Increase Revenue Reducing sliding fee applications Jennifer Hagerty - - PowerPoint PPT Presentation

Manage Coverage & Increase Revenue

Reducing sliding fee applications

Jennifer Hagerty Vice President PointCare

Goal:

Unlock your Enrollment Department

Anchored Renewed Enrolled Reports Qualified

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 1500+ Users

2012 2013 2014 2016 2018

38 States

200,000+ 100,000+ 10,000+ 50,000+ 3,500+

The Enrollment Cycle, Simplified.

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

• Medicaid
• SSI+Medicaid
• Kid Care CHIP
• Emergency Services (ES)
• Presumptive Eligibility (PE)
• Institutional Programs
• Family Planning Program (Title X)
• Pregnant By Choice
• Employed Individuals with Disabilities

(EID)

• Wyoming Cancer Program
• Breast & Cervical Cancer Treatment

(BCCT)

• Children's Special Health (CSH)
• Early Intervention & Education

Program (EIEP)

• HIV Treatment Program
• Crime Victim Compensation Program
• Medicare
• Social Security Disability Insurance

(SSDI)

• Veteran Affairs (VA) Medical Benefits
• Vaccines for Children (VFC)
• Indian Health Services (IHS)
• Tuberculosis Assistance

Additional Benefits

• Women-Infants-Children (WIC)
• Healthy Baby Home Visitation Program
• Wyoming Medication Donation Program (WMDP)
• Head Start Program
• Supplemental Nutrition Assistance Program (SNAP)
• POWER
• Cowboys Against Cancer
• Kickin’ Cancer
• Wyoming Health Insurance Premium Program (WHIPP)
• Qualified Medicare Beneficiary (QMB) Program
• Specified Low-Income Medicare Beneficiary (SLMB) Program
• Qualifying Individual (QI) Program
• Qualified Disabled & Working Individuals (QDWI) Program
• Medicare Extra Help Program
• Low-Income Home Energy Assistance Program (LIHEAP/LIEAP)
• Lifeline
• Vaccines for Uninsured Adults (VUA) Program

Private Plans

• HealthCare.gov (Subsidized & Non-Subsidized) Individual Plans
• Job-Based Options (e.g. Group Plans, SHOP, COBRA, HIPAA, etc.)
• Parent Group Plans for Dependents
• Car Insurance Coverage (Personal Injury Protection (PIP)/No-Fault or

Liability)

• Veterans Choice Program
• Workers’ Compensation
• Black Lung Program

This is 52 % of programs in

• ur system

Changes made all together 31 % of our changes

1748

Total Updates

662

Total Programs Impacted

546

Application Updates

28% of our changes

495

Website Updates

2019 Quarter 1 Highlights

Identify Uninsured Patient Manually Qualify Patient Manage Application Manual Reports Unmanaged Coverage

PointCare

Submit Application

Manual

Spreadsheets

The Enrollment Cycle, Today.

Identify Uninsured Patient Manually Qualify Patient Manage Application Manual Reports Unmanaged Coverage Auto Qualify Patient Automatic Reports Manage Coverage

The Enrollment Cycle

PointCare

Submit Application

Manual Automation

, Simplified.

Spreadsheets

Consistency, Transparency, Transferability

, Today.

Health Care Management Health Coverage Management

5%

• r 3.8M members drop from

public coverage each month

$550-$750

The annual value of a covered Medicaid patient

Medicaid Health System Health System Health System

Current State

Bidirectional Unidirectional

Health Care Management Health Coverage 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:

• Fully managed program database
• Qualify patients in 90 seconds
• Discover all programs
• Provide sign-up checklists for

each

• Text results to patients

Qualify

• Manage enrollments and

documents

• Manage redetermination dates
• Simple work queues
• Collaborate with co-workers
• Manage Sliding Fee

Enroll

• Work with our Customer

Success team

• Identify key areas for

improvement

• Improve your approval success

rate

• Track productivity

Dashboards

High Level Outcomes when Managing Coverage

More covered lives, more revenue Improved access to care for your members Systematic member management Better health outcomes due to continuity of care

What’s next and take-a-ways

Contact Us jhagerty@pointcare.com www.pointcare.com

Enrollment Cycle Certification Evaluating your Enrollment Cycle Webinar 7/30/19 State-Wide Coverage Management Join Ask Learn

Thank you!

Contact Us jhagerty@pointcare.com www.pointcare.com