How to Get Projects Done During Covid-19: An Oral History of Banner Health’s Point-of-Service Implementation

Caleb Burrill
Caleb Burrill
is Marketing Manager, Healthcare at Flywire

A tale of visionary transformation, resilience, and the importance of optimizing the financial environment in order to create a better experience for patients.

A history of the Banner POS implementation project

An integrated delivery healthcare network with hospitals across California, Nevada, Arizona, Colorado, Wyoming, and Nebraska, Banner Health is a sprawling health system, rooted in the West. With everything from critical access hospitals to large community and academic facilities, Banner Health comprises roughly 330 clinics, several thousand physicians that they manage the revenue cycle for, 50-plus urgent care centers, 30 imaging centers, homecare, home services, retail pharmacy, and about a 400,000-member health plan.

Like many health systems over the course of the past decade with an eye towards expansion, Banner Health’s story has been one of continually pushing forward, growing through acquisitions, physician practices, and the opening of new facilities, spreading out into various different types of communities and locations along the way. The sheer breadth of Banner Health’s size and complexity makes setting a vision and executing on that scope challenging on a good day, let alone during one of the biggest health crises in world history. But, in the spring of 2020, Banner Health and Flywire set out to do just that.

The relationship between Banner Health and Flywire began in 2019. When looking at their patient’s financial experience, Banner Health, led by VP of Revenue cycle, Brad Tinnermon, identified key areas for desired improvement in both patient self-service and assisted service options at the front and back-ends of the revenue cycle. Starting on the front-end, they were looking to extend transparent, self-service options to patients for out-of-pocket estimates where they could get an understanding of what care might cost in different places across Banner’s health system. Also in the self-service realm, they wanted to help patients understand what a viable path to payment might look like prior to receiving care via analytically driven payment plans that automatically took into account both bill size and a patient's financial capacity to meet their obligations. On the backend, they were seeking out partners that could help make it easy for patients to look at their accounts, combine statements, and set up payment plans on their own while creating an environment where, if the patient did call in for assistance, the customer service team would be able to easily walk through and work with a patient in those areas.

Working to combine multiple service lines onto a single statement was one of the many challenges they encountered as they looked to roll out this ambitious project into the many diverse communities that comprise the Banner Health family. Banner is not a single host system. Its span ecompasses multiple host systems working together in tight harmony, so the bulk of the work lay in coordinating the data from multiple host systems together to create what appears to be a holistic, single, patient-centric bill from all of the services the patient may have received while presenting it in a way that they would be incentivized to pay or react to a payment plan.

With a motto of “Healthcare made easier”, Banner Health was leaning into the future of patient financial engagement: digital automation, self-service, and AI & machine learning driven decision-making in order to create stickiness, loyalty, simplicity, and ease of access for their patients. By delivering more transparent and flexible financial options, Banner Health was attempting to make their health system more attractive and more competitive to patients that had more options for care than ever before.

And it worked. The point-of-service rollout, which began in June, encompassed 29 hospitals,

over 200 clinics, and 1,800 credit card devices. Since going live, Banner Health has seen over $1.5 million in monthly payment plan revenue with 85% of their payment plans being activated online.

Looking at the trends of patient responsibility and risk sharing from the payers, in his gut Brad Tinnermon, and the entire Banner Health organization, believed that the amount of financial responsibility being shifted to the patient had become unrealistic for a typical family to be able to manage those types of debt. As a north star for the goals of the immense undertaking they were embarking on, they kept reiterating that they didn’t want cost to be a barrier or a frustration to those coming into their health system and wanting to receive care. The ultimate desire was to deliver the financial power back to the patient. And that belief, which lay at the heart of the project, spurred them to bring their point-of-service implementation online despite a crucial piece of the rollout being at the height of the pandemic, a time when the system was experiencing a crunch in resources like it had never seen before. They believed that, in this critical time for patients, families would need financial care almost as much as they needed the world-class clinical care their facilities provided.

A story in their own words

What follows is an indepth look at that story in the key participant’s own words. The bulk of the conversations took place during the early weeks of July, 2020 as we were preparing for a joint webinar hosted by Becker’s Hospital Review between Flywire, Banner Health, and AdventHealth about the steps it takes to build a modern patient financial experience.

Over the course of those conversations, what unfolded was a tale of visionary transformation, of tremendous resilience, and of putting everything on the line in order to create a better financial experience for your patients; a story that had to be told.

But before you can tell a tale like that, you have to go back to the beginning...

Brad comes to Banner with a mandate

Tomer Shoval, SVP of Business Development, Flywire: I always say that Banner Health is an organization of tremendous vision and I believe that. With what we’ve rolled out, patients will look at service as another reason to come to Banner facilities and a lot of that starts with Brad.

Brad Tinnermon, VP of Enterprise Revenue Cycle, Banner Health: I started at Banner in 2017 – late 2017 – and coming on board, I was asked to take a fresh look at the revenue cycle services provided at Banner. We knew we needed to modernize some of our technologies and platforms. We needed to create a stable environment, but we also were a growing organization, so we needed to make sure that we could scale. So, those were some of the things I was asked to do.

