Targeting Self-Pay Patients for Enrollment in NY …files.constantcontact.com/3f8ce7aa001/87e288a8-4c9a-433d...Expansion and Health Insurance Marketplace Plans Sutherland Healthcare

October 19, 2016

Targeting Self-Pay Patients for Enrollment in NY Medicaid

Expansion and Health Insurance Marketplace Plans

Sutherland Healthcare Solutions

Proprietary & Confidential 2

"There have been many revolutions

over the last century, but perhaps

none as significant as the longevity

revolution. We are living on average

today 34 years longer than our great-

grandparents did. Think about that:

that's an entire second adult lifetime

that's been added to our lifespan."

- Jane Fonda


Proprietary & Confidential

Healthcare Reimbursement Challenges

Enhancing the Patient Experience

Case Study, Best Practices, and Lessons Learned

Recap

Questions

Key Talking Points

3

3



Low Reimbursement Challenges Providers

42% NY has the highest % of loss making hospitals in the United States

2nd NY’s rank nationally for highest Medicaid spender1

46th NY’s rank nationally in doctors willingness to treat Medicaid patients

1,900,000 Low-income NY residents who have gained insurance coverage through Medicaid

7,450,000 Number of people enrolled under Medicaid in NY2

49th NY’s rank in Medicaid reimbursements



The Exchange: Payers Participating and Exiting

5

2014 HIX Participants 2015/16

HIX Participants

2017 Plans Exiting or

Reducing HIX

v v



Rate increases are a multiple of inflation

6



NY Major Hospital System Mergers in 2015 & 2016

A December 9 PricewaterhouseCoopers report called 2016 the “Year of Merger Mania”



Hospitals will continue to be a main health facilitator which the uninsured pass through

Hospitals must assist individuals to obtain health coverage, encourage them to enroll before

they need care, and to maintain that coverage

Uninsured Difference ACA Impact

Uninsured Pre-ACA

(2010)

Rate Post-ACA

(2014)

Rate Post-ACA

(2015)

Difference between

2014 to 2015

National 15.50% 11.70% 9.1% - 22%

New York 11.90% 8.70% 5.20% - 40%

New Jersey 13.24% 10.93% 7.8% - 29%

Connecticut

9.10% 6.93% 3.8% - 45%



Presidential Nominees’ Healthcare Policies

• Defend the Affordable Care Act and build on it to

slow the growth of out-of-pocket costs

• Crack down on rising prescription drug prices

• Protect women’s access to reproductive health care

• Proposes an authority to block or modify

unreasonable health insurance premium rate

increases so that coverage is more affordable

• Proposes to give everyone the choice of a public-

option insurance plan, and to expand Medicare by

allowing people 55 years or older to opt in

• Completely repeal Obamacare

• Allow all payers to offer insurance in any state

• Allow individuals to use HSAs tax free

• Require price transparency

• Block-grant Medicaid to the states

• Remove barriers to entry into free markets for drug

providers that offer safe, reliable and cheaper

products

Hillary Clinton Donald Trump

Impact on... Medicaid

HIX

Will Expand

Will Expand Impact on...

Medicaid

HIX

Unclear

Unclear



It is unlikely that White House, House and

Senate (with 60 vote majority) will align.

Developing bipartisan support is unlikely

given the prevalence of non-competitive

districts, created through gerrymandering

Little new major federal policy will be created due to polarization

10



Public Concern Persists

11

• 47% of U.S. workers

can’t come up with

$400 for an emergency

• 71% concerned about

covering everyday

expenses

• Median net worth down

85.3% from 1983 to

2013 (2013 = $54,000)

• LA free clinic: 10,000

patients showed up, a

majority with health

insurance



Patient Spending on Deductibles Outpacing Wages

12



All providers must revamp their patient experience to strategically

transform the services offered in the new ACA environment!

