targeting self-pay patients for enrollment in ny...
TRANSCRIPT
October 19, 2016
Targeting Self-Pay Patients for Enrollment in NY Medicaid
Expansion and Health Insurance Marketplace Plans
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"There have been many revolutions
over the last century, but perhaps
none as significant as the longevity
revolution. We are living on average
today 34 years longer than our great-
grandparents did. Think about that:
that's an entire second adult lifetime
that's been added to our lifespan."
- Jane Fonda
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Healthcare Reimbursement Challenges
Enhancing the Patient Experience
Case Study, Best Practices, and Lessons Learned
Recap
Questions
Key Talking Points
3
3
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Low Reimbursement Challenges Providers
42% NY has the highest % of loss making hospitals in the United States
2nd NY’s rank nationally for highest Medicaid spender1
46th NY’s rank nationally in doctors willingness to treat Medicaid patients
1,900,000 Low-income NY residents who have gained insurance coverage through Medicaid
7,450,000 Number of people enrolled under Medicaid in NY2
49th NY’s rank in Medicaid reimbursements
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The Exchange: Payers Participating and Exiting
5
2014 HIX Participants 2015/16
HIX Participants
2017 Plans Exiting or
Reducing HIX
v v
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Rate increases are a multiple of inflation
6
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NY Major Hospital System Mergers in 2015 & 2016
A December 9 PricewaterhouseCoopers report called 2016 the “Year of Merger Mania”
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Hospitals will continue to be a main health facilitator which the uninsured pass through
Hospitals must assist individuals to obtain health coverage, encourage them to enroll before
they need care, and to maintain that coverage
Uninsured Difference ACA Impact
Uninsured Pre-ACA
(2010)
Rate Post-ACA
(2014)
Rate Post-ACA
(2015)
Difference between
2014 to 2015
National 15.50% 11.70% 9.1% - 22%
New York 11.90% 8.70% 5.20% - 40%
New Jersey 13.24% 10.93% 7.8% - 29%
Connecticut
9.10% 6.93% 3.8% - 45%
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Presidential Nominees’ Healthcare Policies
• Defend the Affordable Care Act and build on it to
slow the growth of out-of-pocket costs
• Crack down on rising prescription drug prices
• Protect women’s access to reproductive health care
• Proposes an authority to block or modify
unreasonable health insurance premium rate
increases so that coverage is more affordable
• Proposes to give everyone the choice of a public-
option insurance plan, and to expand Medicare by
allowing people 55 years or older to opt in
• Completely repeal Obamacare
• Allow all payers to offer insurance in any state
• Allow individuals to use HSAs tax free
• Require price transparency
• Block-grant Medicaid to the states
• Remove barriers to entry into free markets for drug
providers that offer safe, reliable and cheaper
products
Hillary Clinton Donald Trump
Impact on... Medicaid
HIX
Will Expand
Will Expand Impact on...
Medicaid
HIX
Unclear
Unclear
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It is unlikely that White House, House and
Senate (with 60 vote majority) will align.
Developing bipartisan support is unlikely
given the prevalence of non-competitive
districts, created through gerrymandering
Little new major federal policy will be created due to polarization
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Public Concern Persists
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• 47% of U.S. workers
can’t come up with
$400 for an emergency
• 71% concerned about
covering everyday
expenses
• Median net worth down
85.3% from 1983 to
2013 (2013 = $54,000)
• LA free clinic: 10,000
patients showed up, a
majority with health
insurance
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Patient Spending on Deductibles Outpacing Wages
12
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All providers must revamp their patient experience to strategically
transform the services offered in the new ACA environment!
Providers who think outside the box and successfully re-engineer
their end-to-end patient experience will be rewarded with:
Improved revenues and lower attrition rates
Benefits from increased patient advocacy, heightened brand
awareness
More word-of-mouth referrals
Patient Relationship is Central
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Multi-Faceted Approach
Enhanced
Patient
Experience
System
Alignment
Training
Measurement
Service Touch
Points
Ongoing
Communications
Service Recover
Processes
Service
Achievement
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Virtua, Sutherland Healthcare, and the Sutherland Innovation Labs observed staff and patients in a variety of settings, with a focus on billing, registration, and other non-clinical issues
The study leveraged the science of ethnology - researching in the natural hospital setting to better understand patients, their behaviors, and their overall experience
Though there were a variety of specific questions, the more general brief was to observe, see what was working well and where there was room for improvement
We spent two weeks in Virtua’s facilities and Sutherland offices for the study
This was a qualitative study – We spoke to almost 100 patients and members of staff in a large variety of settings
Studying the Patient Experience
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Six Key Findings
1. Offer more online self-service options
2. Move from paper to online to streamline processes and
reduce errors
3. Providers need to make medical costs more transparent
upfront, present financial aid options early on, and provide
empathetic support for those with payment issues
4. Patients want and need to discuss costs to make informed
decisions about their healthcare
5. Health insurance exchanges: There is an opportunity for
healthcare providers to help patients choose plans that
have their facilities in-network
6. Brochure and poster overload: Patients find it difficult to
pay attention to all these messages
Studying the Patient Experience
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Educating and enrolling self-pay patients under the New Jersey Family Care and Health
Insurance Marketplace Exchange
Mailers, billboards, and radio ads – directing uninsured individuals to a toll-free, 1-800 call
center
Financial counselors leveraged to educate patients who are uninsured and get them
qualified for the government programs that exist today
Marketing mailers to identified uninsured people within the community
• Financial counselors fielded calls and scheduled onsite appointments
Case Study: Launch an Outbound Campaign
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Results
We reached out to 250,000 commercially insured
individuals by mail in the first phase
Marketing mailers went out to 100,000 uninsured
people in the second and third phases
Our financial counselors fielded a total of 792 calls
and scheduled 773 onsite appointments