The patient financial experience was a big part of that. Obviously, we want to drive net revenue, lower our costs, accelerate our revenue cycle, but that patient management experience was really important to us, as well. Like I said earlier, we are a health system. We also have a health plan, so we want to make sure that we create an opportunity for our members in the health plan to receive care, and not defer care.

We want them to have some level of spending power, so they can receive the care that they need, and it doesn’t turn into a catastrophic event, where we end up getting hit on the health plan side. In general, as we look at the patient financial experience, as we call it, we had to look through multiple lenses, and get our definitions straight on how our organization was focusing on that.

So, we have interactions from our front-end in transparency, and shopping experience, and the back-end with statements, and balances that we’re dealing with. And with a diverse health system with multiple different markets, and like all healthcare institutions, a very broad spectrum of people, ages, race, everything, we want to identify how do they want to be engaged? Do they want to be engaged in a personal way? Do they want to do things on their own from a self-service standpoint? And how broad can we deliver all of those services in those ways, which is a big challenge.

So, that was how we got started; really identify what is Banner trying to achieve? What do the patient’s need? How does that help us compete in the market, and how does that make us a preferred health system, a preferred health plan? Get our definitions straight, identify how to provide services, and in what medium do we provide it? And that was really the bones of how we got started, and how Flywire became part of that plan.

Pushing forward in times of crisis

Tomer Shoval, SVP of Business Development, Flywire: We’ve run a really complex project to the finish line and rolled it out in the middle of the pandemic. The specific story of this gigantic rollout that we’ve just been going through while Covid was on, it’s such a great call out to both teams about, you know, they had all the excuses to say let’s just put it on hold for 6 months. I’ve seen projects being stalled or cancelled across the board. I think what we’ve done together to power it through and the team being so connected they didn’t want to lose momentum, it's a really great story to share to the market.

Joel Haferbecker, VP of Client Services, Flywire: Ultimately, the decision sat with Banner. We, of course, wanted to push forward with the project.There was talk of delay.The project team (Banner, Elavon, Flywire) had to build an ROI case to present to the Banner CFO that demonstrated how our new functionality would increase their collections over a short period of time.They had to balance the cost of lost opportunity against the cost of lost resources. They were understandably concerned about losing Tech, PM, and SME resources if the project extended into the new year.

Tomer Shoval, SVP of Business Development, Flywire: It’s a huge challenge across the board, and it’s a challenge for an organization. It’s an extra challenge for a healthcare organization that needs to both deal with that, just like any other company, but also you guys are the ones that are saving people’s lives.

Brad Tinnermon, VP of Enterprise Revenue Cycle, Banner Health: We were fully expecting, when we had this disruption, that things would kind of grind to a halt, and we were starting to relook at our financial projections. But honestly, the team’s buy-in to these projects, they weren’t willing to let them go. They wanted to see them come to fruition. Our own design that we had of how we treated our patients, I think, became very obvious that that’s just not how we wanted to do business, anymore.

We really weren’t into this for trying to get more money out of patients to be absolutely frank. Banner was a pretty hard nosed point of service collection organization, and we had groomed our patients to realize that when you come to Banner you’re going to pay up front. Sometimes we’d do a 50 percent discount, or have a package plan, but it was pretty hard collection activity. I think we had 2.5 percent of net coming from point of service.

Then, we’d send out our statements, and if they didn’t pay it, we’d throw it off to bad debt. It was a pretty basic dunning cycle that we had. And the team really identified that that’s not a great way to compete, and it’s not a big patient satisfier.

We really threw a lot at this opportunity from getting out front in the transparent shopping where people can look, adding credit options. Before, front-end payment plans, we just didn’t do. We weren’t talking to you about payment plans in the front end. So, we wanted to add that into the front-end workloads, and make it so that our staff didn’t have to toggle between multiple tools. It literally just floated right through the workload tool. And on the back end, we wanted to add ways to get to your account, and manage your account, add your own payment plan, and combine your statements.

A lot of these projects we try to create a lot of buy-in from the operations leaders, and even the vendors get bought into what we’re trying to do. We sat people down and talked about the vision well before we signed any contracts. And I needed to make sure that my team was bought in and part of the process of deciding and mapping out the vision so it wasn’t just me telling them what was gonna happen. It was part of their grand design as much as it was mine, so they own it...A lot of these folks that work for me they live in the Banner communities, they seek care in the Banner communities...they truly feel like they’re doing great things for the patient. So, they’re very much motivated in getting it done but they're proud of it and they want to talk about what they’ve done.

Tomer’s right during the Covid period of time it was really easy to say we’ll just shut these projects down and figure it out later, but the guys were so passionate about getting this part done this last part on the front-end was a really big part that we felt like was different- what we’re trying to do here, baking this all in and getting this done on the front-end with Flywire- that they didn’t want to quit. So we had to pause and pivot and figure out “how do we deploy something like this in a more socially distant way?”, but they figured it out and I think we lost a few weeks maybe but not a lot.

Tomer Shoval, SVP of Business Development, Flywire: Completely agree.

