What Is an Effective Patient Assistance Program?

Discover why health systems implement patient assistance programs, their key challenges, and effective solutions.

June 20, 2022
A doctor discusses patient assistance programs with a patient

Increasing healthcare and drug prices force many patients to consider forgoing treatment or risk going into debt. Costs are exponentially higher for patients facing cancer and other complex diseases that require specialty therapies. To relieve this crushing financial pressure and to ensure patients don’t have to choose between their health and putting food on the table, many healthcare providers leverage patient assistance programs to cover those who are uninsured or underinsured or pay costs not covered by Medicare. While these programs are invaluable, they come with their own complexities, sometimes making supporting vulnerable patients a challenge.

In this post, we look at why hospitals and health systems leverage external patient assistance programs, how they work, key challenges to do with execution, and solutions to overcome obstacles for patients.

Why Hospitals and Health Systems Have Patient Assistance Programs

Patient assistance programs deliver philanthropic medical financial aid by paying costs not covered by Medicare or providing copay assistance or free drugs to patients who either can’t afford treatment due to a lack of insurance or financial means or who don’t qualify for traditional government programs like Medicaid. Through this opportunity, hospitals and health systems help their patients receive the care they need, regardless of 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. So, what is an effective assistance program? It is a great competitive differentiator and can make all the difference in patient outcomes. There are financial benefits for healthcare organizations as well, including reduced drug spending, 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 thousands of patient assistance and social support programs offering more than $30B in aid annually. However, it’s hard to find and access them. The combination of various eligibility rules, enrollment policies, and reimbursement processes associated with patient assistance programs is what adds 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 advance 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 the effectiveness of patient assistance programs, whether used for taking care of the costs that Medicare won’t cover or helping those who can’t afford treatment at all. 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 assistance program, which is what a patient needs for timely philanthropic support.

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 MAP, to optimize their patient assistance programs for better 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 patient assistance 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. What is a patient assistance program without “turn-on-a-dime” facility for advocates?

Integration and Workflow

What is different about Atlas Health’s approach to finding a suitable patient assistance program is the use of AI and integration with EHRs, pharmacy management systems and billing systems. We operate the largest network of funding sources – specifically patient assistance programs and non-profit foundations, and our AI driven platform proactively matches patients to these funding sources, automates enrollment, and streamlines the back-office collection activities to secure the most awards with the least labor required. 

Atlas was designed by patient 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. Atlas changes the meaning of what a patient assistance program is by streamlining it. 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 MAP provides a single, centralized record system that stores all internal and external medical financial aid documents, including HIPAA-compliant eFax and eSignatures, mitigating compliance risk. Reporting ensures every potential patient is supported and staff productivity is measured. Reporting also objectively tracks community benefits 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. What is achieved is essentially a smooth and efficient administrative tool to locate appropriate patient assistance programs for their intended beneficiaries, benefiting patients needing financial support for costs not covered by Medicare or treatment expenses overall.

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 award estimation to help more patients and maximize funding from philanthropic sources.