Compliatric webinar series 5 enrollment best practices to decrease uninsured rates

C
CompliatricCompliatric
COMPLIATRIC WEBINAR SERIES
5 Enrollment Best Practices to
Decrease Uninsured Rates
www.compliantfqhc.com
Presented by: Jennifer Miksch
VP, Strategic Partnerships
PointCare
+
Enrollment
5 Enrollment Best Practices to
Decrease Uninsured Rates
Alex Richmond
Sales Executive
PointCare
Jennifer Miksch
VP, Strategic Partnerships
PointCare
Who is PointCare?
● 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
1. Identify enrollment best practices
2. Discover all available programs for your state
3. Build strategies for increasing approval rates
4. Learn how to collect and interpret enrollment data
5. Directly connect your O&E staff to Clinic revenues
Learning Objectives
Poll
How Many of Your Members Do You Think
Drop from Medicaid Coverage Each Month?
5%
or 3.8 Million Medicaid patients
drop from public coverage every
month.
$550-$750
The annual value of a covered
Medicaid patient
Medicaid
Health System
Health System
Health System
Current State
Bidirectional Unidirectional
An epidemic of uninsured patients visit
your FQHC constantly
But most qualify for reimbursable
programs. The key is to identify who
Poll
What Percentage of Your Self-Pay Population
Qualifies for Medicaid Today?
We analyzed 235,000 uninsured
patients screened using our
PointCare Qualify tool.
Most qualify for Medicaid and
are not being enrolled
Illinois Programs
Private Plans
● HealthCare.gov (Subsidized & Non-Subsidized) Individual Plans
● Job-Based Options (e.g. Group Plans, SHOP, COBRA, HIPAA, etc.)
● Illinois Comprehensive Health Insurance Plan (ICHIP)(HIPAA Plans)
● Parent Group Plans for Dependents
● Car Insurance Coverage (Personal Injury Protection (PIP)/No-Fault or
Liability)
● Community Care Program (formerly Veterans Choice Program)
● Workers’ Compensation
● Black Lung Program
Additional Benefits
● Women-Infants-Children (WIC)
● Head Start Program
● AIDS Drug Assistance Program (ADAP)
● Illinois HIV Care Connect
● CHIC-Premium Assistance Program
● Supplemental Nutrition Assistance Program (SNAP)
● Commodity Supplemental Food Program (CSFP)(8 Counties)
● Temporary Assistance for Needy Families (TANF)
● Child Care Assistance Program (CCAP)
● Refugee Resettlement Program (RRP)
● Aid to Aged, Blind, & Disabled (AABD)
● Health Insurance Premium Payment (HIPP) Program
● OSF HealthCare Financial Assistance Program
● Senior Health Insurance Program (SHIP)
● Medicare Extra Help Program
● Qualified Medicare Beneficiary (QMB) Program
● Specified Low-Income Medicare Beneficiary (SLMB) Program
● Qualifying Individual (QI) Program
● Qualified Disabled and Working Individuals (QDWI) Program
● Low-Income Home Energy Assistance Program (LIHEAP/LIEAP)
● Lifeline
Illinois Programs Continued
Public Programs
● Medicaid
● All Kids Assist
● All Kids Share
● All Kids Premium Level 1
● All Kids Premium Level 2
● Emergency Medical Coverage for Non-Citizens
● Health Benefits for Workers with Disabilities (HBWD)
● Medicaid Long-Term Care
● Medicaid Spend Down Program
● Medicaid Presumptive Eligibility (MPE)
● Moms & Babies
● Presumptive Eligibility
● Family Planning Program (Title X)
● Illinois Breast & Cervical Cancer Program (IBCCP)
● Illinois Comprehensive Health Insurance Plan (ICHIP)
● Refugee Program
● Illinois State Chronic Renal Disease Program
● Family Planning
● Community Care Program
● Crime Victim Compensation Program
● Veterans Care Program
● Vaccines for Children (VFC)
● Vaccines for Adults (VFA)
● Medicare
● Social Security Disability Insurance (SSDI)
● Veteran Affairs (VA) Medical Benefits
● Supplemental Security Income (SSI)
● Health Benefits for Immigrant Seniors
County-Based Public Programs
● Women's Health (Lake County)
● Ryan White AIDS/HIV Part A Program (Serves 9 Counties)
● WISEWOMAN (Serves 15 Counties)
● CEDA - Energy Assistance Program (LIHEAP)(Cook County)
● CEDA - Energy Assistance Program (STW)(Cook County)
● CEDA - Family Support and Community Engagement (FSACE)(Cook
County)
● CEDA - Home Weatherization Program (Cook County)
● CareLink (Cook County)
● Dental Referral Program (DRP)(Champaign County)
● Carle Financial Assistance Program (Champaign County)
5 Enrollment Best Practices
What is
Coverage
Management?
