Understand why hospitals and health systems implement patient assistance programs, key challenges in executing them and solutions.
Increasing healthcare and drug prices force many patients to consider forgoing treatment or go into debt. Costs are exponentially worse for patients facing cancer and other complex diseases that require specialty therapies. To relieve this crushing pressure and ensure patients don’t have to choose between their health and putting food on the table, many healthcare providers leverage patient assistance programs. While these programs are invaluable, they come with their own complexities, making supporting vulnerable patients a challenge.
In this post, we look at why hospitals and health systems leverage external patient assistance programs, key challenges with execution and solutions to overcome those obstacles.
Why Hospitals and Health Systems Have Patient Assistance Programs
Patient assistance programs deliver philanthropic medical financial aid by providing copay assistance or free drugs to patients that can’t afford treatment or don’t qualify for traditional government programs like Medicaid. Through this opportunity, hospitals and health systems help their patients receive the care they need, no matter their financial situation. This support reduces financial distress and improves clinically relevant patient outcomes such as quality of life, medication adherence, symptom management and survival. Mission-oriented care providers who connect patients with this critical funding are viewed as trusted organizations and sought after. An effective assistance program is a great competitive differentiator. There are financial benefits for healthcare organizations as well, including reduced drug spend, decreased uncompensated care and faster resolution of open A/R.
The Primary Challenges of Patient Assistance Programs
The landscape of patient assistance programs is complex. Healthcare organizations struggle to gain complete visibility into the plethora of available philanthropic medical financial aid opportunities. Remarkably, there are currently more than 20,000 patient assistance and social support programs offering $30B in aid annually. However, it is hard to discover and access each unique program. The various eligibility rules, enrollment policies and reimbursement processes add to the challenge. Changes to existing programs and new opportunities necessitate constant monitoring.
Additionally, there are major resource challenges in staffing, data and workflow to progress from a program match to an award. Identifying eligible patients and enrolling them prior to procedures and prescription fills is a task in itself. There are many forms to complete. Organizing data silos inside and outside hospital and health system EHRs, billing systems, assistance programs and patients all require effort. Other administrative demands include managing supplied drugs, billing, tracking and reporting.
Coordination challenges also impact patient assistance program effectiveness. Hospital and health system stakeholders, from revenue cycle to pharmacy and clinical operations teams, must partner and align for success. Efficient operational logistics are a must to ensure a productive and compliant program.
Solving Patient Assistance Program Challenges
Over the past few years, healthcare providers across the country have relied on Atlas Health’s powerful technology platform, Atlas Navigator, to optimize their patient assistance programs for better patient outcomes and financial results. Our solution advances health equity and grows cash through next-generation philanthropic reimbursement.
A Comprehensive Database
Atlas matches patients against a comprehensive program database of over 20,000 philanthropic programs. It’s a single source for diagnosis-based assistance, copay assistance, free drugs and social support programs. Patient advocates receive real-time alerts as robotic process automation constantly sweeps all programs to uncover every opportunity for pharmacy and medical benefit across the care continuum – for any type of encounter and prescription.
Integration and Workflow
AI and integration between Atlas’ database and EHR and billing systems match qualified encounters and prescriptions to potential programs, with enrollment confidence scores and projected reimbursement. Intelligent bots automate enrollment forms with mapped EHR data, saving time for financial navigators, care coordinators, pharmacy technicians, advocates and patients. Clearinghouse integration allows for automated back-office collections. This enables hospitals and health systems to submit claims and orders, track status and log payments from one enterprise platform.
Atlas was designed by advocates, so everything they need is where they would expect it to be, translating to fewer clicks and screens for faster paths to patient aid. Advocates engage with patients directly from anywhere through secure and compliant calls and text messaging. Patient information, consent and required documents are collected through an easy-to-use, high-quality patient experience, reducing the need to download, print, scan or fax.
Reporting Compliance & Success
Atlas’ solution provides a single, centralized record system that stores all internal and external medical financial aid documents, including HIPAA-compliant eFax and eSignatures with programs, mitigating compliance risk. Reporting ensures every potential patient is supported and staff productivity is measured. Reporting also objectively tracks community benefit for Medicare Cost Reports, Community Health Needs Assessment initiatives and 340B entities. Most importantly, hospitals and health systems can quantify and share patient stories to demonstrate delivery of their organization’s mission.
Ready to Take Your Patient Assistance Program to the Next Level?
Every patient deserves equitable, affordable care. Partner with Atlas Health for an AI-powered patient advocacy solution that leaves no patient behind. Contact us today for a complimentary ROI assessment to help more patients and maximize funding from philanthropic sources.