142 HIX enrollments have been completed while
another 122 people have completed HIX applications
Case Study: Launch an Outbound Campaign
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Design effective enrollment procedures and
practices
Optimize staffing and support for maximum
effectiveness
Work in tandem when educating the patient
Position trained staff at critical access points
Use innovative strategies to reach vulnerable
populations
Outreach and partner with key external resources
Assess the new environment
Eligibility Screening & Enrollment Principles and Best Practices
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Written procedures that address the various steps to enroll
uninsured patients in appropriate programs
Procedural aspects required to implement new processes,
measures or tools, including any technology or software
Operational aspects of using the revised process, and include
cross references to staffing roles and responsibilities required
to implement and operate the process
Reflects the organizational mission, vision and values to meet
care needs in the community
New Patient Experience Procedures
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To warrant an effective eligibility/enrollment process:
Providers should determine the optimal level of staffing and
support necessary to safeguard maximum efficiency
Staffing for outreach, eligibility and enrollment can unite with the
clinical staff to significantly improve access to health coverage
for uninsured individuals
Help patients navigate the system and enroll in appropriate
programs
• Staffing characteristics and needs
• Training, ongoing education, and assessment
• Specific staff-education with a focus on patient education
communications
Staffing and Support for Maximum Effectiveness
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Have Financial Counselors work to develop a partnership-like
relationship with the patient
The goal is to create trust and engage the patient in a
conversation about their health coverage options
Organization-wide values influence how to approach the
patient
Staff is trained to try to make the patient more comfortable
discussing what can be sensitive information (for example,
income or employment status)
Partnership-Like Relationship With Patients
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The eligibility process is complicated and confusing for most patients
Many patients who come to hospitals as uninsured are eligible for one or more coverage
programs, but may not know it
Many hospitals find it helpful to use an advocacy, partnering, or financial counselors
approach in each patient eligibility/enrollment
• Creates a dignified experience, which engages the patient in a discussion of coverage in
a non-threatening way
This includes:
• Young adults ages 18–34
• Dependents under age 26
• Children under age 19
• Individuals with pre-existing conditions
• Immigrants awaiting legal status
• Low-income adults without dependents
• Individuals who recently lost a job
Patient Advocate Approach
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Hospitals currently are one of the most important doors through which patients access
health coverage
More important than ever with the newly-eligible population increases through the ACA
Positioning enrollment staff in these access points is a key way in which hospitals build
strong relationships with patients
Highly trained personnel at strategically identified sites ensures that the hospitals reach
the greatest number of individuals requiring coverage eligibility and enrollment
assistance
Positioning Trained Staff at Critical Access Points
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Extensive outreach and partnering initiatives with entities in surrounding communities
These include other healthcare organizations, physicians and other providers, state and
county agencies, and other sites in the community such as schools and places of worship
Many groups offer an extensive array of community outreach programs to serve our
community
Professional staff and volunteer network continually work to offer meaningful ways to help
people enjoy better health, greater personal independence and a higher quality of life
Outreach and Partnering with Key External Stakeholders
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Many Providers decide to use eligibility and enrollment service companies based on
analysis of capabilities and expertise
Hospitals commonly assess organizational eligibility and enrollment functions and
compare them to vendor capabilities
• With the broad range of available programs and enrollment requirements, offering
assistance for all types of applications and ensuring their timely completion can be
challenging
• Requires experts who are knowledgeable about local, county, state, federal and private
programs on all levels, and many “boots on the ground” to follow up with coverage
program staff and patients to obtain required documents
Assessment of Capabilities and Potential Assistance
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Innovation
Revamping the patient experience transforms services offered in the new ACA environment
which improves revenues, lowers attrition rates and expands brand awareness
Leverage ethnology techniques when trying to understand the patient experience
A recent qualitative study of patients with a focus on billing, registration and non-clinical
issues identified six immediate opportunities for improvement
Providing leadership and education in an “all-hands-on-deck” approach to enroll the
eligible population is vital to ensure that individuals will have coverage
Developing a partnership-like relationship with the patient through the eligibility process
and financial counselors requires planning and execution
Recap – Key Takeaways
Questions?
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Horses for Sources: Recasting the Patient Billing Experience with Design Thinking
Sutherland Innovation Labs: How do you make hospital processes more efficient and
compassionate?
SHS Optimizing the Patient Experience Brochure
Additional Resources
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About Virtua
Virtua is a comprehensive South Jersey
healthcare system with three hospitals in the
New Jersey area.
Find out more at https://www.virtua.org/
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About Sutherland Healthcare Solutions & Sutherland Innovation Labs
Sutherland Healthcare Solutions is a leading
provider of Revenue Cycle Management, Coding,
and Patient Experience Solutions. SHS is a wholly
owned subsidiary of Sutherland Global Services.
Find out more at www.SutherlandHealthcare.com
Sutherland Innovation Labs provides strategic
innovation, customer experience research and
design thinking to create beautifully designed
and intuitive solutions. SIL is a wholly owned
subsidiary of Sutherland Global Services.
Find out more at www.SutherlandLabs.com
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About the Speaker
Tina Eller
Vice President of RCM and Patient Experience Solutions
Sutherland Healthcare Solutions
Phone: 720-206-9142
Email: [email protected]
LinkedIn Profile: Here