Coverage Management means
tracking and preventing lapses
in your member’s coverage.
With the right data and the right
management platform, your
uninsured patients can become
covered members and stay that
way!
● Mapping out your current process and identifying a baseline makes it easier to
track and quantify change
● We know you are making a positive impact on the community, but it can be
difficult to measure results
● Determining where you started sets you up for success
Step One: Understand Your Current
Enrollment Process
How to Evaluate Your
Current Enrollment Cycle
Identify
Uninsured
Patient
Manually
Qualify
Patient
Manage
Application
Unknown
Approvals
Unmanaged
Coverage
PointCare
Submit
Application
Manual
Spreadsheets
The Enrollment Cycle, Today.
● Do we have enrollment staff responsible for
enrolling patients?
● How many patients qualify, submit, and get
approved monthly?
● How reliable is this data? Spreadsheets or
systems-based?
● What is our process for approving & actively
anchoring patients?
● What is our process for redetermining
member coverage?
● What happens if an enroller leaves the
organization?
Evaluation
Questions
● Ensure you are up-to-date with the latest eligibility requirements
● Qualify patients for all programs and benefits, there are many options beyond
Medicaid
○ Public programs
○ Private programs
○ Additional benefits
● Develop a systematic qualification process
● All-in-all there are over 1,300 programs available across the United States and
they change constantly
Step Two: Increase Accuracy in your
Qualifications
Poll
How Are You Screening Patients Today to
Determine Eligibility?
How Do You
Screen Today?
● Limited time to reach
patients
● Keeping patients engaged
throughout the enrollment
process is challenging
● Eligibility requirements and
program information is
always shifting
1461
Total Updates
This is 34% of
programs in our system
Total Programs Impacted Application Updates
Website Updates
2021 Quarter 2 Highlights
470 423 592
29% of our changes 41% of our changes
Total changes made
PointCare’s
Screening Best
Practices
● Screen consistently and collect
data
● Screen for all programs, including
programs that address SDoH
● Regularly maintain your
knowledge base of rules and
program data
● Ask yourself, am I getting the 81%
of self-pay for expanded states?
● How are you determining Medicaid approvals?
● It’s critical to anchor a member before they are assigned to another FQHC
● Need a member coverage profile that makes it easy to:
○ Anchoring
○ Recertification
○ Coverage churn
● EMRs may not always have the best tools for member management
● When reterdermination is active, 5% of members drop from coverage each
month. This makes keeping up on spreadsheets challenging
Step Three: Quickly Anchor Patients to
Your Clinic
Anchoring Best
Practices
● Identify roles and
expectations for reach outs
based on Medicaid
verifications
● Stress the importance of
PCP selection
● Provide a script around PCP
selection and methods
● Communicate retention
metrics and wins
● Redetermination is on the horizon, and the time to start planning is now
● Each member that drops from coverage results in financial loss to your FQHC
from both capitation payments and uncovered visits
● Members have limited visibility as to when their coverage expires
● Medicaid does not easily provide access to coverage effective dates
● If a member does fall out of coverage, it is important to have a system that
alerts you to this change. It is easier to keep someone covered than to keep re-
enrolling them when they arrive for care
Step Four: Prepare for Redetermination
Important Redetermination Updates
In August CMS released an update on Redetermination
and the Public Health Emergency (PHE)
CMS announced that states will now have 12
months, instead of 6, to complete outstanding
eligibility and enrollment tasks post PHE
After the PHE lifts, states will still have up to 4
months to begin processing applications
● Ask yourself, what numbers would you like to track?
● Who needs these numbers?
○ Do you need to share with leadership?
○ Are you reporting them for grants?
○ Do you have specific department goals you want to hit?
● How often would you like to track these numbers?
● Do you have a system in place to properly capture the data or is it manual?
Step Five: Continually Measure
Outcomes
Bob Janet Kaila Mike Jill Bob Janet Kaila Mike Jill
Bob
Janet
Kaila
Mike
Jill
Qualified
Anchored
Submitted
Renewed
Approved
Reports
Numbers You
Should be
Tracking
Benefits:
● Team performance transparency
● Identify areas for improvement
● Directly connect the O&E staff to
revenue
● Make better decisions based on
data
Where Do You Begin?
Identify
Uninsured
Patient
Manually
Qualify
Patient
Manage
Application
Unknown
Approvals
Unmanaged
Coverage
Auto
Qualify
Patient
Automatic
Approvals
Manage
Coverage
The Enrollment Cycle
PointCare
Submit
Application
Manual
PointCare
, Simplified.