Providers who think outside the box and successfully re-engineer

their end-to-end patient experience will be rewarded with:

Improved revenues and lower attrition rates

Benefits from increased patient advocacy, heightened brand

awareness

More word-of-mouth referrals

Patient Relationship is Central



Multi-Faceted Approach

Enhanced

Patient

Experience

System

Alignment

Training

Measurement

Service Touch

Points

Ongoing

Communications

Service Recover

Processes

Service

Achievement



Virtua, Sutherland Healthcare, and the Sutherland Innovation Labs observed staff and patients in a variety of settings, with a focus on billing, registration, and other non-clinical issues

The study leveraged the science of ethnology - researching in the natural hospital setting to better understand patients, their behaviors, and their overall experience

Though there were a variety of specific questions, the more general brief was to observe, see what was working well and where there was room for improvement

We spent two weeks in Virtua’s facilities and Sutherland offices for the study

This was a qualitative study – We spoke to almost 100 patients and members of staff in a large variety of settings

Studying the Patient Experience



Six Key Findings

1. Offer more online self-service options

2. Move from paper to online to streamline processes and

reduce errors

3. Providers need to make medical costs more transparent

upfront, present financial aid options early on, and provide

empathetic support for those with payment issues

4. Patients want and need to discuss costs to make informed

decisions about their healthcare

5. Health insurance exchanges: There is an opportunity for

healthcare providers to help patients choose plans that

have their facilities in-network

6. Brochure and poster overload: Patients find it difficult to

pay attention to all these messages

Studying the Patient Experience



Educating and enrolling self-pay patients under the New Jersey Family Care and Health

Insurance Marketplace Exchange

Mailers, billboards, and radio ads – directing uninsured individuals to a toll-free, 1-800 call

center

Financial counselors leveraged to educate patients who are uninsured and get them

qualified for the government programs that exist today

Marketing mailers to identified uninsured people within the community

• Financial counselors fielded calls and scheduled onsite appointments

Case Study: Launch an Outbound Campaign



Results

We reached out to 250,000 commercially insured

individuals by mail in the first phase

Marketing mailers went out to 100,000 uninsured

people in the second and third phases

Our financial counselors fielded a total of 792 calls

and scheduled 773 onsite appointments

142 HIX enrollments have been completed while

another 122 people have completed HIX applications

Case Study: Launch an Outbound Campaign



Design effective enrollment procedures and

practices

Optimize staffing and support for maximum

effectiveness

Work in tandem when educating the patient

Position trained staff at critical access points

Use innovative strategies to reach vulnerable

populations

Outreach and partner with key external resources

Assess the new environment

Eligibility Screening & Enrollment Principles and Best Practices



Written procedures that address the various steps to enroll

uninsured patients in appropriate programs

Procedural aspects required to implement new processes,

measures or tools, including any technology or software

Operational aspects of using the revised process, and include

cross references to staffing roles and responsibilities required

to implement and operate the process

Reflects the organizational mission, vision and values to meet

care needs in the community

New Patient Experience Procedures



To warrant an effective eligibility/enrollment process:

Providers should determine the optimal level of staffing and

support necessary to safeguard maximum efficiency

Staffing for outreach, eligibility and enrollment can unite with the

clinical staff to significantly improve access to health coverage

for uninsured individuals

Help patients navigate the system and enroll in appropriate

programs

• Staffing characteristics and needs

• Training, ongoing education, and assessment

• Specific staff-education with a focus on patient education

communications

Staffing and Support for Maximum Effectiveness



Have Financial Counselors work to develop a partnership-like

relationship with the patient

The goal is to create trust and engage the patient in a

conversation about their health coverage options

Organization-wide values influence how to approach the

patient

Staff is trained to try to make the patient more comfortable

discussing what can be sensitive information (for example,

income or employment status)

Partnership-Like Relationship With Patients



The eligibility process is complicated and confusing for most patients

Many patients who come to hospitals as uninsured are eligible for one or more coverage

programs, but may not know it

Many hospitals find it helpful to use an advocacy, partnering, or financial counselors

approach in each patient eligibility/enrollment

• Creates a dignified experience, which engages the patient in a discussion of coverage in

a non-threatening way

This includes:

