By Ethan Davidoff
America’s health systems have reached a breaking point in the COVID-19 environment, with many healthcare executives struggling to find a silver lining in the face of lost revenues. The American Hospital Association (AHA) estimates a total four-month financial impact of $202.6 billion in losses for America’s hospitals and health systems, or an average of $50.7 billion per month, due to the COVID-19 pandemic.
One ray of hope comes in the form of a progressive solution that quickly identifies financial relief for patients, especially those who are underinsured or uninsured, and helps health systems remain solvent and resilient. More than 10,000 medical financial aid programs fund $75 billion of patient care, and the volume of programs and funding continues to grow every year. Such a solution can reap unexpected benefits in a time of great uncertainty:
- Reduced uncompensated care
- Increased patient satisfaction and referrals
- Improved operating margins
- Higher levels of compliance
- Enhanced reputation in the community
To make the most of financial aid opportunities, health systems should embrace technology-enabled services.
Move Beyond Obsolete Methods
Health systems strive to put patients first—and provide the maximum level of financial assistance—but obsolete methods of identifying financial aid resources, matching patients to those opportunities, enrolling patients and managing the claims reimbursement processes mean these resources are often underutilized. This is where innovative, technologically-enabled service solutions can play a key role in accelerating the rate at which health systems can secure reimbursement and help patients afford the care they need.
Atlas Health, for example, offers a solution that can be implemented easily and quickly – with no capital investment, resources or personnel required. Its eligibility matching engine accounts for each financial aid program’s coverage window, which can be up to 365 days retroactive, enabling health systems to convert uncompensated care to revenue.
Optimize Financial Counseling
Program policies and patient eligibility are in constant flux, which often leads to missed opportunities for patients to enroll in financial aid programs. The right solution can predict the optimal eligible coverage options based on electronic health record (EHR) data and the results of a simple questionnaire administered at registration. This enables efficient routing of tasks and automation across a wide variety of financial counselors, financial navigators, patient assistance coordinators and customer service representatives.
Health systems should look for an AI-powered technology solution to increase health system reimbursement and patient savings. This level of capability ingests EHR data on a daily basis and uses algorithms to analyze clinical, insurance and financial data to match patient accounts to reimbursement opportunities.
Ideally, matched patient information is fed to a cloud-based portal with functionality to streamline the enrollment and reimbursement workflows. It’s also important for the team of financial counselors to appear to patients and programs as health system staff and work the opportunities, submit claims and secure reimbursements so that positive reputation value can be retained by the health system to help establish goodwill with the communities it serves.
Completely digital and pre-populated applications, along with digital communications to secure patient authorization and information, can potentially contribute to a drastic reduction in the amount of time it takes to submit applications and clean claims. What’s more, health care workers report burnout due to computer use and the rising burden of administrative work, which has been exacerbated by COVID-19. For this reason, it’s important to find a solution that offers a remote financial counseling team to augment existing resources and decrease the burden of working with thousands of financial aid programs
Prioritize Opportunities and Resources
The best financial aid solutions work with all 3,000+ philanthropic programs across inpatient, outpatient, infusion, oncology, specialty pharmacy and outpatient pharmacy. The goal is to enable health system chief financial officers and chief pharmacy officers to reduce uncompensated care while better supporting their community, as well as those seeking an immediate cash lift due to declining volumes from the COVID-19 pandemic.
Once health systems have access to significantly more medical financial aid opportunities, they’ll need to prioritize their efforts to efficiently maximize reimbursements and allocate appropriate resources based on the opportunities for the communities they service.
In some cases, philanthropic programs rapidly open and close based on availability of funds and might close within a matter of hours. Health systems should have a system in place to tap into these programs as quickly as possible. Therefore, it’s important to find a solution that utilizes smart web crawler technology to sweep all medical financial aid programs every few minutes, triggering real-time email alerts when a program becomes open for enrollment. These real-time alerts give financial counselors the opportunity to enroll patients in programs they might otherwise miss.
Because each reimbursement opportunity is associated with a date by which a patient must be enrolled, a claim must be submitted, or a date by which a medication must be ordered, the solution should map each program coverage window to each matched account. When financial counselors adhere to those dates and deadlines, they can work in order of chronological priority to convert charity care or bad debt to revenue for the healthcare system. This is a critical imperative to reduce uncompensated care and improve free cash flow.
Consider the results of these two real-world scenarios, which demonstrate what health systems can expect when they address medical financial aid with the right technology and service expertise:
- Within the first 90 days of implementation one health system experienced a reimbursement lift from philanthropic aid programs by 241%, putting the health system on track to recover more than $3 million annually while eliminating patients’ out-of-pocket costs. At 180 days post-implementation, the annual run-rate reached nearly $4 million
- Another health system saw a reimbursement lift from medical financial aid programs by 192%, putting the health system on track to recover more than $5.7 million annually while helping reduce financial burden for patients
Finding the right medical financial aid solution results in improved cost savings for patients at a time when they are feeling most vulnerable, especially during the COVID-19 pandemic when many individuals are furloughed and without health insurance coverage — 43% of working-age adults had no stable insurance in the first half of 2020 due to the pandemic and affordability issues. The leading solutions enable health systems to better support the communities they serve by finding ways to improve access to lifesaving treatments they may not have otherwise been able to afford.
Ethan Davidoff is Founder & CEO of Atlas Health.
With over 10 years of healthcare, enterprise software, and cyber security experience, Ethan Davidoff founded Atlas Health in 2017 and maintains the role of CEO. Under his direction, the company has become the leader in philanthropic reimbursement.
Prior to Atlas Health, Davidoff was a founding member of RiskIQ. Serving as Vice President and General Manager of Internet Security, he managed a cross-functional team to grow an emerging business unit with fortune 500 and top technology companies.
Davidoff studied business, entrepreneurship, and software development at the University of California at Berkeley and the London School of Economics.