This issue we're bringing you some thoughts on a persistent challenge for healthcare providers - how to deliver patient refunds. Seems like a no-brainer in today's digital payments economy, right? Not so fast in healthcare. More on this below.
We also share some data on which specialties have the greatest penetration of medical credit cards, according to a recent study published in JAMA, and perspectives on a potential Epic agentic AI offering as well as an interview with MEDITECH's COO. Company news includes Office Ally, Thatch, Stripe, Therapy Brands and a new entrant, Openhand.
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DEAL NEWS
Office Ally receives strategic growth investment
Nashville-based Office Ally, a provider of cloud-based clearinghouse and other software solutions to healthcare providers and health plans, announced a strategic growth investment from New Mountain Capital. The amount was not disclosed. Existing investor Francisco Partners will contribute additional capital as well. Office Ally enables the exchange of more than 950 million transactions annually between providers and payers, and is used by more than 80,000 healthcare organizations.
Thatch raises $40 million and brings in new growth leader
San Francisco-based Thatch just completed a $40M Series B funding round, led by Index Ventures with a16z, General Catalyst, The General Partnership, ADP Ventures, and SemperVirens. The company also announced that it hired Gary Daniels, the former CEO for UnitedHealthcare’s Pacific Northwest division, as its Chief Growth Officer. ADP, the payroll company, has also partnered with Thatch and participated in this investment. Thatch is a leader in the fast-growing ICHRA market.
Startup: OpenHand helping patients save on medical bills
OpenHand plans to use AI to help patients examine unpaid medical bills to see if they can identify potential savings. The company's software takes a patient's bill and analyzes it for errors, provides an analysis of estimated savings, and gives the patient the option to have OpenHand negotiate with the provider or give the patient information to negotiate on their own. OpenHand references the Medical Billing Advocates of America, which estimates that 80% of medical bills have errors. The company has not formally launched, but patients can request "early access" and has been publishing a blog since September 2024.
FEATURE ARTICLE:
Why Do Providers Still Send Patient Refunds by Mail?
Healthcare providers often find themselves caught in the paradox of modern medicine: cutting-edge treatments paired with payment systems that seem to have been teleported from the 1980s. Patient refunds, an outwardly simple concept, have become a financial and operational burden for provider organizations. The reliance on outdated processes like issuing paper checks not only drains resources but also frustrates patients who expect the same seamless digital experiences they enjoy in other aspects of their lives.
You’d think the healthcare sector would have noticed the rest of the world has moved on. Retailers are zipping refunds back to customers’ phones in seconds, landlords are accepting rent through Venmo, and your niece is receiving birthday money via Apple Pay. Meanwhile, hospitals and provider organizations are issuing checks like they’re sponsoring a county fair bake-off.
Financial Burden of Paper Checks and Antiquated Processes
The inefficiencies surrounding patient refunds aren’t just a headache – they’re a massive market opportunity. In 2022 alone, U.S. healthcare providers issued an estimated $3.1 billion in patient refunds.
However, issuing patient refunds is far from cheap. Processing a single paper check costs providers between $4 and $6, with some estimates climbing as high as $20 when factoring in administrative labor, postage, and fraud prevention measures. Multiply that amount by thousands of refunds annually, and you’re looking at a significant financial impact. Worse still, these costs are largely fixed – printing checks, mailing them, and managing unclaimed property compliance. Costs don’t scale down even when the refund amount is small.
All of that doesn’t even count the cost of issuing stop-payments and reissuing when patients inevitably toss those envelopes thinking they’re junk mail. Because who wouldn’t want to play “guess what this envelope contains” with their healthcare provider?
In an industry where margins are already stretched due to economic pressures and labor shortages, these inefficiencies are regrettable, if not unsustainable.
The Healthcare Consumer
Here’s the kicker: patients do not want paper checks. A J.D. Power survey found that 65% of patients prefer electronic payment options over checks, with younger demographics (Millennials and Gen Z) particularly favoring digital wallets like Apple Pay, Google Pay, Venmo, PayPal, Zelle.
Consumers have come to expect choice, convenience, and speed in financial transactions – basically everything the current healthcare refund process fails to deliver.
Where Vision Meets Today’s Patient Experience
Thankfully, a few payment tech companies have decided enough is enough. Companies like OnBe, Dash Solutions, Verity Pay others are leading patient refunds out of the Jurassic age. These companies provide digital disbursement platforms that enable providers to give patients modern choices for how they receive their money. No more printing checks, sealing envelopes, or fielding phone calls about uncashed payments.
So why hasn’t every provider switched to digital payments? The usual suspects – privacy concerns, integration challenges, and resistance to change – loom large. But these barriers are rapidly eroding as modern platforms prove they can meet HIPAA standards while offering seamless integration with existing systems. The real hurdle may simply be inertia: after decades of doing things “the old way,” many organizations struggle to envision a better path forward. And let’s face it – healthcare organizations still receive 80-90% of their revenues from payers, and are still adapting to the reality that patients are paying a much bigger slice of their healthcare cost out of their own pocket.
Modernizing Your Approach to Patient Refunds
So if you are a provider and still mailing checks in 2025, it might be time for an intervention. Patient expectations have changed. The market has changed. And thankfully, the technology exists to stop treating refunds like some arcane ritual passed down from the billing gods of yesteryear.
If you are part of a healthcare organization and want to upgrade your patient refund process, FinMed Partners will assess your current approach, match your tech stack, workflows, and strategic goals with payment solutions, and support you through implementation. Reach out today to learn more at info@finmedpartners.com.
COMPANY NEWS
Stripe applies for a banking license
Stripe recently applied for a Merchant Acquirer Limited Purpose Bank (MALPB) charter in the state of Georgia. Its application was accepted. Review and approval of the application is likely to take a minimum of 6-12 months. This charter will allow Stripe to obtain direct membership with Visa and Mastercard in the U.S., and process payments without a sponsoring bank. It will not allow Stripe to take deposits or undertake other banking activities. Stripe already is a direct member in other countries, including the U.K. Various outlets provided good coverage of this news, including its limited scope:
Birmingham, AL-based Therapy Brands, provider of software and services for mental and behavioral health therapists and majority-owned by KKR since 2021, recently changed its name to Ensora Health. Ensora Health's solutions include practice management software, electronic health records, revenue cycle management services, e-prescribing tools, and clearinghouse services. The company says its products are used by over 200,000 individual providers and more than 28,000 practices.
JAMA Network recently published the results of a study that looked at which types of healthcare providers have the greatest penetration of medical credit cards, measured as a percentage of known locations. The study authors used the websites of Alphaeon (Comenity Capital Bank of Bread Financial), CareCredit (Synchrony Financial), and Wells Fargo Health Advantage (Wells Fargo) to gather location data.
Data for total practice locations was sourced from the US Census Bureau, and was not available for many specialties including vision and cosmetic medicine, which had the second and third highest number of locations accepting medical credit cards. As a result, we find the data most useful for understanding how many locations of each specialty accept medical credit cards, as opposed to the study's calculations of percentage of locations accepting medical credit cards.
Dentistry was number one, with 90,644 locations, followed by vision (22,681), cosmetic (15,590), chiropractic (11,908), and pharmacy (8,029). Podiatry, physical therapy, dermatology, radiology, and orthopedics round out the top ten.
Consumers are prioritizing high-end wellness spending
The Mastercard Economics Institute recently shared data showing that consumers have prioritized spending on experiences including hospitality, live entertainment, and travel. This includes luxury experiences such as high-end wellness resorts, beauty treatments, and fitness clubs.
According to the report, "Wellness resorts are the strongest contributor to luxury experience spending growth, in line with consumers’ prioritization of wellness since the pandemic. High-end fitness also drove luxury experience spending in markets like Greece, the U.K. and the U.S., while premium beauty treatments outperformed in Australia, the Netherlands and the UAE." The interactive website enables users to filter spending by luxury experience, country, and season.
Epic and Agentic AI. A reader asked for my take on Epic’s plans for agentic AI - I have no inside knowledge, so this is pure spitballing. (HIStalk Blog)
Google Cloud expands AI agent tools for healthcare. Google unveiled a centralized hub where organizations can access pre-built agents as well as a protocol that allows multiple agents to communicate with one another. (Healthcare Dive)
WHAT WE'RE READING
HIStalk Interviews Helen Waters, COO, Meditech. 2500 word article covering the hospital EHR market, EHR lock-in, platform consolidation, perspectives on the cloud, working with Google, and important focus areas in the next couple years. (HIStalk)
ADDITIONAL RESOURCES
Conference List. Rolling twelve month look ahead at conferences and other events covering healthcare payments, revenue cycle, fintech and related areas. Updated through September 2025.
FMP Blog. Thoughts from healthcare payments CEOs and investors on their right to win and plans for the next 12 months, as well as data and perspectives on healthcare payments.
Newsletter Archive. News, trends, and insights from the healthcare payments industry compiled in our bi-weekly newsletter. Last six months of newsletters.
Epic MyChart. Excel sheet with full listing of all Epic MyChart instances as of May 2024, categorized by state, provider type and specialty.
All of these resources can also be accessed at the FinMed Partners Insights page.
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FinMed Partners is a management consulting and advisory business focusing at the intersection of payments/ fintech and healthcare. Our founders have developed deep expertise from decades of experience with health IT companies, healthcare providers and many players within the payments ecosystem. Investors, boards and executive teams work with us to maximize business value through strategic input and tactical execution.
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