Carilion Clinic Improves Their Patient Financial Experience with Innovation and Compassion

Headquarters: Roanoke, Virginia
Hospitals: 7
Total sites: 250+
Beds: 1,026
Net Patient Revenue: $2B+
Employees (non-RN or MD): 12,000
EMR: Epic

At a Glance

  • Business Challenge

    As patients face increasing financial responsibilities due to changing benefits designs and cost shifts away from payers and employers to patients, Carilion Clinic sought an advanced technology solution to create a better patient billing experience: one that treats patients with financial compassion and works with them to address their needs with flexibility.

  • Transformation

    Through partnering with VisitPay, Carilion Clinic launched Carilion Bill Pay [VisitPay] in late 2019. With this new system, they were able to enhance a data-driven approach, and it enabled them to offer patients an end-to-end solution that provides transparency and flexibility. As the COVID-19 pandemic affected the community, VisitPay had an unexpected and important positive impact. The new financial solution helped give patients the flexibility they needed and encouraged them to stay engaged in the process.

  • Results

    More than 30,000 patients have registered with the Carilion Bill Pay [VisitPay] system since launch in January 2020, more than doubling Carilion’s goal and improving patient satisfaction along the way. Carilion Bill Pay’s Net Promoter Score has increased steadily since the launch and is now approaching an industry-leading 40. In addition, patients who have enrolled in Carilion Bill Pay [VisitPay] are repaying 60% more of every dollar owed than those still using traditional payment approaches.

Business Challenge

Carilion Clinic is a Virginia-based, physician-led, integrated academic health system. With more than a thousand physicians and advanced care providers, they serve a population of nearly one million people in Virginia. The health system is dedicated to making sure their community is treated with empathy and given the best possible care. And, they are committed to achieving the highest level of patient satisfaction. They exist to “improve the health of the communities we serve,” as their mission statement says.

To live up to that, Carilion continually evaluates the evolving state of the industry and looks for areas of opportunity. With the rise in high-deductible health care plans, patients needed new and flexible options for paying their financial responsibilities.

“Our patients want to pay their bills,” said Brett Tracy, Vice President of Revenue Cycle at Carilion. “They’re hardworking and really care about their livelihood. And the impact of the rising deductible in healthcare costs has really hit home.”

Carilion saw how real these challenges were becoming for the people in their community and took action.

“A one-size-fits-all approach is no longer viable in today’s complex environment,” said Tracy. “We needed to find a way to address individual situations that patients find themselves in.”

Carilion’s approach to their financial relationships with patients had to adapt. The focus would be on treating patients as individuals—with compassion and a human touch—and offering the same level of financial service as they did clinically. “While there’s shared responsibility in our financial relationship with patients,” said Tracy, “I believe the onus starts with us.”

They set out to solve a specific problem: how could they adapt and improve the patient financial experience to fit the growing needs of their community in a way that best served their mission?

Carilion Clinic discusses how a new financial solution enabled them to create a better patient billing experience that provides transparency and flexibility.


Carilion believed a technological solution was critical to build the foundation that would support a long-term relationship with their patients. That solution needed to integrate with Epic, which they’d been using since 2008. To complement Epic’s enhanced operating effectiveness across the health system, Carilion felt that a purpose-built approach was needed to improve the patient financial experience. To take this step, Carilion reviewed its approach and looked at the revenue cycle across the patient journey.

Carilion and VisitPay partnered to launch Carilion Bill Pay, white labelling the VisitPay platform to maintain the provider/patient relationship in Carilion’s name. The implementation of the VisitPay technology marked the next step in Carilion’s emphasis on a patient-first approach to the patient payment experience, allowing them to offer patients unprecedented transparency and flexibility.

Shortly after Carilion implemented VisitPay, the COVID-19 pandemic hit. The impact of COVID-19 on the economy resulted in many patients facing financial uncertainty. For some, paying medical bills became more difficult. Carilion knew providing this financial solution for their patients was more important than ever.

Patient-first Approach

By implementing VisitPay’s proprietary segmentations, Carilion is able to glean valuable insights into their patient base to help shape their patient engagement strategy. The data segmentation gives the health system information to better cater to each individual patient—informing which financial offers to make available to a patient and the potential for personalizing the provider/patient financial relationship.

