Medical financial aid can help patients cover bills during COVID-19 pandemic and beyond
Medical financial aid programs can be a life jacket for patients who are facing burdensome medical bills.
With businesses struggling under the financial burdens associated with COVID-19 and pressures to keep their workforce intact while maintaining health benefits for employees, the fall-out of this pandemic is raining down hard upon individuals and families. On the darkest side, many are facing illness and hospitalizations exacerbated by work furloughs, and millions of people are losing their health insurance coverage completely. For those workers lucky enough to retain their jobs, many have no choice but to accept diminished coverage, increasingly higher deductible plans and extraordinary out-of-pocket expenses for medical services and products.
In the vortex of this seemingly endless cascade of health benefits challenges, America’s health systems are bearing the brunt of uncompensated and charity care that translates into 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. Although the federal government moved quickly to provide relief, more help is needed.
Related: Expect more medical debt in the wake of COVID-19
There is one piece of good news shining on this otherwise dismal outlook: the availability of a progressive model for medical financial aid.
Fortunately, 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.
This is an opportunity for stakeholders throughout the benefits community to play an essential role in boosting awareness of this medical financial aid life jacket that is helping to tap into badly needed funds that bring financial relief. Despite current uncertainties, this financial relief represents a rare chance to help both patients and health systems remain solvent and resilient.
Superpower your financial counseling department with technology
In some cases, health systems may have designed a financial counseling strategy, but lack the technology to fully optimize the opportunities. For this reason, an end-to-end financial aid enrollment solution can help health systems capture reimbursement from medical financial aid programs and enable patients to access and afford care.
Health systems strive to put patients first—and provide the maximum level of financial assistance—but outdated methods of identifying financial aid resources, matching patients to those opportunities, and managing the application and claims process, mean these resources are often underutilized. This is where innovative, technologically advanced solutions like Atlas Navigator play a key role in accelerating the rate at which health systems can secure reimbursement and help patients afford the care they need.
Program policies and patient eligibility are dynamic, however, which often leads to missed opportunities for patients to enroll. AI-powered technology can provide a tech-enabled service that combines a constantly updated program database, matching engine and cloud-based enrollment portal with expert financial counselors to increase health system reimbursement and patient savings. This level of capability ingests health system Electronic Health Record (EHR) data on a daily basis and uses algorithms to analyze clinical, insurance and financial data to match patient accounts to reimbursement opportunities.
Matched patient information is fed to a cloud-based portal with functionality to streamline the enrollment and reimbursement workflows. A team of financial counselors, who appear to patients and programs as health system staff, work the opportunities, submit claims and secure reimbursements, so positive reputation value is retained by the health system to help establish goodwill with the communities it serves.
Implement quickly, during the pandemic and beyond
Now, more than ever, health systems need rapid implementation of new solutions. In the case of Atlas Navigator, health systems are provided with EHR-specific code, so their IT team doesn’t have to write any code to push and pull data with the cloud-based enrollment portal. With this method, the data integration is solved in days, not months.
In addition, expert financial counselors use the cloud-based enrollment portal, so no training is necessary in order for them to begin helping patients and for health system product owners to gain visibility into progress and reporting.
Take a holistic approach to financial counseling
Many health systems employ various vendors and solutions across their practice areas and departments. But a unified approach with one vendor solution that can holistically service all areas provides the consistency and visibility across all opportunities that health system administrators need to maximize reimbursements, ensure a cohesive patient experience and allocate effective and efficient resources.
The optimal 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 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.
Prioritize opportunities and resources
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 existing state of their team and opportunities for the communities they service.
Ideally, a matching engine accounts for each program’s coverage window, which can be up to 365 days retroactive. This means that most health systems would benefit from focusing on generating reimbursement from these inactive accounts before moving on to others. 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. Smart web crawler technology can weep 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 dropped, 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.
Expect an immediate lift from these efforts
Two real-world scenarios demonstrate what health systems can expect when they address medical financial aid with technology, automation, expediency and a holistic approach in partnership with a tech solution:
- 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
Take on the burden and the goodwill
Rather than putting administrative burdens on patients, especially during the pandemic, the right medical financial aid platform lets health systems deliver this service–profitably–to their communities. The result is cost savings for patients and increased revenue for health systems, eliminating inefficiencies and improving experiences for everyone.
It’s about improving cost savings for patients at a time when they are feeling most vulnerable, especially during the COVID-19 pandemic. These capabilities also enable health systems to better support the communities they serve, finding ways to improve access to lifesaving treatments they may not have otherwise been able to afford.
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