The system that made affordability a byproduct, not a program

This post is part of a five-part series profiling health systems featured in Patient Affordability as a Strategic Imperative, new research from Cedar and The Health Management Academy (THMA) on how health systems are responding to rising patient out-of-pocket costs. Read the full report for all five case studies and THMA's complete findings.

System A improved its patient cost-estimate accuracy from the low-50% range to 70%, and grew pre-service collections to 47% of total patient cash, by treating patient affordability as a byproduct of operational efficiency rather than a standalone program.

Most health systems treat patient affordability as its own initiative: a program, a task force, a line item. System A, a large academic and multi-specialty system with deep reach across one state, took a different path. Leadership doesn't talk about affordability as a discrete effort at all. It's a byproduct of something else entirely: operational efficiency.

"Most of our conversations about patient affordability will tie back to becoming more efficient," said the system's CFO in the case study. "Nearly all of the things that I think have the largest impact on affordability are things that allow you to do similar or better quality care with the same or less resources."

That philosophy shows up most clearly in the system's investment in patient cost estimates. Rather than treating estimates as a compliance requirement under the No Surprises Act, System A built its estimation and financial-clearance capability over roughly a decade, well before federal rules required it. The system transitioned from a legacy, historical-data estimator to an EHR-native tool, expanding coverage service by service: starting with radiology, then surgical, laboratory, infusion, and therapy services.

The results are hard to argue with. Estimate accuracy improved from the low-50 percent range at go-live to the 70 percent range, even as the system tightened its own accuracy tolerance from 10 percent to 5 percent. Pre-service and point-of-service collections now account for roughly 47 percent of total patient cash, up from the mid-to-high 30 percent range the year prior. Estimate volume has grown from 65,000 in the tool's first full year to nearly one million in the most recent year.

None of this happened through a single department acting alone. Executive, facility, regional, and clinical leadership co-developed the program together, which is part of why the resulting financial-clearance policy could be enforced consistently across the organization. A centralized pricing office—part operational unit, part internal consultancy—continuously refines the payer rules that underpin accurate estimates, an ongoing effort as payer behavior and plan designs continue to shift.

As one senior revenue cycle leader at the system put it: "We know you can have an amazing clinical experience… and have it destroyed by your financial one because you had no idea what was coming."

System A's approach suggests something worth sitting with: an affordability strategy doesn't need its own name to be effective. Built as a byproduct of efficiency and consumer-experience investment, it may end up more durable than a standalone initiative that has to compete for budget and attention every year.

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FAQ

How did System A improve its patient cost estimate accuracy? By replacing a historical-data-based estimator with an EHR-native tool, rolled out service by service over roughly a decade, improving accuracy from the low-50% range to 70%.

What share of patient cash does System A collect before or at the point of service? Approximately 47% of total patient cash, up from the mid-to-high 30% range the year before.

What makes System A's approach to patient affordability distinctive? System A doesn't treat affordability as a standalone program. It frames the work as a byproduct of operational efficiency and consumer-experience investment, governed by a centralized pricing office rather than distributed across separate departments.

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