Spreadsheets
Consistency, Transparency,
Transferability
, Today.
Expected Outcomes
More covered lives
and more revenue
Pleasant patient
experience
Systematic member
management
High quality data
that’s useable
Need help evaluating your
current enrollment process?
Contact Us
info@pointcare.com
www.pointcare.com
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Compliatric webinar series 5 enrollment best practices to decrease uninsured rates

  • 1. COMPLIATRIC WEBINAR SERIES 5 Enrollment Best Practices to Decrease Uninsured Rates www.compliantfqhc.com Presented by: Jennifer Miksch VP, Strategic Partnerships PointCare
  • 3. 5 Enrollment Best Practices to Decrease Uninsured Rates
  • 4. Alex Richmond Sales Executive PointCare Jennifer Miksch VP, Strategic Partnerships PointCare
  • 5. Who is PointCare? ● 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
  • 6. 1. Identify enrollment best practices 2. Discover all available programs for your state 3. Build strategies for increasing approval rates 4. Learn how to collect and interpret enrollment data 5. Directly connect your O&E staff to Clinic revenues Learning Objectives
  • 7. Poll How Many of Your Members Do You Think Drop from Medicaid Coverage Each Month?
  • 8. 5% or 3.8 Million Medicaid patients drop from public coverage every month.
  • 9. $550-$750 The annual value of a covered Medicaid patient
  • 10. Medicaid Health System Health System Health System Current State Bidirectional Unidirectional
  • 11. An epidemic of uninsured patients visit your FQHC constantly But most qualify for reimbursable programs. The key is to identify who
  • 12. Poll What Percentage of Your Self-Pay Population Qualifies for Medicaid Today?
  • 13. We analyzed 235,000 uninsured patients screened using our PointCare Qualify tool. Most qualify for Medicaid and are not being enrolled
  • 14. Illinois Programs Private Plans ● HealthCare.gov (Subsidized & Non-Subsidized) Individual Plans ● Job-Based Options (e.g. Group Plans, SHOP, COBRA, HIPAA, etc.) ● Illinois Comprehensive Health Insurance Plan (ICHIP)(HIPAA Plans) ● Parent Group Plans for Dependents ● Car Insurance Coverage (Personal Injury Protection (PIP)/No-Fault or Liability) ● Community Care Program (formerly Veterans Choice Program) ● Workers’ Compensation ● Black Lung Program Additional Benefits ● Women-Infants-Children (WIC) ● Head Start Program ● AIDS Drug Assistance Program (ADAP) ● Illinois HIV Care Connect ● CHIC-Premium Assistance Program ● Supplemental Nutrition Assistance Program (SNAP) ● Commodity Supplemental Food Program (CSFP)(8 Counties) ● Temporary Assistance for Needy Families (TANF) ● Child Care Assistance Program (CCAP) ● Refugee Resettlement Program (RRP) ● Aid to Aged, Blind, & Disabled (AABD) ● Health Insurance Premium Payment (HIPP) Program ● OSF HealthCare Financial Assistance Program ● Senior Health Insurance Program (SHIP) ● Medicare Extra Help Program ● Qualified Medicare Beneficiary (QMB) Program ● Specified Low-Income Medicare Beneficiary (SLMB) Program ● Qualifying Individual (QI) Program ● Qualified Disabled and Working Individuals (QDWI) Program ● Low-Income Home Energy Assistance Program (LIHEAP/LIEAP) ● Lifeline
  • 15. Illinois Programs Continued Public Programs ● Medicaid ● All Kids Assist ● All Kids Share ● All Kids Premium Level 1 ● All Kids Premium Level 2 ● Emergency Medical Coverage for Non-Citizens ● Health Benefits for Workers with Disabilities (HBWD) ● Medicaid Long-Term Care ● Medicaid Spend Down Program ● Medicaid Presumptive Eligibility (MPE) ● Moms & Babies ● Presumptive Eligibility ● Family Planning Program (Title X) ● Illinois Breast & Cervical Cancer Program (IBCCP) ● Illinois Comprehensive Health Insurance Plan (ICHIP) ● Refugee Program ● Illinois State Chronic Renal Disease Program ● Family Planning ● Community Care Program ● Crime Victim Compensation Program ● Veterans Care Program ● Vaccines for Children (VFC) ● Vaccines for Adults (VFA) ● Medicare ● Social Security Disability Insurance (SSDI) ● Veteran Affairs (VA) Medical Benefits ● Supplemental Security Income (SSI) ● Health Benefits for Immigrant Seniors County-Based Public Programs ● Women's Health (Lake County) ● Ryan White AIDS/HIV Part A Program (Serves 9 Counties) ● WISEWOMAN (Serves 15 Counties) ● CEDA - Energy Assistance Program (LIHEAP)(Cook County) ● CEDA - Energy Assistance Program (STW)(Cook County) ● CEDA - Family Support and Community Engagement (FSACE)(Cook County) ● CEDA - Home Weatherization Program (Cook County) ● CareLink (Cook County) ● Dental Referral Program (DRP)(Champaign County) ● Carle Financial Assistance Program (Champaign County)
  • 16. 5 Enrollment Best Practices
  • 17. What is Coverage Management? Coverage Management means tracking and preventing lapses in your member’s coverage. With the right data and the right management platform, your uninsured patients can become covered members and stay that way!
  • 18. ● Mapping out your current process and identifying a baseline makes it easier to track and quantify change ● We know you are making a positive impact on the community, but it can be difficult to measure results ● Determining where you started sets you up for success Step One: Understand Your Current Enrollment Process
  • 19. How to Evaluate Your Current Enrollment Cycle
  • 21. ● Do we have enrollment staff responsible for enrolling patients? ● How many patients qualify, submit, and get approved monthly? ● How reliable is this data? Spreadsheets or systems-based? ● What is our process for approving & actively anchoring patients? ● What is our process for redetermining member coverage? ● What happens if an enroller leaves the organization? Evaluation Questions
  • 22. ● Ensure you are up-to-date with the latest eligibility requirements ● Qualify patients for all programs and benefits, there are many options beyond Medicaid ○ Public programs ○ Private programs ○ Additional benefits ● Develop a systematic qualification process ● All-in-all there are over 1,300 programs available across the United States and they change constantly Step Two: Increase Accuracy in your Qualifications
  • 23. Poll How Are You Screening Patients Today to Determine Eligibility?
  • 24. How Do You Screen Today? ● Limited time to reach patients ● Keeping patients engaged throughout the enrollment process is challenging ● Eligibility requirements and program information is always shifting
  • 25. 1461 Total Updates This is 34% of programs in our system Total Programs Impacted Application Updates Website Updates 2021 Quarter 2 Highlights 470 423 592 29% of our changes 41% of our changes Total changes made
  • 26. PointCare’s Screening Best Practices ● Screen consistently and collect data ● Screen for all programs, including programs that address SDoH ● Regularly maintain your knowledge base of rules and program data ● Ask yourself, am I getting the 81% of self-pay for expanded states?
  • 27. ● How are you determining Medicaid approvals? ● It’s critical to anchor a member before they are assigned to another FQHC ● Need a member coverage profile that makes it easy to: ○ Anchoring ○ Recertification ○ Coverage churn ● EMRs may not always have the best tools for member management ● When reterdermination is active, 5% of members drop from coverage each month. This makes keeping up on spreadsheets challenging Step Three: Quickly Anchor Patients to Your Clinic
  • 28. Anchoring Best Practices ● Identify roles and expectations for reach outs based on Medicaid verifications ● Stress the importance of PCP selection ● Provide a script around PCP selection and methods ● Communicate retention metrics and wins
  • 29. ● Redetermination is on the horizon, and the time to start planning is now ● Each member that drops from coverage results in financial loss to your FQHC from both capitation payments and uncovered visits ● Members have limited visibility as to when their coverage expires ● Medicaid does not easily provide access to coverage effective dates ● If a member does fall out of coverage, it is important to have a system that alerts you to this change. It is easier to keep someone covered than to keep re- enrolling them when they arrive for care Step Four: Prepare for Redetermination
  • 30. Important Redetermination Updates In August CMS released an update on Redetermination and the Public Health Emergency (PHE) CMS announced that states will now have 12 months, instead of 6, to complete outstanding eligibility and enrollment tasks post PHE After the PHE lifts, states will still have up to 4 months to begin processing applications
  • 31. ● Ask yourself, what numbers would you like to track? ● Who needs these numbers? ○ Do you need to share with leadership? ○ Are you reporting them for grants? ○ Do you have specific department goals you want to hit? ● How often would you like to track these numbers? ● Do you have a system in place to properly capture the data or is it manual? Step Five: Continually Measure Outcomes
  • 32. Bob Janet Kaila Mike Jill Bob Janet Kaila Mike Jill Bob Janet Kaila Mike Jill Qualified Anchored Submitted Renewed Approved Reports
  • 33. Numbers You Should be Tracking Benefits: ● Team performance transparency ● Identify areas for improvement ● Directly connect the O&E staff to revenue ● Make better decisions based on data
  • 34. Where Do You Begin?
  • 36. Expected Outcomes More covered lives and more revenue Pleasant patient experience Systematic member management High quality data that’s useable
  • 37. Need help evaluating your current enrollment process? Contact Us info@pointcare.com www.pointcare.com