• Young adults ages 18–34

• Dependents under age 26

• Children under age 19

• Individuals with pre-existing conditions

• Immigrants awaiting legal status

• Low-income adults without dependents

• Individuals who recently lost a job

Patient Advocate Approach



Hospitals currently are one of the most important doors through which patients access

health coverage

More important than ever with the newly-eligible population increases through the ACA

Positioning enrollment staff in these access points is a key way in which hospitals build

strong relationships with patients

Highly trained personnel at strategically identified sites ensures that the hospitals reach

the greatest number of individuals requiring coverage eligibility and enrollment

assistance

Positioning Trained Staff at Critical Access Points



Extensive outreach and partnering initiatives with entities in surrounding communities

These include other healthcare organizations, physicians and other providers, state and

county agencies, and other sites in the community such as schools and places of worship

Many groups offer an extensive array of community outreach programs to serve our

community

Professional staff and volunteer network continually work to offer meaningful ways to help

people enjoy better health, greater personal independence and a higher quality of life

Outreach and Partnering with Key External Stakeholders



Many Providers decide to use eligibility and enrollment service companies based on

analysis of capabilities and expertise

Hospitals commonly assess organizational eligibility and enrollment functions and

compare them to vendor capabilities

• With the broad range of available programs and enrollment requirements, offering

assistance for all types of applications and ensuring their timely completion can be

challenging

• Requires experts who are knowledgeable about local, county, state, federal and private

programs on all levels, and many “boots on the ground” to follow up with coverage

program staff and patients to obtain required documents

Assessment of Capabilities and Potential Assistance



Innovation

Revamping the patient experience transforms services offered in the new ACA environment

which improves revenues, lowers attrition rates and expands brand awareness

Leverage ethnology techniques when trying to understand the patient experience

A recent qualitative study of patients with a focus on billing, registration and non-clinical

issues identified six immediate opportunities for improvement

Providing leadership and education in an “all-hands-on-deck” approach to enroll the

eligible population is vital to ensure that individuals will have coverage

Developing a partnership-like relationship with the patient through the eligibility process

and financial counselors requires planning and execution

Recap – Key Takeaways

Questions?



Horses for Sources: Recasting the Patient Billing Experience with Design Thinking

Sutherland Innovation Labs: How do you make hospital processes more efficient and

compassionate?

SHS Optimizing the Patient Experience Brochure

Additional Resources

http://www.hfsresearch.com/recasting-the-patient-billing-experience-with-design-thinking-sb

http://www.hfsresearch.com/recasting-the-patient-billing-experience-with-design-thinking-sb

http://www.sutherlandlabs.com/thoughts/make-hospital-processes-efficient-compassionate/




http://www.sutherlandhealthcare.com/media/upload/Optimizing the Patient Experience.pdf



About Virtua

Virtua is a comprehensive South Jersey

healthcare system with three hospitals in the

New Jersey area.

Find out more at https://www.virtua.org/

https://www.virtua.org/










About Sutherland Healthcare Solutions & Sutherland Innovation Labs

Sutherland Healthcare Solutions is a leading

provider of Revenue Cycle Management, Coding,

and Patient Experience Solutions. SHS is a wholly

owned subsidiary of Sutherland Global Services.

Find out more at www.SutherlandHealthcare.com

Sutherland Innovation Labs provides strategic

innovation, customer experience research and

design thinking to create beautifully designed

and intuitive solutions. SIL is a wholly owned

subsidiary of Sutherland Global Services.

Find out more at www.SutherlandLabs.com

http://www.sutherlandhealthcare.com/






http://www.sutherlandlabs.com/







About the Speaker

Tina Eller

Vice President of RCM and Patient Experience Solutions


Phone: 720-206-9142

Email: [email protected]

LinkedIn Profile: Here

mailto:[email protected]

https://www.linkedin.com/profile/view?id=66832859&trk=nav_responsive_tab_profile

Documents

Targeting Self-Pay Patients for Enrollment in NY …files.constantcontact.com/3f8ce7aa001/87e288a8-4c9a-433d...Expansion and Health Insurance Marketplace Plans Sutherland Healthcare