How Eskenazi Well being boosted Medicaid approvals by 111%

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Within the 12 months since steady Medicaid enrollment ended, more than a fifth of enrollees have misplaced important protection. Avoidable procedural components like outdated contact Information and missed deadlines are accountable for nearly 70% of disenrollments, emphasizing the pressing want for sturdy software and renewal processes. Many disenrolled will need to reapply, placing further strain on suppliers and sufferers. To shortly decide eligibility for Medicaid or presumptive charity and guarantee sufferers get the assist they want, healthcare organizations like Eskenazi Health are turning to automated monetary help screening. The Indiana Health system carried out Affected person Monetary Clearance (PFC), leading to a formidable 111% enhance in Medicaid approvals in a single 12 months.

Stephanie Williams, Director of Affected person Entry Companies at Eskenazi Health, and Kim Berg, Director of Product Consulting at Experian Health, shared the technique behind the group’s success in a latest webinar, summarized beneath.

Deciding on the suitable monetary support automation to fulfill the wants of sufferers and workers

4 targets had been prime of thoughts as Eskenazi Health sought a brand new vendor to enhance Medicaid functions and approval charges:

• Prolong monetary help to underinsured, uninsured and undocumented households
• Improve Medicaid software approval charges via collaboration with Indiana Medicaid
• Conduct screenings of households in line with their particular wants
• Assist workers to expedite software processing

As Stephanie Williams explains, “Each affected person has a distinct story. We needed to ensure that we carried out one thing that allowed us to hearken to household tales and meet their particular person wants. However we additionally wanted a software that might expedite software processing to make sure that we met all of the wants of not solely our sufferers, their households but in addition our workers.”

They wanted a versatile software to go well with numerous demographics and combine seamlessly with the Epic system workers already used. Affected person Monetary Clearance match the invoice.

Affected person Monetary Clearance guides sufferers to the right monetary pathway – shortly and confidently

Kim Berg outlined the three key information components that underpin the software:

• Capability to pay: Affected person Monetary Clearance runs automated pre-service checks to gauge sufferers’ eligibility for Medicaid and presumptive charity based mostly on their estimated earnings and family measurement. IT makes use of this to calculate a Federal Poverty Stage (FPL) share to check towards charity care insurance policies.
• Propensity to pay: Experian Health’s confirmed healthcare credit score scoring mannequin tells suppliers how probably the affected person is to repay their healthcare debt. Berg says, “We offer a rating of 1 to 999 based mostly on excessive, medium or chance to pay. After all, you’re not going to disclaim that particular person charity based mostly on this estimate alone. Nonetheless, if the affected person has a low propensity to pay, you possibly can request paperwork, present estimates and provide different choices up entrance to make sure they perceive their duty. We offer you the info to grasp your sufferers’ monetary scenario so you possibly can have the suitable dialog on the proper level within the income cycle.”
• Cost plan advisor: The software additionally identifies these needing fee plans to handle self-pay balances and recommends inexpensive month-to-month fee quantities to extend profitable collections.

A peek inside Eskenazi Health’s Affected person Monetary Clearance workflow

Eskenazi Health labored carefully with the Experian Health implementation group to customise set-up and accommodate the wants of sufferers and households. The group constructed a affected person questionnaire in order that screening, FPL calculations and propensity to pay scores might be compiled shortly, and according to Indiana Medicaid rules and organizational insurance policies. They created workflows to facilitate real-time approvals for Eskenazi Health’s monetary help and sliding scale packages, and included an automatic digital system to permit sufferers to add and digitally signal their paperwork.

Williams says, “Working with Experian was nice. Implementation was a breeze and the customization helped us obtain what we wanted.”

The consequence? Medicaid approvals up by 111% in a single 12 months

After implementing Affected person Monetary Clearance, the variety of permitted Medicaid functions surged by 111% in 2022 in comparison with the earlier 12 months. Approvals elevated by a further 27% in 2023. Williams says the software has additionally helped double appointment capability, enhance software monitoring and obtain an software conversion fee of 93%, all with out recruiting further workers.

Williams says the power to drill down into location-specific efficiency (by way of eCare Subsequent Energy Reporting) aided resourcing choices, particularly in neighborhood clinics:

“The ability reporting instruments enable us to interrupt down information by location to make sure we’re staffed appropriately and assembly operational wants. Not solely had been we serving to households and sufferers safe the protection they wanted with Indiana Medicaid, however we additionally gave our monetary counselors and advocates a lift of confidence to know that they’re assembly their particular person efficiency month over month.”

Subsequent steps: Make monetary support simpler for employees and sufferers with self-service screening

Eskenazi Health’s subsequent step can be to include a self-service mannequin that permits sufferers to use for monetary help on-line at their comfort. Self-Service Affected person Monetary Clearance permits sufferers to obtain safe hyperlinks by way of textual content message or via their supplier’s web site or affected person portal. In each circumstances, sufferers nonetheless have the choice to talk to a monetary counselor if they like, however the workload for employees is prone to be enormously diminished.

Berg says the self-service choices “take the hassle off your workers to allow them to give attention to sufferers who actually need assistance with their functions.”

Watch the webinar to listen to extra about how Eskenazi Health boosted Medicaid approvals, and the way Self-Service Affected person Monetary Clearance results in extra accomplished functions, larger affected person satisfaction and improved productiveness.