Maximize the $30B Opportunity in Patient Assistance

In a recent webinar hosted by HFMA (view on demand), Atlas Health’s Senior Vice President of Pharmacy Tim L’Hommedieu, alongside St. Joseph’s Candler Health System’s Director of Specialty Physician Revenue Cycle Joseph Zehler, presented on how hospitals and health systems can optimize their patient assistance program to help patients access and afford care. This article summarizes the webinar and explains the opportunities for philanthropic financial aid, why these programs exist and how they help hospitals and health systems reduce the financial strain on patients and increase reimbursement.

Defining Philanthropic Medical Financial Aid

Philanthropic medical financial aid provided through patient assistance programs is typically supplied to eligible recipients in two separate ways: either co-pay assistance via a cash card/grant or free drugs, supplies, and devices, especially for patients on specialty therapies. Philanthropic medical financial aid not only helps cover expensive out-of-pocket costs for self-pay patients but also for those with insurance including Medicare and commercial insurance beneficiaries.

Why Does Philanthropic Medical Financial Aid Exist?

Many Americans are familiar with the financial stress that often accompanies vital health care. In fact, 25% of Americans put off receiving treatment due to unaffordable costs. In addition, 56% have medical debt, and over a quarter of that debt is over $10,000. Unfortunately, these costs are only rising along with premiums for both government and commercial health insurance plans. Just this year, we saw the most significant increase in Medicare Part B premiums in history and a 6.5% jump in general healthcare costs. Rising premiums and the escalation of high deductible health plans and health savings accounts have created a need for philanthropic medical financial aid.  Without it, many patients simply can’t afford the high out-of-pocket costs.

The mental and emotional toll these costs take on already ill patients, such as those battling cancer, has been coined financial toxicity: the detrimental effects on the well-being of patients, their families and society due to the excessive financial strain of a diagnosis. The financial toxicity problem is not going away. Organizations can expand their patient assistance program, leverage the $30B in philanthropic financial aid available every year and reduce the financial distress often associated with essential healthcare.

Throughout the webinar, Tim L’Hommedieu poses live polling questions to the audience to gather information in real-time and discuss their personal experiences. We’re revisiting these questions below:

Poll: How many patient assistance and social supportprograms are available?

Answer: While most webinar attendees guessed 5,000 programs, there are actually over 20,000 patient assistance programs who distribute more than $30B in medical financial aid to eligible beneficiaries. These thousands of programs support patients with copay assistance, diagnosis-based assistance, social programs and free drugs.

Poll: Is your organization maximizing reimbursement from available assistance and social support programs?

Answer: Many attendees reported their organizations were not maximizing the opportunity, and for good reason. Patient assistance programs are complex and challenging, making it an uphill task to secure aid for patients in need. Multiple factors contribute to these complications, including the plethora of programs to sort through, varying application types and requirements and different eligibility criteria, enrollment and reimbursement processes.

Additionally, foundations often open and close due to inconsistent funding.  Without constant monitoring, understanding what is available and when can be time and resource intensive.

Atlas recognizes these constraints and recommends technology to maximize your patient assistance program. This ensures every patient is offered every available opportunity for support. EHR integration and workflow automation capture more reimbursement while improving patient experience and outcomes.

Poll: What is your largest challenge with patient assistance programs?

·      Patient identification

·      Awareness of programs

·      Program complexity

·      Staffing resources and manual processes

·      Coordination across patients, departments and programs

Answer: Many attendees answered, “All of the above.”

Many hospitals and health systems recognize there’s a lot to be learned about patient assistance programs, and most organizations likely aren’t operating as efficiently and effectively as they could. Atlas’ solution was specifically designed with the input of patient advocates and financial navigators to address each of these challenges (learn more).

Revenue Cycle Value

There are also financial incentives for hospitals and health systems to improve their patient assistance programs. As organizations support more patients, they can also increase operating revenue on existing volume, reduce uncompensated care, improve the margin on separately payable drugs, leverage patient assistance as a competitive differentiator and better deliver on their mission to serve their communities.

Patient Assistance Best Practices

To improve your hospital or health system’s patient assistance program, here is a high-level overview of some best practices to follow that were covered in detail in the webinar:

·      Focus initiative: Determining a baseline and prioritize what and where to improve

·      Identify opportunities for patient matching: Consider utilizing technology to improve identification of eligible patients and programs

·      Identify philanthropic programs at scale

·      Develop workflow to execute enrollment, reimbursement and compliant billing processes

·      Reports to optimize program efficiency and share patient success stories

Saint Joseph’s Candler Health System implemented this approach with the help of Atlas Health and has identified more patients for enrollment, standardized workflow, streamlined enrollment and enhanced reporting for better visibility and oversight. They’ve seen reimbursement grow 2.4x from the baseline in 2020 and 3.6x from the baseline in 2021. Most importantly, they ensured more patients can afford the care they deserve.

Watch the complete webinar with audience Q&A for an in-depth exploration of how your hospital or health system can better improve your patient assistance programs.

‍