too familiar with the downward trend in collections recoveries over the last few years, which is exacerbated by labor shortages and rising self-pay balances. In Experian Health’s August 2023 survey, Short-Staffed for the Long Term, 100% of respondents said that staffing shortages had affected revenue cycle management. Many reported that resource shortages in patient collections made it harder to follow up on late payments or help patients who were struggling to pay.

With six vacancies in their own Patient Revenue Services team, St. Luke’s needed a way to improve efficiency. Cindy Samuels says, “more and more dollars were falling to the patient. I had a team of folks making outbound phone calls to collect outstanding dollars, but staff were leaving messages all day long and our cash wasn’t increasing. Outsourcing wasn’t an option that we wanted to pursue, so we looked at technology automation.”

Since St. Luke’s were already using Experian products in other parts of the revenue cycle, replacing their outdated call center platform with an Experian Health solution made sense.

Developing a successful strategy for collecting self-pay balances

To handle increasing self-pay balances with limited staff resources, St. Luke’s used Collections Optimization Manager to generate a daily accounts receivable (AR) file and then screen, segment and monitor accounts so they could be managed in the most efficient way. Samuels explains:

“Every active self-pay account goes through [Experian’s] scrubbing system, so they’re finding medical assistance, presumptive charity, deceased bankruptcy, and other types of insurance. So, we know to set those accounts aside. The rest are segmented into five segments [based on propensity to pay] so I know where to put my resources when it comes to reaching out to patients.”

With the help of an Experian Health consultant, Collections Optimization Manager users can then implement specific collections strategies that are tailored to each segment. For St. Luke’s, this included automating patient calls using PatientDial, a cloud-based call system that facilitates inbound, outbound and blended call environments to help collect patient balances. The combination of segmentation and automation allows St. Luke’s to have multiple call campaigns running at once, so more patients can be contacted and in a way that is more likely to lead to payment.

Maximizing collections by shifting focus from “high dollar” to “ability to pay”

Typically, collections teams focus on aged accounts with the highest dollar amounts. Unfortunately, this can result in staff chasing accounts that are unlikely to be paid. Collections Optimization Manager’s segmentation strategy means accounts are sorted according to likelihood of payment, and treated in a way that is more likely to yield results without wasting staff time.

With Collections Optimization Manager and Patient Dial, patients that are more likely to pay can be allocated to an unassisted call campaign and given an automated reminder about their balance at the appropriate time. It may not make sense to have staff spend time calling patients at the other end of the spectrum who are unable to pay or even engage with the process. An automated message with information about financial assistance may be a more appropriate approach.

St. Luke’s focused their resources on the segments in the middle, who are likely to be engaged but may have specific issues to resolve, such as needing details of payment plans or updating a credit card. This approach has helped the team reach more patients than ever and maintain an abandon rate of below 1.2%.

Samuels says, “not only have we been able to collect more cash, but we’ve also been able to resolve more accounts, because with segmentation we’ve been able to clean up the AR that don’t belong in the collections world. We can also help patients go down the financial assistance road if that’s what they need. So maybe not every call results in cash, but at least we’ve been able to speak to patients and help them resolve any questions or concerns.”

Boosting staff efficiency through automation

Around 90% of St. Luke’s Patient Services Team work remotely. This adds a new challenge for managers, who need to be sure that staff have the information they need to work confidently and effectively, while being able to monitor workloads and maintain productivity levels.

While the increase in call volumes and collections speaks to the boost in productivity, PatientDial’s reporting function has made it possible to generate a scorecard for each representative to measure performance. This allowed Samuels to identify potential training needs and foster knowledge exchange, especially when remote working means staff can’t simply ask the person next to them for help.

Samuels says her staff have welcomed the ability to handle more calls, more efficiently, without having to redial patients several times. PatientDial provides user-friendly dashboards, so call center agents have all the necessary details at their fingertips. Staff have said they find it motivating to be able to help more patients, which is reflected in high employee satisfaction scores in St. Luke’s annual employee engagement survey.

A snapshot of success

In addition to increasing average monthly collections by $1.7 million in a little under a year, St. Luke’s has seen the following results:

“We have increased our outbound call volume by 274% since last November, so we’re reaching more patients. If we’re not reaching them, we’re leaving more messages. The dialer has also saved 740 hours monthly because staff are no longer dialing numbers and getting nothing. And we’re using an interactive voice response (IVR) campaign for payments, so we’ve saved around 253 hours each month, because patients make their payment electronically over the phone with no need to speak with a representative. It was a very positive thing for us.”

Cindy Samuels provides more details of their approach on the webinar, plus her tips for others who may be considering implementing Collections Optimization Manager and PatientDial in future.

Watch the webinar for full details on how St. Luke’s increased collections despite staffing shortages, or contact us to learn how Experian Health can help optimize your collections efforts.