Joel Haferbecker, VP of Client Services, Flywire: The Banner Exec team ensured that momentum was maintained at all times. In the instances where we needed a decision, our escalation process was very quick, we were never bogged down.

Likewise, the Banner project team were extremely motivated. They were constantly driving, driving, driving, and not getting caught up in details of every little issue. I think that’s because there was trust between Banner and the vendors. We had solid processes in place to triage and address issues while maintaining momentum throughout the rollout.

Brad Tinnermon, VP of Enterprise Revenue Cycle, Banner Health: This Banner team they’re so bought into what’s going on and really feel like it’s the right thing to do. It's kind of well beyond me at this point. Even if I told them to stop, at this point, I’m not sure that they would because they want it done.

Tomer Shoval, SVP of Business Development, Flywire: I always say that when I kind of got into healthcare, I said, “Look, yes, the doctors, the nurses, they’re kind of the frontline; they’re the heroes, but I truly believe that the administrators, they can bring innovation; they can bring a lot of value to the system, and really kind of enjoy that, and have a lot of satisfaction with that partner,” and I think this is just a great example of that.

The feeling of having scaled a mountain

Tomer Shoval, SVP of Business Development, Flywire: We’ve got our Slack channel that we put all different updates in. And the updates that came from the Banner pre-service project from Joel and from Michael Strickland (Vice President of Product) they were different from the usual project updates -” Yeah we’re great.” “Things are going live.”- this one felt very personal to say “Hey if we can do it in these times then that’s a much more amplified win.”

Joel Haferbecker, VP of Client Services, Flywire: I think, for us, the biggest challenge was conducting everything virtually. Usually UAT and Training sessions are held in person as it provides a much better experience. Therefore, we invested heavily in the training aspect of this project, working extensively with Banner Education. Banner is training all PAS employees in a live environment, which is refreshed periodically throughout the project.

This project also required physical deployment and support of devices to local clinics, so it was critical that the project team developed a plan to ensure that all techs were supported very well by Flywire, Elavon, and Banner IT. Similarly, the process and documentation, were again very thoroughly handled since all support from Flywire had to be handled remotely.

Ideally, we would normally travel to be with the client, sitting in the “war room”, in order to support them as waves of clinics are taken live. This all had to be conducted virtually, which meant many day-long Zoom calls where local clinic leads or Banner IT staff could jump in and receive support directly from the project team, Banner SMEs, Flywire, and Elavon instantly.

In POS device rollouts, it’s critical to “round” at each clinic to ensure everything is working properly. This responsibility was picked up by the clinic group leads and Banner Education teams.

Brad Tinnermon, VP of Enterprise Revenue Cycle, Banner Health: A lot of this couldn’t have come at a better time either as we’re all trying to work virtually now. And sending people home some of the pre-service and financial clearance functions, they’re already hard to do and then when you send people home it gets harder but having these workflows and these controls, these tools and options and then the ability to measure in the dashboard and see things as we send people to a virtual environment honestly it couldn’t come at a better time because we really need that structure.

Tomer Shoval, SVP of Business Development, Flywire: I agree with Brad. It’s interesting that he said that because I’ve heard that from Joel and the team about enabling some of the staff members at Banner to work from home. I’ve got a niece that works at a call center, she’s young, and they forced them to go into the call center and somebody got the virus and everyone’s freaking out and they’ve got to like quarantine and you tell yourself: “look technology should enable people now to be able to do things remotely”. Now, in order to do it you have to have visibility, you need to have the right tools, and you need to be able to have checks and balances and those are part of the things that we hoped to bring to the table.

Joel Haferbecker, VP of Client Services, Flywire: We increased scope throughout to assist Banner as it deployed employees to work from home. This had the unexpected effect of shortening the time-to-value, as Banner’s Pre-Service team was among the first waves of employees to be launched on Flywire.

From my perspective, I was definitely nervous about supporting non-technical personnel on Flywire using network-enabled CC devices on their home networks. I had visions of supporting my mom and dad with their computer issues over the phone. Again, the project team w/ Banner IT taking the lead, really built a solid solution with very few issues reported. It’s been a runaway success.

As Brad said, Banner did not have a pre-service pay plan solution prior to Flywire, so were only able to provide estimated increases in collection. From Day 1 of the project we saw a much higher than expected adoption of pre-service pay plans (ePlans).

Brad Tinnermon, VP of Enterprise Revenue Cycle, Banner Health: I think it’s an important point. I will reiterate that no solution is going to solve all your problems- it takes a village so to speak. I know that sounds corny, but having Flywire sit down with us and understand what we were trying to accomplish and work with us and make that happen was no small feat. We know that that was a strain to work with us on this front-end solution and make it happen the way we felt like it should happen and that’s a big commitment to a client to go “I hear what you’re saying and we’re going to give this a shot with you” and it took us time to get there but the real magic happens when you bake it all together so that the end user can view these tools seamlessly and not have to tab and bounce around to different systems and tools and human interfaces getting in. It just creates inefficiencies and potential errors. I just want to be clear there’s a lot of components that went into this but Flywire is a big part of it, their ability to collaborate with us is what really made this what I think is really special.