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How CVHS is Transforming Medicaid Enrollment with PointCare

The Challenge

For Community Health Centers, balancing quality patient care with operational efficiency is no easy feat. Central Virginia Health Services (CVHS), a Virginia-based clinic, like many others, faced mounting pressure to do more with less. Stagnant Medicaid rates, increasing costs, and a critical period of Medicaid unwinding made it increasingly difficult to manage patient needs. Without the ability to grow their staff, CVHS sought an innovative solution. They turned to PointCare. 

The Outcome

When CVHS partnered with PointCare, the results were remarkable. Imagine reclaiming nearly $287,300 in lapse recovery value—that’s the kind of breakthrough they achieved. Even more impressive, they slashed their cost per coverage by an incredible 64.9%. What once cost $188 to guide a patient back to coverage now stands at just $66. This wasn’t just a shift; it was a game-changer, reshaping how CVHS supports its patients and maximizes its resources.

$287,300 Recovered Revenue
64.9% Decrease in Cost per Coverage

Challenge Overview

Staffing Constraints
 Amid financial strain, CVHS had little room to hire additional staff. Current employees were stretched thin, juggling enrollment tasks alongside their primary responsibilities.
Financial Pressure
 Medicaid reimbursement rates had remained static since 2001, while supply costs continued to rise. On top of that, cuts to the 340B program further squeezed budgets. These pressures threatened CVHS's ability to maintain operational capacity and deliver care at the level patients needed.
Limited IT Resources
 Innovative technologies could have eased the burden, yet CVHS lacked the IT capacity to research, implement, or manage them effectively.
Patient Engagement Demands
 Many of CVHS’s patients relied heavily on in-person or phone-based support for Medicaid enrollment processes. While automation was a priority, it needed to coexist with direct, personalized assistance for patients who required it most.
Regulatory Uncertainty
Looming changes to Medicaid work requirements made patient coverage management unpredictable and placed additional strain on CVHS's already overburdened team.

Solution Overview

  1. Automated Enrollment Tracking
     PointCare provided a platform to automate the tracking and renewal of Medicaid enrollments. By minimizing the need for time-intensive manual intervention, staff could reallocate their energy to more critical tasks.
  2. Performance-Based Approach with Quarterly Reviews
     Regularly scheduled business reviews ensured that CVHS and PointCare remained aligned. These sessions tracked key performance metrics, identified areas needing adjustment, and reinforced a culture of accountability and continual improvement.
  3. Empowering Patients Through Self-Service
     Recognizing that some patients were comfortable managing their own coverage, PointCare introduced self-service features. This freed CVHS staff to dedicate their attention to patients who required in-person or phone-based assistance, striking a crucial balance between automation and personalized support.
  4. Custom-Fit for an FQHC
     Perhaps most importantly, PointCare’s solution wasn’t one-size-fits-all. The tools and guidance were tailored to CVHS’s specific operational constraints, ensuring seamless integration without overloading existing systems or personnel.

Results Overview

  • Improved Patient Coverage
The newfound efficiencies in managing Medicaid enrollment meant CVHS could maintain more patients on Medicaid during a time of sweeping regulatory changes. This ensured continuity of care and better health outcomes.
  • Enhanced Operational Efficiency
    By reducing manual workflows through automation, CVHS saved time and resources. This allowed staff to focus more on community outreach initiatives and member education on different public coverage options, critical, valuable work that only staff can do.
  • Financial Sustainability
     By preventing gaps in Medicaid coverage for their patient base, CVHS safeguarded a critical revenue stream. This outcome was essential in light of stagnant reimbursement rates and rising costs.

The partnership with PointCare proved that even in the face of financial and operational headwinds, innovative technology can drive meaningful change.

cvhs

"And the fact of the matter is, when we do that, then we free up our staff to really help those who need the help and just use PointCare for those that can help themselves … And it’s going to be really crucial going forward as to whatever happens with Medicaid during, you know, this next couple of years, during this new administration with the cuts."

- Paula Tomko, CEO, CVHS

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