Executive Summary
Patients are shouldering a growing share of their care costs, driven by high-deductible plans, rising coinsurance, and higher premiums. As a result, the underinsured population—those who have insurance but can’t absorb thousands of dollars in costs—is rising, leaving balances unpaid or delaying care. With margins thin and public coverage shrinking, health systems must prioritize affordability as an enterprise strategy that spans financial access, growth, strategic pricing, and revenue integrity.
This case series, conducted in partnership with Cedar, profiles five health systems that differ in scale, market, payer mix, and EHR infrastructure. Through interviews with CFOs, revenue cycle leaders, and operational staff, this research maps each system’s affordability approach from scheduling through final payment. It also takes a closer look at one standout solution at each system, from centralized price transparency and paperless billing to ACA premium sponsorship and extended payment plans.
The findings show a clear contrast between two approaches. The reactive status quo is payer-centric, one-size-fits-all, and siloed across the patient journey. A more deliberate, strategic approach offers individualized, actionable support that is coordinated across stages and regularly recalibrated. No system reached an ideal end state, and the most persistent barrier isn’t technology. It’s coordinating existing capabilities across teams, reporting lines, and technology stacks fast enough to pace ahead of the market, rather than reacting to it.
Key Takeaways
Patient liability is a fast-growing, often deprioritized revenue risk. Systems reported rising patient liability, yet many leaders still ranked addressing it below payer denials and reimbursement. The tools to intervene largely exist; the opportunity is giving patient liability attention proportional to its growth.
Individualized, actionable interventions outperform broad education. The strongest results came from approaches tailored to each patient’s situation, used at every stage of the patient journey. Examples include structured deposit requests, coverage and premium support, and payment plans matched to likelihood to pay.
An EHR-native feature isn’t always a solved problem. In some cases, EHR-native tools remain unoptimized, require years of configuration, or are missed entirely. The build, buy, or wait decision deserves a deliberate cost-benefit analysis rather than a default position.
Organizational agility matters more than any single initiative. Strategies erode as markets, policies, and patient behavior shift. The systems best positioned for what’s next routinely revisit their tools, policies, and partnerships—treating payer and regulatory changes as early warning signals.
The full report expands on these themes with five detailed case studies and a framework of four dimensions that shape each system’s strategy: market environment, digital infrastructure, systemness, and financial standing. It also includes an executive self-assessment to help leadership teams identify gaps and plan their next steps.