Manage Coverage & Increase Revenue Reducing sliding fee applications
Jennifer Hagerty Vice President PointCare
Goal: Unlock your Enrollment Department Qualified Enrolled Anchored Renewed Reports
Who is PointCare? ● Founded in 2012 ● The Problem: 5% or 3.8 Million Medicaid Members ○ fall out of coverage every month Our Mission: ● ○ To enable health systems to discover, secure, and manage private and public coverage for their members Our Passion: ● ○ Creating a “no barriers” approach to healthcare
600+ Facilities The Enrollment Cycle, Simplified. 200,000+ 100,000+ 1500+ Users 50,000+ 10,000+ 3,500+ 38 States 2012 2013 2014 2016 2018
Why are clinics defaulting to sliding fee?
An epidemic of uninsured patients visit your FQHC constantly. But most qualify for reimbursable programs. The key is to identify who.
We analyzed 235,000 uninsured patients screened using PointCare. Most qualify for Medicaid and are not being enrolled.
Public Programs Private Plans ● Medicaid ● HealthCare.gov (Subsidized & Non-Subsidized) Individual Plans ● SSI+Medicaid ● Job-Based Options (e.g. Group Plans, SHOP, COBRA, HIPAA, etc.) ● Kid Care CHIP Parent Group Plans for Dependents ● Emergency Services (ES) ● Car Insurance Coverage (Personal Injury Protection (PIP)/No-Fault or ● Presumptive Eligibility (PE) ● Liability) ● Institutional Programs ● Veterans Choice Program ● Family Planning Program (Title X) ● Workers’ Compensation ● Pregnant By Choice Black Lung Program ● Employed Individuals with Disabilities ● Additional Benefits (EID) ● Wyoming Cancer Program ● Women-Infants-Children (WIC) ● Breast & Cervical Cancer Treatment Healthy Baby Home Visitation Program ● (BCCT) Wyoming Medication Donation Program (WMDP) ● Children's Special Health (CSH) ● ● Head Start Program Early Intervention & Education ● ● Supplemental Nutrition Assistance Program (SNAP) Program (EIEP) ● POWER ● HIV Treatment Program Cowboys Against Cancer ● ● Crime Victim Compensation Program Kickin’ Cancer ● Medicare ● ● Wyoming Health Insurance Premium Program (WHIPP) Social Security Disability Insurance ● ● Qualified Medicare Beneficiary (QMB) Program (SSDI) ● Specified Low-Income Medicare Beneficiary (SLMB) Program ● Veteran Affairs (VA) Medical Benefits Qualifying Individual (QI) Program ● ● Vaccines for Children (VFC) Qualified Disabled & Working Individuals (QDWI) Program ● Indian Health Services (IHS) ● ● Medicare Extra Help Program Tuberculosis Assistance ● ● Low-Income Home Energy Assistance Program (LIHEAP/LIEAP) ● Lifeline Vaccines for Uninsured Adults (VUA) Program ●
2019 Quarter 1 Highlights 1748 662 495 546 Changes made all together This is 52 % of programs in 28% of our changes 31 % of our changes our system Total Programs Impacted Total Updates Website Updates Application Updates
The Enrollment Cycle, Today. PointCare Manual Identify Manually Manual Unmanaged Manage Submit Uninsured Qualify Application Application Reports Coverage Patient Patient Spreadsheets
The Enrollment Cycle , Today. , Simplified. PointCare Automation Manual Identify Manually Auto Automatic Manual Unmanaged Manage Manage Submit Uninsured Qualify Qualify Application Application Reports Reports Coverage Coverage Patient Patient Patient Consistency, Transparency, Spreadsheets Transferability
Health Health Care Coverage Management Management
5% or 3.8M members drop from public coverage each month
$550-$750 The annual value of a covered Medicaid patient
Current State Health System Bidirectional Unidirectional Medicaid Health System Health System
Health Health Care Coverage Management Management
How did these clinics adjust their vision to Manage Member Coverage?
We asked an Executive how she felt after investing in her Enrollment Team
The solution from Sliding Fee to Medicaid:
Qualify Fully managed program database ● Qualify patients in 90 seconds ● Discover all programs ● Provide sign-up checklists for ● each ● Text results to patients
Enroll Manage enrollments and ● documents ● Manage redetermination dates ● Simple work queues Collaborate with co-workers ● Manage Sliding Fee ●
Dashboards ● Work with our Customer Success team ● Identify key areas for improvement ● Improve your approval success rate ● Track productivity
High Level Outcomes when Managing Coverage Improved access to care Systematic member for your members management Better health outcomes due More covered lives, to continuity of care more revenue
What’s next and take -a-ways
Learn Join Ask Evaluating your State-Wide Enrollment Cycle Enrollment Cycle Coverage Certification Webinar Management 7/30/19 Contact Us jhagerty@pointcare.com www.pointcare.com
Thank you! Contact Us jhagerty@pointcare.com www.pointcare.com
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