Coverage Management vs. Care Management [Infographic]

Why it’s Time to Invest in your Enrollment Department

Did you know your health system is operating two businesses? Healthcare Management and Health Coverage Management.

You’ve invested heavily in your healthcare operations with EMRs, admins, providers, billers and more. But what have you invested in your Enrollment Department? Most still use spreadsheets to manage productivity. Your Enrollment Department is a revenue generating team for your organization. Give them the proper tools and watch the covered visits increase.

You’ll gain access to Enrollment Intelligence dashboards allowing you to see all Enrollment Department success on demand. See for yourself:

FEMA Programs Added to PointCare to Support Relief Efforts

In response to the Hurricane Harvey and Hurricane Irma, PointCare has added temporary resources to our database for individuals who live in the affected counties.

If individuals are screened in these counties, they will be provided with information on FEMA resources available to them, the contact information, and everything they need to sign-up. Below is an overview of the programs we’ve added to PointCare’s coverage management platform.

FEMA Disaster Assistance (Individuals & Household Program): Provides financial and direct services to eligible individuals and households affected by disasters who have uninsured or underinsured necessary expenses and serious needs. IHP is not a substitute for insurance and cannot compensate for all losses caused by a disaster; it is intended to meet the survivor’s basic needs and supplement disaster recovery efforts

FEMA Transitional Sheltering Assistance: Provides short-term lodging assistance for evacuees who are not able to return home for an extended or indeterminate period of time following a disaster. FEMA will pay for the cost to stay in certain hotels or motels for a limited period of time. Costs covered are for the cost of the room and taxes, and any other expenses are not included.

At PointCare, we take pride in having a platform that allows us to support communities when they need it the most. We wish for a speedy recovery of those devastated areas and send good thoughts to everyone affected by the recent hurricane.

Partnership Beyond the Clinic: Lone Star Family Health Center

PointCare checked-in our friends/customers at Lone Star Family Health Center in Conroe, Texas after the news of Hurricane Harvey. Many of the Lone Star staff members’ homes were affected by this event, needing demo and rebuilding from the ground up. After connecting with Karen Harwell, Lone Star’s CFO, the PointCare team banded together to collect donations and supplies to support the clinic’s clean-up/relief efforts. Through donations and the hard work of the Lone Star Staff coming together, they began the process to recovery during Labor Day weekend. We applaud Lone Star’s tenacity as an organization to stand strong, and together ,for their staff as well as patients. We are happy to have helped our partners in their time of need and wish them a speedy and safe rebuild in the coming months. 

Screening for Patients Affected by the Fallout of the Nevada Nuclear Test Sites

An elderly woman came into North County HealthCare, to establish care at their St. Johns location. Before completing the new patient onboarding process, one of the Family Health Advocates conducted a resource screening through PointCare. One of the questions asked was “Have you lived in one of the following counties: Coconino, Apache, Navajo, Gila, Yavapai or Mohave, north of the Grand Canyon, between January 21, 1951 – October 31, 1958 or July of 1962?” Something she may not have asked otherwise unless prompted by PointCare.

Because the patient answered “yes” to this question,  the PointCare screening results indicated that this woman, who had a history of cancer, was eligible for the Radiation Exposure Screening & Education Program (RESEP).

RESEP provides individuals that were affected by the fallout of the Nevada nuclear test sites during the 1950s and early 1960s no-cost medical screening exams and, at times, assistance with filing a claim for compensation through the Department of Justice.

If our Family Health Advocate had not conducted a PointCare screening, this “downwinder” may never have learned about RESEP or received a referral to access this incredible resource.

Have a great patient story? Share it with us at marketing@pointcare.com for a chance to be featured on our site!

3 things to know about the AHCA Bill

Earlier this month, the American Health Care Act won passage in the House, shaking up the healthcare industry yet again. The proposed bill impacts everyone across the spectrum, including 25 million low-income and underserved patients and communities served by our customers.

At PointCare, we are actively reviewing the details of the new bill and how it impacts the coverage landscape. We do know that this bill places more power in the hands of the States to determine the fate of their health coverage landscape. As we have seen changes in health policy in the past, the fact is that it will go through several iterations between the House and Senate before getting signed into law. We anticipate 3 to 5 years before we know and feel the real impact of the law, similar to what we saw with the ACA.

In preparation for the changes coming to healthcare, we must be well versed on what to expect and most importantly, be proactive in our approach to providing quality care to our communities. We’ve outlined a few items on the bill that together, we can attack head on, regardless of the outcome of the AHCA.

Consumers who let their coverage lapse for more than 63 days in a year would be charged 30% surcharges to regain insurance. This would include people with pre-existing medical conditions. Through proactive and diligent coverage management, you can develop a process to catch people when they fall out of coverage and get them re-enrolled to ensure coverage while keeping premium costs down.

End to Medicaid expansion funding. FQHCs in particular, need a framework for sustainable funding outside of grants. This can be done by generating more covered patient visits for better reimbursements across the board.

Changes Medicaid from an open-ended program to one that gives States fixed amounts of money per person. It’s more important than ever to work with your patients to promote coverage consistency. Knowing what your patient is eligible for remains critical as changes to program eligibility rules are expected to fluctuate.

During this time, we urge our customers to continue to advocate for your patients and work towards making healthcare accessible and affordable for all. With PointCare, we’ll continue to develop and enhance our platform to ensure your coverage management framework allows you to immediately respond to coverage changes in healthcare in real-time.

– Everett Lebherz, Co-founder & CEO, PointCare

Implement a coverage management platform that allows you to adapt to the ever-changing coverage landscape.

The Control Group for Healthcare

[fullwidth background_color=”” background_image=”” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ background_repeat=”no-repeat” background_position=”left top” video_url=”” video_aspect_ratio=”16:9″ video_webm=”” video_mp4=”” video_ogv=”” video_preview_image=”” overlay_color=”” overlay_opacity=”0.5″ video_mute=”yes” video_loop=”yes” fade=”no” border_size=”0px” border_color=”” border_style=”” padding_top=”20″ padding_bottom=”20″ padding_left=”” padding_right=”” hundred_percent=”no” equal_height_columns=”no” hide_on_mobile=”no” menu_anchor=”” class=”” id=””][fusion_text]In the last few months, it seems that the only thing certain in healthcare is uncertainty itself. As the House Republicans officially introduced their repeal to Obamacare this week, many in the health community are wondering how the restructuring will affect their funding, programs and patients’ coverage.

While we cannot control the political climate and its effects on our clinics and health systems, at PointCare, we are striving to provide stability for our partners, pioneering coverage management so that no matter what the health system becomes, it is readily available and accessible to eligible patients – creating our own control group for healthcare.

In January’s issue of Health Affairs, Dr. Lisa Simpson, the president and CEO of AcademyHealth, and nationally recognized health policy researcher and pediatrician, addressed how innovation within healthcare can help bridge the disparities in health equity and aim for innovation, especially during uncertainty.  She states, “As researchers, we really are still in the infancy of a new way of thinking about and using massive streams of new information to inform our work, and there remains a need for new methods and collaborations to extract actionable insights from new and newly available data sources.”

With the ability to manage and invest in data, Total Coverage Management is at the forefront of creating proactive ways to stabilize/enhance the patient experience, especially considering the fluidity of governmental changes to come.

As health centers prepare for a “new” healthcare system, it is important now more than ever to connect patients to coverage, provide quality care and secure revenue across the board.

–  Flannery Davis | Solutions Advisor, PointCare[/fusion_text][/fullwidth]

Data: A Love Story

[fullwidth background_color=”” background_image=”” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ background_repeat=”no-repeat” background_position=”left top” video_url=”” video_aspect_ratio=”16:9″ video_webm=”” video_mp4=”” video_ogv=”” video_preview_image=”” overlay_color=”” overlay_opacity=”0.5″ video_mute=”yes” video_loop=”yes” fade=”no” border_size=”0px” border_color=”” border_style=”” padding_top=”20″ padding_bottom=”20″ padding_left=”” padding_right=”” hundred_percent=”no” equal_height_columns=”no” hide_on_mobile=”no” menu_anchor=”” class=”” id=””][fusion_text]With Valentine’s Day falling on the first day of the California Primary Care Association (CPCA) Quality Care Conference, love was definitely on our minds…and so was data.

