Taking it to the Streets Emerging Practices for Hospitals to Engage Patients in the Field and on the Phone
Presenters Larry Roberts Principal IHMS Mary Lee DeCoster Principal MLDeCoster Consulting
Talking Points Securing Medicaid and Other Healthcare Coverage for the Uninsured Expanded Medicaid Coverage Strategic Choices in finding the Uninsured Coverage Contacting and qualifying the uninsured Touchpoints before Discharge Getting Ready to go to the Field Field Work Challenges you can expect Techniques used to meet those challenges Measuring Success Community Outreach
Assisting Patients in Obtaining Coverage Program Goals Secure healthcare coverage for uninsured patients Improve Third Party Revenues Increase Patient Satisfaction Numbers Develop solid Community Partnerships Challenges To Achieving Goals Limited Financial Resources to Develop a Program Frequent Flyers challenge your success metrics
Measuring Success How to Measure Success Conversion Rate of the Uninsured to a Payer Source Total uninsured patients/encounters (by discharge) Less misclassified patients/encounters (key indicator) Equals Net uninsured patients/encounters (by discharge) Total uninsured patients/encounters converted to third party coverage
Expanded Medicaid States (Impact) Expansion is proportionate to DSH reduction More reasons to find third party coverage
Provider Strategies Working In-house (Provider based Program) Financial Counseling Are you providing Field Services, if so, who is Responsible? New Roles within Patient Access/PFS Costs (insurance, transportation, recruiting, system modifications) Risks (accidents, insurance, training) Monitoring Productivity / Results (does system support monitoring) Financial Incentives for Staff Hospital Based Presumptive Eligibility
Vendor Partner Provider Strategies Who is the Financial First Point Contact with the Patient? Screen Patients for All Coverage Opportunities Financial Assistance (Charity) Applications (taken at bedside) Field Work (necessary and a key success factor) Agree on how to measure Results
NAHAM Access Keys Conversion Rate of Uninsured Patients Good 30% Better 60% Best 90% Important Factors Methodology used to Calculate Conversion Rates Expanded Medicaid Coverage Hospital Presumptive Eligibility
One Provider s Experience Maricopa Integrated Health System (MIHS) In-house Program under the County Included Field Support (and associated costs) Conversion Rate - 28% (approx.) System did not support Measuring Results
One Provider s Experience Outsourced to Vendor Partner Vendor as First Point of Contact for Financial Discussion Staffing in ED (Treat & Release) (7 days - busiest hours) Field Services Community Outreach Granular Reporting on Work Activities
Rewards Partnered Field Services Improvements Conversion Rate of Uninsured to Covered 49% in 6-9 months following implementation Medicaid Revenue Increased $25M in First year Cash Flow increased by $7M in First year Savings Reduced Operations Expense - $150K Annually Labor, Auto, Insurance, Productivity Reduced Bad Debt Expense
Success = Mix of Technology and People Onsite Assistance (Key Success Component) Obtaining a signed Authorization Call Center Outreach for Outpatient Volume Key Partners Vendor Financial Counselors Care Management Nursing
Field Services Personnel Background Social Services Law Enforcement, Department of Corrections Healthcare Public Service Bilingual (usually required) Confident Individual Street Smarts help to keep them safe Able to make important decisions (solo vs paired field visits)
Requesting Field Services Who Can Request a Field Visit Vendor Partner Financial Counselors Care Management Criteria for Field Visits All Uninsured Inpatients Long Stays / High Dollar Cases (setting Priorities) High-Dollar Outpatients / Frequent Flyers Discharge Planning Challenges (Care Management Requests)
Field Services Planning Itinerary Types of Field Visits Locating a Patient Patient Needs Assistance Document Retrieval Transportation Planning the Day Check addresses / Sort by Zip code Scheduled Appointments are First Identify Distressed Neighborhoods (morning visits) Keep in contact with office / supervisor
Field Visit Protocols Tools GPS Document Scanner Laptop / Internet Access Mobile Phone Pepper Spray Business Cards/Letters Safety Awareness Training Self Defense Training Identification Recognizing Danger Bridges Vacant Lots Gunfire Drug/Alcohol Related Challenges Police & Law enforcement
Visiting a Home Knocking on a door may provoke an emotional response Pre-printed Letters & Business Cards as leave behinds make a difference Introduces who you are Explains what you are there for Includes a public service message Invokes a positive response Inbound Calls from Letters Secures a positive contact May require multiple visits
Work Pipeline Field visits made "Positive Contact" made Application complete Application approved Field work pipeline
Pipeline Statistics Facility A 734 Cases 1,352 Field Visits Requested/Completed 1,188 Positive Contacts (87.9%) 686 Applied for coverage (93.5%) 559 Approved for coverage (76.2 %)
Pipeline Statistics Facility B 260 Cases 292 Field Visits Requested/Completed 235 Positive Contacts (80.5%) 222 Applied (85.4%) 157 Approved (60.4%)
Field Service Metrics Reporting Number of Field Visits Requested/Completed Number of Positive Contacts Applications Completed from Field Visits Applications Approved Existing Coverage Discovered due to a Field Visit
Community Outreach Round Table discussions with Homeless Shelters Meetings with religiously based Social Services Participation in Health Fairs Working with Other Community Based Services Foreign Language Resources Additional assistance to patients applying for: Food Stamps WIC Internet / Phone Access Open Enrollment Strategies? Work Programs Utilities Assistance Other
Field Services Benefit Several Constituents Hospitals Reduced Bad Debt Enhanced Third Party Revenue Increased Patient Satisfaction Better Community Support Physicians & Specialists Ongoing Patient Care, Prescriptions 501r Compliance What does your Financial Assistance Plan require?
Strategic Win in a Safety-Net System Revenue Increases Doubled conversion rate from selfpay to coverage through Medicaid Field Services results can pay for the cost of any vendor based program Increased Medicaid Revenue Expense Reductions Outsourcing - Reduces overall expense (labor, cars, insurance, etc.) Reduced bad debt expense
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