How AI and Automation Are Shaping the Future of Patient Payments

Inbox Health CEO Blake Walker shares insights on how health care organizations can modernize patient billing by treating it as an experience challenge, leveraging artificial intelligence (AI) and automation to improve clarity, communication, and collections.

Please introduce yourself by stating your name, title, and any relevant experience you’d like to share.

Blake Walker: I'm Blake Walker. I am the CEO and co-founder of Inbox Health, a patient billing platform. I've been working on patient billing for pretty much my whole career. A lot of that has been at Inbox Health. We started the company about 11 years ago. I worked on another startup for a few years before this that was also a patient billing company and worked at a patient financing business prior to that. Most of my career has accidentally ended up being focused on patient billing and payments.

Why are more health care organizations struggling to collect patient payments, even as patient financial responsibility continues to grow?

Walker: Patient financial responsibility has been increasing pretty rapidly for the last 20 years, but it's still a relatively small piece of the total puzzle for a provider when it comes to revenue cycle management. There have been huge shifts in the payer reimbursement landscape. There have been staffing shortages and issues that they're addressing there, as well as complexities around electronic health record (EHR) implementation over that time.

EHR has still been the hub of how providers do everything in the office. With EHR, it's always been an afterthought on how a provider bills and engages with patients after a visit. As that has continued to grow, providers have started to look more and more for point solutions to add onto the EHR to start to address this.

Patient mindset has changed quite a lot over the last 10 years, as patients have started to think a lot more about how those costs are impacting them. As part of that, providers are starting to realize that the patient experience with the bill after the visit has become an extension of their clinical care.

It's important that providers start to think about how they're impacting the patient experience through the billing experience that happens after the visit. It's been a bit of a slow roll. Even though patients are paying hundreds of billions of dollars now out of pocket, we're just starting to see a real investment be made by providers in how the patient financial experience needs to adapt and modernize to patient's consumer expectations today.

How can automation and artificial intelligence (AI) improve the timing and tone of billing communications without compromising the patient experience?

Walker: AI can play a huge role. There has been a lot of work done over the last 10 years using AI to optimize how we engage with patients—the messaging, making it more personalized to specific patients and specific issues. It's been done a lot by startups.

The typical billing experience, for most patients, is still getting a paper bill that's the same paper bill that everyone else is getting. But a lot of the startups in the patient billing space have been able to start to make progress on using AI to make the communications tailored to the specific circumstances of the patient. It helps the patient take more action in what they actually need to do. AI can play a huge role there.

The other area where AI can play a huge role is helping the patients get a better experience around patient support. The more patients owe, the more questions they have about why they have a balance, how the balance came to be, and why their insurance didn't cover things. It's always been difficult to get answers from human support, partly because of staffing, partly because of training. AI can play a huge role there, especially with the advent of large language models and their improvements over the last couple of years. That's going to change the patient experience with health care billing in the next 5 years as more and more chatbot experiences dominate the patient support landscape, but I think can improve how patients interact with and understand their bills and improve the support that they get from their providers.

Patients are often confused about what they owe and why. What practical steps can health systems take to improve billing transparency and trust?

Walker: Ultimately, it is most important that you spend time upfront investing in the staff at the front desk—medical receptionists, intake—to make sure that patients understand at a high level, at the very least, their benefits for a particular visit before they leave the office or the hospital. That's the key to starting off on the right foot.

Obviously, after the patient leaves, there is always some unpredictability with regards to what the patient is going to owe. It's important to then make sure that your bills are as clear as possible in terms of explaining why patients have a balance. It has to include information about whether or not it was co-insurance, deductible, or some combination; how things were written off because of contractual rates with the insurance providers; and if you have multiple coverages, it needs to be clear about how each coverage was applied to the particular charges. That's easy to say and harder to do.

All aspects of it can be really difficult, including actually finding time in the intake workflows to make sure that benefits are checked and explained to a patient prior to them leaving. That can be a huge challenge. Staffing challenges are a key factor there. Time is a factor there. If you don't have time to do that, the backside becomes all the more important when it comes to how we're communicating with the patient afterwards.

The challenge there is that most of our billing systems for patient billing don't do a good job of communicating with the patient about why they have a balance because it's innately difficult to do with the data that's present—most of the time it comes out of the EHR. That's where finding the right point solutions comes into play for the health system.

More than a quarter of patients who receive a bill need to ask a question before they're ready to pay. Many more need payment plans now than they have in the past, and so you need to have the right support system in place for those patients. It needs to be readily available. Optimally, it's digitally available, not just on the phones. Applying large language model-powered AI bots to that can have a big impact on how effective that support is in closing the gap of the clarity of the bill and the patient experience needs.

In your view, what’s the right balance between digital self-service tools and human support in patient billing?

Walker: It is changing. If you asked me a year ago, I probably would have answered very differently. I do think you need both. Patients want, for the most part, digital self-service, when it works well. But there has to be both.

Even as AI has improved, with regards to patient support in particular, it really only gets you 70% or 80% of the way there. Having a human in the loop is critical to closing the gap, and there can't be a big falloff when patients are having an experience with a very human AI chat and hit a wall. It can't be a follow-up; it needs to be a seamless transition to human support that has the same level of empathy training and the ability to take the extra actions that patients need.

That will continue to evolve. I do think that there will be a consistent need for human support alongside digital self-service and AI-enabled support tools. But I think that the ratio will continue to shift from the current right mix, which is somewhere close to 50-50 in terms of digital self-service and having really good human support, and I think that mix could end up closer to 80-20 in a couple of years. It could potentially go further than that. There will always be the need to balance the two appropriately and make sure that both are effective and the handoff is clean.

If you had one piece of advice for health care executives looking to tighten up patient revenue capture, what would it be?

Walker: I would say to treat patient billing as an experience problem and not just a collections problem. You have to make it easy for patients to understand their bill and to ask questions. It has to be a modern, good experience. Once you do those things, the revenue capture itself will naturally improve alongside that.

You have to invest in the front-end experience, the communication, the transparency, and flexibility. Meet consumers where they are with those things. That's where you're going to see the biggest lift to get collections up. You'll also see patient loyalty and operational efficiencies across your business improve as a result.

The providers that are going to win are the ones that are going to see billing as part of the care journey and not just an afterthought. That's the key takeaway I'd give.