Healthcare financial modelling: How to manage costs and revenue streams

Healthcare financial modelling How to manage costs and revenue streams

With healthcare costs projected to grow by 5.4% annually, managing finances has become a critical concern. Balancing the rising cost of delivering quality care with fluctuating revenues is a challenge faced by both small clinics and large hospitals alike.

The healthcare industry operates in a uniquely complex financial environment; particularly in the United States. Providers must navigate operational costs, unpredictable patient volumes, regulatory compliance expenses, and varying reimbursement rates from insurance companies. Without a structured approach to managing these financial variables, healthcare systems risk overspending or underutilising resources.

Financial modelling offers a powerful way for your healthcare organisations to address these challenges. By creating detailed forecasts, analysing scenarios, and managing both costs and revenue streams effectively, financial modelling empowers healthcare providers to make informed decisions and plan for a sustainable future.


What is financial modelling in healthcare?

Financial modelling is the process of creating a detailed representation of a business’ financial situation. In healthcare, this involves constructing models that simulate costs, revenues, and other financial variables over a specific period. These models help you to forecast outcomes, identify risks, and evaluate the financial impact of different decisions.

Why is it important for healthcare providers to plan their finances?

There are dozens of reasons that a healthcare provider would want to plan their finances – as would any business. We’ve listed a few of these below.

1. Balancing quality patient care with operational efficiency

Modelling your finances ensures that resources are allocated efficiently – without compromising the quality of care. You can identify areas of inefficiency and reallocate funds to critical services.

2. Managing complex payments and insurance reimbursements – particularly in the USA

With multiple payment sources like private insurance, government programs, and out-of-pocket payments, understanding cash flow is critical. Financial models help you to better understand your revenue streams and can help to optimise billing processes.

3. Planning for regulatory changes and compliance costs

Healthcare is heavily regulated, and compliance requirements can lead to unexpected expenses. Financial modelling helps you to anticipate these costs and incorporate them into your long-term planning.


What are the benefits of financial modelling for healthcare?

1. Improving cost management

Financial modelling helps your healthcare business to track and control expenses while maintaining a high quality of care. By identifying areas of inefficiency, you can reallocate resources, reduce unnecessary spending, and ensure financial sustainability.

2. Ensuring revenue is optimised

With financial modelling, your healthcare company can better predict patient volumes and optimise their billing processes. This includes identifying the most profitable services, reducing errors in reimbursement claims, and enhancing overall revenue management.

3. Forecasting for future growth and expansion

Financial models allow you to assess the viability of expanding  facilities or opening new locations based on demographic trends and market demands.

4. Planning for new services

By analysing patient needs and potential revenue streams, you can strategically introduce new services to meet demand while ensuring profitability.

5. Better visibility on risk

Financial modelling helps you to prepare for unexpected events, such as economic downturns or health crises, by running worst-case scenarios and creating contingency plans.

6. Ensuring optimal cash flow

You can use models to set aside reserves for uncertain times, ensuring stability and operational continuity even during challenging periods.

What are the benefits of financial modelling for healthcare


How do you build a healthcare financial model?

Our step-by-step guide

1. Define your objectives: Make sure you clearly outline the purpose of your model. Are you forecasting for a new facility, reducing costs, or expanding services? Having a defined objective ensures that your model is tailored to specific goals.

2. Gather the necessary data: Collect comprehensive data to form the foundation of the model. This includes:

3. Create assumptions: Identify and quantify key variables that will impact your model. Common assumptions include:

  • Patient growth rates.
  • Cost inflation for medical supplies and labour.
  • Average revenue per patient.

4. Build your model: Use a financial modelling tool like Brixx to:

  • Input the collected data and assumptions.
  • Create formulas to project revenues, costs, and cash flows.
  • Visualise projections with charts and graphs for easier interpretation.

5. Test multiple scenarios: Run multiple scenarios to prepare for uncertainties:

  • Best-case scenarios for optimal outcomes.
  • Worst-case scenarios for potential risks.
  • Baseline scenarios as the most likely projection.

6. Regularly monitor and update: Financial models are dynamic tools. Regularly update the model with real-time data to ensure its accuracy and relevance. This allows for proactive decision-making and timely adjustments to changing conditions.


What sort of tools are used for modelling your healthcare business’ finances?

Spreadsheet software

Spreadsheet tools like Excel or Google Sheets remain popular for creating financial models due to their flexibility and accessibility. They allow users to customise calculations and formulas, but they can become cumbersome for complex models or when integrating large data sets. Additionally, spreadsheets often lack the advanced forecasting and scenario analysis features required for detailed healthcare financial planning.

Dedicated financial modelling tools

Platforms like Brixx offer specialised features tailored for financial modelling:

  • Scenario planning: Easily test different financial outcomes to prepare for uncertainties.
  • Revenue and cost breakdown: Gain insights into detailed revenue streams and cost allocations.
  • User-friendly interfaces: Simplified interfaces that allow teams to collaborate effectively without advanced technical expertise.

Using dedicated tools saves time, reduces the risk of errors, and offers more robust capabilities for healthcare-specific forecasting.

What sort of tools are used for modelling your healthcare business’ finances


Case study: an example of optimising income for a hospital

The challenge

A moderately-sized hospital faced consistently-increasing operational costs and inconsistent revenue streams. Patient volume fluctuated due to seasonal trends, and reimbursement delays from insurance providers created cash flow challenges. Additionally, the hospital was considering opening a new outpatient clinic but lacked the data to justify the investment.

The initial review

Using Brixx, the hospital built a comprehensive financial model to address these issues. The team:

  1. Collected relevant data, such as historical financial records, patient demographics, and market trends.
  2. Defined their key scenarios, allowing for patient volume changes and cost inflation.
  3. Tested the feasibility of expansion, modelling the impact of opening a new clinic and assessing startup costs, potential revenue, and all expenses.

What was the result?

The financial model allowed for our hospital to take action:

  • They identified opportunities to reduce operating costs by 12% through more efficient staffing and resource allocation.
  • They predicted a 15% increase in revenue by optimising the revenue cycle and reducing claim rejection rates.
  • They were able to justify the new clinic expansion, projecting profitability within two years due to high local demand.

This case highlights how financial modelling can empower healthcare organisations to make informed, strategic decisions while maintaining financial stability.


What to do next?

Are you ready to transform your healthcare organisation’s financial planning? Discover how Brixx can streamline your financial modelling process. With tools dedicated to the planning process, Brixx enables you to forecast with confidence, manage costs effectively, and plan for a sustainable future.

Start your journey toward better financial management today. Sign up for a free trial to see how Brixx can work for you!

FAQs for financial modelling in healthcare

What types of healthcare organisations can benefit from financial modelling?

Financial modelling is beneficial for hospitals, clinics, long-term care facilities, and even individual practitioners. Any organisation that deals with managing costs and revenues can leverage modelling to improve financial outcomes.

How often should healthcare organisations update their financial models?

Financial models should be updated regularly, ideally monthly or quarterly, to reflect the most recent financial data, regulatory changes, and market trends. This ensures their accuracy and relevance.

Can financial modelling predict patient volumes accurately?

Financial modelling can provide valuable insights into patient volumes by analysing historical data, though it may not predict with 100% accuracy.

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