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Following implementation of the Affordable Care Act, patient assistance programs seemed bound for extinction. Recently, however, hospitals and health systems have found great success deploying them to ease the financial burden associated with caring for under- and un-insured patients.
New Ways of Leveraging Proven Programs to Care for the Under- and Un-insured
Recover Millions in Uncompensated Care
How Patient Assistance Programs Can Help Hospitals and Health Systems
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The Solution
The Underinsured
1. American Hospital Association. Uncompensated Hospital Care Fact Sheet. December, 2016. http://www.aha.org/content/16/uncompensatedcarefactsheet.pdf
People who have health insurance but are unable to pay etremely high out-of-pocket costs or deductibles
The Uninsured
Individuals with no health insurance
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Since 2000, hospitals and health systems have provided more than $400 billion in uncompensated care to:
The Issue
Hospitals and health systems can provide medication and medical devices to under- and un-insured patients at no cost and, in turn, receive free replacements from manufacturers.
Manufacturer-sponsored patient assistance programs:
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Once eligible patients are identified, the recovery process can begin.
After the medications are administered
Retrospectively
Before the patient's next visit
Prospectively
Engaging with a third-party consultant experienced in administering patient assistance programs is a cost-effective way to recover the cost of uncompensated care. These specialists match patients in need with the right plan on two levels:
The Answer
As a result, they forego thousands — if not millions — of dollars in potential reimbursements.
Meeting the requirements of patient assistance programs often involves technical, administrative and other resources healthcare organizations can't spare or simply don't have.
The Challenge
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These real-world examples demonstrate the level of cost savings that can be achieved through effective patient assistance programs.
The Metrics
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— Increased patient adherence — Improved outcomes — Strengthened care team engagement and collaboration — Considerable cost savings
Properly administered patient assistance programs can have far-reaching benefits for hospitals and health systems, including:
The Results
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In another 12-month period, the consultant helped the physican group save nearly
After engaging a consultant in 2013, a large physician group that is part of
an integrated academic health system in the Midwest saved
2
1
worked with a consultant to better support underinsured patients and achieved
A 581-bed academic medical center in Tennessee
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— Identify and match eligible patients with eligible products in real time — Complete and submit all program applications and accompanying documents — Administer all paperwork electronically — Track claims and appeal of claims denials
Deliver an established, reputable program that can:
— Lower drug and medical device costs — Reduce write-offs and uncompensated care costs — Control personnel costs — Decrease patients' burden of medical expenses — Improve access to care for disadvantaged patients
Provide proven, automated processes to identify uninsured and underinsured patients that are eligible for patient assistance programs.
Offer a comprehensive approach to product recovery, with assessment and inventory management tools that can help:
Choosing an effective consultant for a successful initiative means finding one that can:
Caring for under- and un-insured patients has traditionally been a source of significant loss. But now it can present an opportunity. By aligning with the right partner, hospitals and health systems can leverage patient assistance programs to close the uncompensated care gap.
The Takeaway
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For more information on patient assistance consulting and services, contact Pharmacy Healthcare Solutions:
