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ALTAMED CASE STUDY

How AltaMed Implemented a Proactive Approach to Protect Revenue for their Clinics, and Continuity of Care for their Patients

With patient coverage statuses rapidly changing and EMR systems that aren’t equipped to monitor coverage events, patients find themselves unknowingly dropping from Medicaid coverage. The result? An inconsistent member coverage experience, expensive churn, uncovered visits, and delays in billing. 

CHALLENGES

  • Medicaid coverage statuses change constantly
  • Existing systems don’t provide ongoing coverage insight
  • Once Medicaid coverage is established, it isn’t maintained
  • Patient retention suffers as members lapse out of coverage
  • Coverage lapses disrupt continuity of care and revenue
  • Providers are expected to act as liaison between patients and Medicaid

FROM REACTIVE TO PROACTIVE

AltaMed, the nation’s largest federally qualified health center (FQHC), serves over 350,000 patients in Los Angeles and Orange County, with approximately 70% of their patients enrolled in Medi-Cal. Upon discovering that roughly 17,000 members were lapsing out of coverage every month at an annual value of $850 per member, AltaMed realized that they were exposing themselves to the risk of an annual revenue loss of over 170 million. Unable to ignore the glaring issue in front of them, AltaMed’s Vice President of Patient Financial Services Dr. Robert Young, and the leadership team, knew that they needed to focus on how to keep patients covered and assist with Medi-Cal re-enrollment.

Dr. Young connected with PointCare to work together in implementing their Coverage Management Platform. By launching PointCare’s Lapse Detection feature, AltaMed has access to invaluable information, allowing them to perform member outreach in a timely manner; as the sooner a lapse is detected, the easier it is to get them re-enrolled. This quick turnaround of patient engagement and re-enrollment is also easily tracked in PointCare’s Coverage Management Platform, which provides ongoing monitoring and insight into the direct ROI. Through this initiative, AltaMed has been able to transform their coverage management from a reactive state, to a proactive one.

THE SOLUTION

LAPSE DETECTION Time sensitive alerts on patients who have fallen out of coverage  
RE-ENROLLMENT OUTREACH Proactive outreach to members to initiate re-enrollment immediately after a lapse  
SCREENING & COVERAGE INTELLIGENCE

Screen members for programs and gain insight into who is covered

  
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“Medicaid coverage data is fragmented and difficult to interpret. PointCare has the foresight and resources to deliver critical coverage insights combined with automated processes designed to get and keep patients covered.”
Robert U. Young, MD VP of Financial Patient Services, AltaMed
73% of Lapsed Patients Required Action to Re-Enroll
88% of Lapsed Patients Didn't Know they've Lost Coverage
28% of Lapsed Patients Regained Coverage with PointCare

THE RESULT

With detected lapses coming in, AltaMed allocated a team of 8 representatives to re-enroll patients. Using PointCare’s Screening & Intelligence+, the team contacted the lapsed patients and walked them through the process of re-enrollment. While most patients were unaware that they had even lapsed from coverage, all patients were grateful for the proactive outreach and individualized attention they received.

To date, the AltaMed team has re-enrolled 28% of the patients who were identified as lapsing out of Medi-Cal coverage. A process that is often confusing and lengthy for patients, has been streamlined with re-enrollments taking, on average, less than 3 weeks to be approved.

And using PointCare’s platform, AltaMed has ongoing visibility into patients’ Medi-Cal application status, easily identifying next steps in outreach and tracking their team’s success.

 

BE THE NEXT POINTCARE SUCCESS STORY

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