This new capability came just at the right time for Carilion and its patients. “We introduced things like payment holidays for patients, especially in the early part of COVID-19,” said Don Halliwill, Chief Financial Officer at Carilion. “We added VisitPay to introduce new payment plans for patients, and we’ve changed several other ways we interact with patients to secure payments for healthcare services.”

Halliwill believes with more experience and more data, they’ll continue to improve patient service. This deeper understanding of their patients helps Carilion offer the right choices to the right person at the right time, also creating maximum efficiency within the revenue cycle. Flexible bill payment options provide patients with sustainable and longer-term solutions to meet their needs—while remaining fully compliant with state and national regulations.


The team at Carilion knows that transparency matters more now than ever.

“When people talk about how expensive healthcare has become, they are often referring to the increased burden patients have borne in recent years,” said Halliwill. “To be sure, costs of delivering care have increased due to inflation and investments in new technology, but the real increase is the shift in who is paying for it. Employers and government payers are changing benefits plans, and more costs are now borne by patients.”

Carilion believes that improving the patient financial experience begins with transparency, including being upfront with patients about their bill.

“For far too long, patients have not had any idea of what to expect to see on a bill from the provider until they get it,” said Halliwill. He and his team knew that, with the amount of financial responsibility resting on the shoulders of those patients, this was no longer acceptable.

The VisitPay platform connects to payment options and insurance information so patients have all the information they need in a single view. Billing information is easily accessed digitally or through Carilion’s patient call center. Patients are able to see and pay their entire family’s bills, too, in addition to their clear breakdown of what insurance is paying. And with VisitPay, integration with Epic is totally seamless from start to finish—a low IT burden on the Carilion end, and virtually unnoticeable to the patient.

With the platform, patients will have access to pre-service estimates throughout the process. They can even get updated estimates directly on their mobile devices.

“In this new financial environment, cost transparency for healthcare providers is an absolute necessity if you want to have a deep, continuing, meaningful relationship with your patients,” Halliwill said. “The more they know, the better decisions they can make and the better they’ll feel about the overall experience.”

“Transparency in the current environment for healthcare providers is an absolute necessity.”
-Don Halliwill, Executive Vice President & Chief Financial Officer, Carilion Clinic


Giving patients a choice in how to engage is also crucial. “Not all patients like to interact exactly the same way with regards to their financial responsibilities,” Halliwill said.

Knowing that a one-size-fits-all approach to patient communications was no longer sufficient, Carilion set out to adapt their approach around patient preferences. Payment solutions need to be tailored to fit those individual circumstances.

“Our goal is to make sure we have more options for our patients to be able to pay for their bills,” said Tracy. “Fifty percent of patients, or more, do not want to talk to someone on the phone when they have an issue. They want to pay their bills with ease. They don’t want to have to work to do it.”

With VisitPay, Carilion has automated tools to customize communications for patients based on their preferences. Patients can pay online, over their phone, or call the call center, receiving a consistent and compliant financial offer tailored to their circumstances regardless of the channel they use.

Patients now have more freedom and control over the financial part of the relationship. They have trust in their health system, knowing that Carilion is there with solutions that work for them.

“Our mission is to improve the health of the communities we serve. And health does not just refer to physical health and wellbeing. It’s not limited to emotional and mental health. It also has to do with one’s financial health,” said Halliwill.


By the Numbers

  • 30K

    Users registered

  • NPS 40

    Billing experience
    Net Promoter Score

  • 60%

    Patient payment lift
    for Carilion Bill Pay [VisitPay] users

With VisitPay, Carilion has accomplished and surpassed their goals during a time of financial uncertainty, and with compassion.

Carilion’s original goal was to register 12,000 patients within nine months; instead, they quickly reached 30,000 users.

Since implementing VisitPay, Carilion has seen a 60% patient payment lift for Carilion Bill Pay [VisitPay] users, which is another step toward furthering their mission to improve the health of their community.

Patient satisfaction has soared. Net Promoter Score is approaching 40.