The importance of data was the overarching theme at this year’s conference held in Newport Beach. Given tighter funding constraints, as well as the uncertainty engulfing healthcare under the new administration, the story data tells will have an even bigger impact throughout health systems in the coming months. “Being more data driven and securing our own revenue is absolutely key,” explained Carmela Castellano‐Garcia, Esq., President and CEO of the CPCA.

Seeing what the data tells us today and what it will look like six months from now, and being adaptable to change, is what will make community health centers successful for years to come. Using PointCare, health centers have the ability to visualize and understand the data that’s most important to them, including up-to-date coverage stats on all patients, patient churn (how many fall out of coverage each month), assists, enrollments, and other HRSA-required metrics. From this data, health centers can then have the insight to craft the story they want to (and need to) tell.

During the Welcome Address at the conference, Carmela stated, “with the data, we are able to identify successes and opportunities for improvement across the board and improvement are what we need to be about in this day and age.”

With PointCare Verify, health centers are able to see which members are getting enrolled into coverage and, more importantly, which are falling out of coverage – prompting staff to proactively reach out to those members to help them get covered once again. This creates value for health centers by securing revenue through more covered visits. By taking a more proactive approach to coverage, they are not only building an enhanced operational relationship with the data they already collect, but are also establishing a better, more engaging relationship with their patients.

As we begin to collect more data and better understand key metrics affecting health system success, a more exceptional story will unfold. Just as love grows deeper as more positive experiences occur and more connections are made, the innovation of gathering meaningful data combined with the impactful and positive work health centers are already doing will make for the ‘happily ever after’ story that health centers can tell for years to come.

 

–  Maricel Risano | Marketing Lead, PointCare[/fusion_text][/fullwidth][one_fifth last=”no” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_size=”0px” border_color=”” border_style=”” padding=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”” animation_speed=”0.1″ animation_offset=”” class=”” id=””][/one_fifth][three_fifth last=”no” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_size=”0px” border_color=”” border_style=”” padding=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”” animation_speed=”0.1″ animation_offset=”” class=”” id=””][vimeo id=”204069848″ width=”600″ height=”350″ autoplay=”no” api_params=”” class=””][/vimeo][/three_fifth][one_fifth last=”yes” spacing=”yes” center_content=”no” hide_on_mobile=”no” background_color=”” background_image=”” background_repeat=”no-repeat” background_position=”left top” hover_type=”none” link=”” border_position=”all” border_size=”0px” border_color=”” border_style=”” padding=”” margin_top=”” margin_bottom=”” animation_type=”” animation_direction=”” animation_speed=”0.1″ animation_offset=”” class=”” id=””][/one_fifth]

The Secret to Addressing Social Determinants of Health

After this year’s JP Morgan Healthcare Conference, even with investments in healthcare IT trending down, I feel the industry is finally moving forward. I say this because social determinants of health are finally gaining the recognition it deserves in the industry.

Addressing social determinants of health is not a new concept in healthcare. Community Health Centers (CHCs) and Federally Qualified Health Centers (FQHCs) have been spearheading this effort for years. Having worked closely with these organizations, we have found that better health is enabled when people are informed and have means to access helpful programs that go beyond healthcare.

According to a 2015 study, “Poverty affects health by limiting access to proper nutrition; shelter; safe neighborhoods in which to learn, live, and work; clean air and water; utilities; and other elements that define an individual’s standard of living.” “Poverty and Health – The Family Medicine Perspective (Position Paper)”, Czapp, MD, Kovach, MSc, CHES, et al., American Academy of Family Physicians (aafp.org), 2015

Plain and simple: a person’s standard of living affects their health. But how do you reach this underserved population effectively?

The secret: A well-built patient relationship.

