How UW Health is Redefining the Patient Financial Experience

By prioritizing proactive price transparency, realistic automation strategies, and cross-departmental staff development, UW Health is redefining the patient financial experience and driving pre-service revenue cycle operations excellence.

The revenue cycle begins long before a claim is ever generated, according to Ryan Klein, Senior Director of Patient Access and Financial Experience at UW Health.

Overseeing frontend operations at the academic medical center, Klein has adopted the philosophy that patients cannot make intelligent healthcare decisions without understanding their out-of-pocket costs.

As health systems across the country grapple with the complexities of price transparency, UW Health has taken a highly proactive approach to patient estimates, sending out more than one million annually. However, providing an estimate is only half the battle; ensuring that patients actually understand the nuances of healthcare billing is where the real work happens.

Driving Pre-Service Collections

A core part of this proactive transparency strategy involves early communication regarding authorizations and referrals. For example, when scheduling patients who require a referral, UW Health's team has started leveraging automated campaigns to notify the patient that they must obtain one from their primary care provider and insurance company. This initial communication also includes a self-pay estimate notifying the patient of prepayment requirements in the event a referral is not secured.

If the referral is not secured within a few days of the service, the health system has future plans to send another notification, reiterating expectations that payment will be required at the point of service.

This process has a direct domino effect on the rest of the revenue cycle.

"Increased estimates has led to increased pre-service collection, which has led to reduced work on the back end," Klein said.

By capturing more revenue before the patient even walks through the door, UW Health has freed up its back-end self-pay collections team to move away from constant cold-calling and instead focus on thoughtful, targeted outreach strategies.

The Reality of Front-End Automation

Despite the hype around revenue cycle automation, Klein cautions that "touchless" prior authorization remains elusive. Automation is only as good as the data feeding it, meaning health systems must first ensure frontend orders are as accurate as possible.

Furthermore, simply securing an automated authorization from a payer does not guarantee payment. Payers have complex medical policies that technology often overlooks, according to Klein. For instance, a surgical case might receive an automated approval, but if the patient's medical record doesn't document the required six weeks of conservative therapy, the payer will still deny the claim.

"We have it authorized, which is fantastic, right? But we still need to ensure that the medical policy is being met, otherwise it'll get denied," Klein said.

Cultivating a Front-End Workforce

Sustaining these complex frontend operations requires a dedicated team. While UW Health boasts high retention rates thanks to highly engaged leadership, Klein acknowledges a structural challenge common in patient access: a lack of upward mobility.

With large teams of frontline staff but limited supervisory roles, leaders must find alternative ways to keep employees engaged. For Klein, the solution lies in cross-training and intentional development.

"We need to develop these people that want advancement, we need to develop their skills outside of their silo," Klein noted.

By committing time to help staff build relationships and expertise across the broader revenue cycle, health systems can maintain a resilient and motivated patient access workforce.