Within the yr since steady Medicaid enrollment ended, greater than a fifth of enrollees have misplaced important protection. Avoidable procedural elements like outdated contact info and missed deadlines are responsible for nearly 70% of disenrollments, emphasizing the pressing want for strong utility and renewal processes. Many disenrolled will wish to reapply, placing further strain on suppliers and sufferers. To rapidly decide eligibility for Medicaid or presumptive charity and guarantee sufferers get the help they want, healthcare organizations like Eskenazi Well being are turning to automated monetary help screening. The Indiana well being system carried out Affected person Monetary Clearance (PFC), leading to a formidable 111% improve in Medicaid approvals in a single yr.
Stephanie Williams, Director of Affected person Entry Providers at Eskenazi Well being, and Kim Berg, Director of Product Consulting at Experian Well being, shared the technique behind the group’s success in a current webinar, summarized under.
Deciding on the fitting monetary support automation to fulfill the wants of sufferers and employees
4 objectives have been prime of thoughts as Eskenazi Well being sought a brand new vendor to enhance Medicaid purposes and approval charges:
Prolong monetary help to underinsured, uninsured and undocumented households
Improve Medicaid utility approval charges by way of collaboration with Indiana Medicaid
Conduct screenings of households in line with their particular wants
Help employees to expedite utility processing
As Stephanie Williams explains, “Each affected person has a distinct story. We wished to guarantee that we carried out one thing that allowed us to hearken to household tales and meet their particular person wants. However we additionally wanted a device that will expedite utility processing to make sure that we met all of the wants of not solely our sufferers, their households but in addition our workers.”
They wanted a versatile device to swimsuit numerous demographics and combine seamlessly with the Epic system employees already used. Affected person Monetary Clearance match the invoice.
Affected person Monetary Clearance guides sufferers to the proper monetary pathway – rapidly and confidently
Kim Berg outlined the three key knowledge components that underpin the device:
Means to pay: Affected person Monetary Clearance runs automated pre-service checks to gauge sufferers’ eligibility for Medicaid and presumptive charity based mostly on their estimated revenue and family dimension. It makes use of this to calculate a Federal Poverty Stage (FPL) proportion to match towards charity care insurance policies.
Propensity to pay: Experian Well being’s confirmed healthcare credit score scoring mannequin tells suppliers how seemingly the affected person is to repay their healthcare debt. Berg says, “We offer a rating of 1 to 999 based mostly on excessive, medium or probability to pay. After all, you’re not going to disclaim that individual charity based mostly on this estimate alone. Nonetheless, if the affected person has a low propensity to pay, you may request paperwork, present estimates and provide different choices up entrance to make sure they perceive their duty. We give you the information to know your sufferers’ monetary scenario so you may have the fitting dialog on the proper level within the income cycle.”
Cost plan advisor: The device additionally identifies these needing cost plans to handle self-pay balances and recommends inexpensive month-to-month cost quantities to extend profitable collections.
A peek inside Eskenazi Well being’s Affected person Monetary Clearance workflow
Eskenazi Well being labored intently with the Experian Well being implementation crew to customise set-up and accommodate the wants of sufferers and households. The crew constructed a affected person questionnaire in order that screening, FPL calculations and propensity to pay scores may very well be compiled rapidly, and in step with Indiana Medicaid rules and organizational insurance policies. They created workflows to facilitate real-time approvals for Eskenazi Well being’s monetary help and sliding scale applications, and integrated an automatic digital system to permit sufferers to add and digitally signal their paperwork.
Williams says, “Working with Experian was nice. Implementation was a breeze and the customization helped us obtain what we would have liked.”
The end result? Medicaid approvals up by 111% in a single yr
After implementing Affected person Monetary Clearance, the variety of authorised Medicaid purposes surged by 111% in 2022 in comparison with the earlier yr. Approvals elevated by an extra 27% in 2023. Williams says the device has additionally helped double appointment capability, enhance utility monitoring and obtain an utility conversion charge of 93%, all with out recruiting further employees.
Williams says the power to drill down into location-specific efficiency (through eCare Subsequent Energy Reporting) aided resourcing selections, particularly in group clinics:
“The facility reporting instruments enable us to interrupt down knowledge by location to make sure we’re staffed appropriately and assembly operational wants. Not solely have been we serving to households and sufferers safe the protection they wanted with Indiana Medicaid, however we additionally gave our monetary counselors and advocates a lift of confidence to know that they’re assembly their particular person efficiency month over month.”
Subsequent steps: Make monetary support simpler for employees and sufferers with self-service screening
Eskenazi Well being’s subsequent step will likely be to include a self-service mannequin that permits sufferers to use for monetary help on-line at their comfort. Self-Service Affected person Monetary Clearance permits sufferers to obtain safe hyperlinks through textual content message or by way of their supplier’s web site or affected person portal. In each instances, sufferers nonetheless have the choice to talk to a monetary counselor if they like, however the workload for employees is prone to be drastically diminished.
Berg says the self-service choices “take the hassle off your employees to allow them to deal with sufferers who actually need assistance with their purposes.”
Watch the webinar to listen to extra about how Eskenazi Well being boosted Medicaid approvals, and the way Self-Service Affected person Monetary Clearance results in extra accomplished purposes, increased affected person satisfaction and improved productiveness.