Healthcare is hyper-localized. For the patients to effectively communicate a need for additional assistance, they need to have a relationship with a provider that lasts.These meaningful relationships are built when the provider and patient are from the same community. This localization creates a better understanding for the environmental stressors the patient may be facing.This is what makes FQHCS and CHCs successful when it comes to providing this type holistic care to their communities.

Collecting information to address social determinants of health is not as simple as a quick name or date of birth. It requires a high level of engagement and empathy from enrollment counselors for the patient to open up about their very personal situation outside of the basic demographics.

For health centers, this starts at enrollment. More often than not, it is easier to collect this personal information during the enrollment process. Patients are more vulnerable and prepared to provide the necessary information given their urgency to see a provider.

PointCare is helping health centers provide reportable data on social determinants of health through the industry’s first Total Coverage Management platform. The data shows that in addition to qualifying patients for healthcare coverage, 86% of the patients screened by PointCare also qualify for additional assistance, such as food, cash, or premium support. 53% of the patients qualify for programs with food or cash assistance, helping support the basic elements patients need to live a healthier lifestyle. This data allow communities to proactively better address the needs of their population.

As the industry begins to scratch the surface on social determinants of health, I recommend they look to FQHCs and CHCs as a model to provide the care patients need to truly transform population health. Forging these long-lasting relationships and providing additional assistance programs that directly affect a patient’s well-being is taking a much needed systematic approach to managing coverage. This brings a true holistic healthcare into reality, going beyond the clinic walls by impacting the patient’s physical and financial health through proper coverage management. This not only creates a valuable relationship and insight to our population’s health, but also builds trust in the provider (and in the healthcare industry).

 

Everett Lebherz
CEO and Co-founder, PointCare

Grant Drought & Other 2017 Healthcare Predictions

[fullwidth background_color=”” background_image=”” background_parallax=”none” enable_mobile=”no” parallax_speed=”0.3″ background_repeat=”no-repeat” background_position=”left top” video_url=”” video_aspect_ratio=”16:9″ video_webm=”” video_mp4=”” video_ogv=”” video_preview_image=”” overlay_color=”” overlay_opacity=”0.5″ video_mute=”yes” video_loop=”yes” fade=”no” border_size=”0px” border_color=”” border_style=”” padding_top=”20″ padding_bottom=”20″ padding_left=”” padding_right=”” hundred_percent=”no” equal_height_columns=”no” hide_on_mobile=”no” menu_anchor=”” class=”” id=””][fusion_text]With the new federal administration in place, changes in the healthcare industry are coming and impacting every aspect of the spectrum. Community Health Centers in particular will face new challenges in 2017. Below are few of the changes we are predicting to take place in the market affecting our FQHC partners in the coming months:

Is grant drought on the horizon?

There is always the risk of grant drought, perhaps now more than ever with ACA marketplaces and exchanges feeling the increasing pressure. Federal healthcare dollars are in limbo with only temporary resolutions in place for the 2017 fiscal year and still up for debate in congress. With the changing political landscape, the allocation of healthcare dollars is amplified with uncertainty. Now is the time to secure revenues with covered visits to ensure long-term sustainability should grant drought become a reality.

Who will manage member Medicaid/Subsidized coverage?

The state? Nope. The member? To a degree. The provider? Definitely. The industry is evolving to Provider Driven Coverage Management. Patients are looking to healthcare providers as their go-to coverage experts when it comes to health. Patients are yearning for providers to manage their coverage proactively, providing patients a one-stop shop for healthcare.

Holistic healthcare, a reality.

FQHCs are well-positioned to foster dynamic patient relationships by going beyond healthcare. In 2017, health centers will become the center for all coverage management including social determinants of health (food and housing assistance, etc.). Providing access to these services,  not only creates a better patient experience but also provides a holistic approach to healthcare that is currently lacking.

Regardless of what 2017 brings, one thing is for sure – patients need help getting access to healthcare coverage and managing it. I truly believe the holistic provider-patient relationship is the answer and look forward to seeing how it all unfolds in the New Year.

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