By Steven Abramson and Everett Lebherz
While Pennsylvania has chosen to limit the impact of the Affordable Care Act in 2014, clinics currently serving a large uninsured population can still benefit from enrolling the tens of thousands of Pennsylvanians who are newly eligible for Medicaid. The biggest hurdle for most clinics is the need to streamline the enrollment process. With the Federal Poverty Level increased to 319%, (a family of 4 can now make up to $75,000 and still receive Medicaid for children), this large clinic-using population still needs to be converted to program coverage in order to increase needed reimbursements and greater financial stability for each health center.
To be sure, clinics everywhere are still bogged down by uninsured patients who are not educated about their coverage options. And, for its part, enrollment technology, such as screening software allows clinics to easily identify insurance for patients and track them throughout the process.
The good news is that newly eligible individuals and families are likely to come to clinics with questions about Medicaid, looking for help on how to sign up. And if clinic employees were able to enroll patients before they present for an illness or needed services, the clinic will not only better serve the patient, but also save funds for the clinic that otherwise would be used for uninsured care.
As a case in point, one community clinic, Community Health Alliance of Pasadena (ChapCare), has found answers to the problem through utilizing enrollment technology to get patients screened and enrolled. While Medicaid is different from state to state, the experience and results generated by the California-based-ChapCare outreach staff is eye-opening. The organization provides more than 55,000 medical, dental, and behavioral health visits annually. With a goal to enroll 20% of those uninsured but Medicaid eligible, ChapCare has been relying on taking portable technology out into the community to qualify and enroll the local population.
ChapCare staff screens for insurance eligibility by using a cloud-based software initially created for the nonprofit Coverageforall.org website and later developed as PointCare PA. Featuring a 90-second questionnaire, this program allows staff to access a database with every available state, county, and federal health coverage program. Screening consists of providing the patient’s employment status, demographic, household, and income information, as well as health conditions. Along with screening patients at community and outreach events on tablets, ChapCare is also using the tool at point-of-care.
With an early fall enrollment in California, ChapCare’s outreach staff enrolled an average of 200 people per month last fall. To draw greater visibility to their efforts, the organization held insurance enrollment events, screening 260 people and enrolling 188 with a 72% insurance conversion rate.
Once a person is screened, there are more steps that need to take place in order to get that person insured. After Screening, which provides a list of coverage programs personalized for each patient, staff then initiate, manage, and complete enrollment of the patient into his or her requested program. The Enrollment step includes having the patient provide appropriate verification documents, such as proof of income, residency, and identity. The last step is Eligibility when the patient gets approved for the program.
A key feature is electronic access to up-to-date health coverage options. Programs like PointCarePA, a web-based screening and enrollment system with a tracking device, play a significant role in allowing the uninsured to explore every option. The software also provides an invaluable patient tracking capability to assist the clinic with follow-up. PointCarePA is based on a low-cost monthly subscription, which provides access to more than 2,000 national health coverage options, including ACA-Exchange plans as well as grant and charity care programs.
3 Ways Clinics Can Boost Enrollment
Similar to methods used by ChapCare, the following three strategies can help clinics boost screening and enrollment numbers:
1. Develop partnerships with other local community health clinics and providers. Collaborations could include a shared database and combined outreach opportunities.
2. Expand community-based and localized enrollment by attending health fairs and local events. Use a tablet or electronic-based medium to screen potential patients on the go.
3. Use a simple screening program to streamline the insurance process in the field and at the office – the screening program should be accessible by computer and iPad, so that it can be utilized at multiple locations.
Continuing to reach out to the nation’s uninsured throughout 2014 will help patients secure their medical home and just as important, help clinics’ bottom lines. The result of such efforts not only will greatly help uninsured patients, it benefits busy office staff who don’t have to take time away from patient care or other duties to manage uninsured patients and also ensures providers of healthcare services secure prompt reimbursement.
Steven Abramson is Marketing Manager for ChapCare, a California clinic which provides medical, dental, and behavioral health services to more than 15,000 patients annually.
Everett Lebherz is Vice President of PointCare, developer of the cloud-based health coverage screening software, PointCarePA, and educational trainings for hospitals, community clinics, providers, and third party vendors. More information is available at www.pointcare.com.