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Improved automation and data-driven solutions are optimizing the patient collections process, even as providers face rising costs, shrinking reimbursements, looming changes to credit reporting, and an ongoing push toward greater efficiency. How do current solutions stack up against these challenges? Matt Hanas, Lead Product Manager at Experian Health, shares responses to some of the questions he's hearing from around the industry.  Q: Automation continues to be a buzzword in 2025, but what does it mean day-to-day for patient collections? What can automation do for healthcare providers and hospitals in 2025?  “Automation can mean many different things,” says Hanas. “It might mean saving on full-time employee hours or the number of clicks made by a user with an EHR like Epic. It could mean removing human intervention from a process, or trusting a vendor to deliver results without needing oversight.”  “When deployed correctly, automation will either reduce waste or increase profitability---or both,” he continues. “Imagine being able to export AR files out of an EHR on a daily basis. Those files trigger multiple processes that check for missed insurance coverage, bankruptcy filings, bad addresses and charity qualifications, to name a few possibilities. That information can be scored and segmented to drive hands-off dialer and text campaigns, with results delivered back to the EHR automatically and used to populate work lists and queues for staff to review—or, better yet, to create additional automation rules within the EHR to perform automated tasks like adjustments and write-offs.”  “Collections Optimization Manager has the proven ability to automate workflows. It's used at hospitals around the country to discover overlooked Medicaid coverage, apply charity write-offs, utilize interactive voice responses (IVR) to collect payments, send out text message payment reminders and more,” Hanas says. “These are all key drivers behind a profitable and efficient healthcare organization. Thousands of hours are being saved, while hospitals and providers achieve greater efficiency and profitability.”  Q: Can segmentation increase collections and boost patient satisfaction? How does the power of intuitive segmentation improve the patient collections process?  “For certain, failing to understand patients' individual needs is not a recipe for improving collections or increasing patient satisfaction,” says Hanas. Healthcare costs are rising, physician reimbursement is decreasing, and many consumers are feeling an economic squeeze. A 2024 survey by Commonwealth Fund found nearly half of respondents (48%) had skipped care, declined to fill a prescription, or decided against seeing a specialist because of cost. In this environment, segmentation can help providers develop a more responsive process, which may help to facilitate patient collections.  “When providers use detailed, comprehensive segmentation, they can implement specific contact strategies, payment plans or even automatic write-offs based on a patient's unique financial status,” says Hanas. “They can ensure that each patient has the right number of touches and can offer them a range of possible payment options.” For example, Patient Financial Clearance can connect eligible patients with financial assistance or charity.   “There are various data models used across the industry,” Hanas explains. “They group patients by credit data, payment history, demographics, geolocation, and a variety of other factors. What makes Experian Health segmentation so powerful is that it includes all of these factors. Having many types of data come together via algorithms and analytic models helps providers better understand their patients' financial factors, patient by patient. With properly deployed and utilized segmentation, collections can become a better-informed interaction between a patient and their provider that benefits both,” Hanas says.   Q: Outsourcing the patient collections process is standard practice, but do most providers really know how their agencies are performing? How can providers optimize these important relationships?  “Once providers have done the time-consuming research and picked an agency to partner with, their challenge is knowing whether those agencies are performing to standards,” Hanas says. “With thousands and thousands of accounts flying back and forth between the hospital and the agency (or agencies), monitoring performance manually would take an unimaginable amount of time.”  Experian Health has tools to automate the process. “Collections Optimization Manager has an offering built into it that monitors agency performance on multiple levels,” says Hanas. “It includes details [like] whether an agency's license has expired, or whether they've had a complaint or lawsuit filed against them. Because money collected is the true performance metric, it also compares account balances for each provider account against what the agency says they've collected. These results are then reported on dashboards, reports and scorecards, so providers get easily digestible information.”   Data also helps providers compare performance between agencies. “Clients are using performance metrics from Collections Optimization to line agencies up against each other and compare,” Hanas says. “This 'challenger' technique allows providers to see which agency is delivering superior performance,” and then these providers can ultimately make decisions on how to allocate business going forward.  Q: In addition to keeping up with operational challenges and technology, providers are navigating changes in the regulatory space. How are fast-evolving state regulations around financial assistance affecting collections strategies?  “More and more states are passing financial assistance-specific regulations,” says Hanas. “Illinois, Oregon, Minnesota, Maine, California, and North Carolina are just a few of the states that have enacted such laws, and each state has its own rules around how financial assistance should be approached. These regulations affect when action can be taken before sending statements to patients or sending accounts to collections."  “For example, in Maine, individuals who are eligible for charity care – defined as being at or below 150% of the federal poverty line (FPL) – may not have their bills sent to collections. For individuals over 150% FPL, nonprofit hospitals must wait at least 120 days after they send the first post-discharge bill before sending the bill to collections, by federal law,” Hanas explains.  “In New York, a bill can be sent to collections if the patient has been provided written notification of the financial assistance program within 30 days of the bill being referred to a collector,” Hanas says. “However, for a hospital to participate in New York's indigent care pool, a hospital cannot send a bill to collections if there is a pending financial assistance application.  “In New Jersey, an individual can only be sent to collections for amounts that are determined to be not eligible for charity care,” says Hanas. “A hospital must give applicants written notice informing them about charity care, Medicaid, or NJ FamilyCare, or refer them to a medical assistance program within three months of the date of service. If they don't, then the hospital cannot pursue collections.  “Because every state has different laws, it can be very cumbersome and time-consuming for providers to comply with these changes,” Hanas concludes. “Finding and implementing the tools needed to carry out these requirements can be a challenge.”  Q: How can the right tools help providers meet regulatory requirements without disrupting collections?   “One common theme among many of these regulations is for states to require providers to screen patients at the start of the patient care cycle to make sure they're offered the proper charity care and financial assistance options they may be eligible for,” says Hanas.   “Here's an example,” he continues. “On January 1, 2025, North Carolina enacted the Comprehensive Medical Debt Relief and Reform Incentive Program. 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