AltaMed Case Study

Challenge

Navigating Unprecedented Churn

This visibility gap creates a cycle of expensive churn, rejected claims, and interrupted patient care.

Patient coverage is fluid, but standard EMR systems are static. Because these tools cannot monitor daily coverage events, patients often unknowingly drop from Medicaid due to procedural errors.

AltaMed realized nearly 17,000 members fell out of coverage each month–a potential annual revenue loss of over $170 million.

Core Obstacles

Medicaid coverage statuses change constantly

Existing systems don’t provide ongoing coverage insight

Patient retention suffers as members lapse out of coverage

Providers are expected to act as the sole liaison with Medicaid

Solution

Transitioning to Proactive Care

By leveraging PointCare’s Lapse Detection, AltaMed gains immediate visibility into coverage gaps, enabling rapid member outreach.

This entire lifecycle is tracked within the Coverage Management Platform, providing real-time monitoring and clear insight into direct ROI.

Because lapses are identified early, the re-enrollment process is significantly faster and more successful.

Unified Response

Coverage Tracking: Time sensitive alerts when patients fall out of Medicaid coverage.

Re-enrollment Outreach: Automated patient text messages to initiate re-enrollment through CoverageCare.

Coverage Intelligence: A snapshot into the entire Medicaid population and their current coverage status.

Outcome

Shortening the Path to Care

AltaMed shifted from a manual 8-person outreach team to a digital-first workflow.

Proactive Coverage Management

By empowering patients to re-enroll online, they boosted recovery rates to 28.5% and shortened the path from lapse to approval to under three weeks.

This transition provides real-time visibility, allowing staff to focus on high-need cases instead of chasing paperwork.

PointCare has the foresight and resources to deliver critical coverage insights combined with automated processes designed to get and keep patients covered.

Stop the Churn:

How the nation's largest safety net protected $20M in revenue.

$20+

30,000

29%

Challenge

Navigating Unprecedented Churn

Solution

Transitioning to Proactive Care

Outcome

Shortening the Path to Care

— Robert U. Young, MD

VP of Financial Patient Services, AltaMed

Scale impact without scaling staff.