How Patient Assistance Programs
Can Help Hospitals and Health Systems
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
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Recover Millions in
Uncompensated Care
1. American Hospital Association. Uncompensated Hospital Care Fact Sheet. December, 2016.
http://www.aha.org/content/16/uncompensatedcarefactsheet.pdf
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The Uninsured
Manufacturer-sponsored patient assistance programs:
The Issue
Individuals with no health insurance
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People who have health insurance but are unable to pay etremely high out-of-pocket costs or deductibles
The Solution
Since 2000, hospitals and health systems have provided more than $400 billion in uncompensated care to:
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.
The Underinsured
Before the patient's next visit
Once eligible patients are identified, the recovery process can begin.
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The Challenge
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:
As a result, they forego thousands — if not millions — of dollars in potential reimbursements.
After the medications are administered
Meeting the requirements of patient assistance programs often involves technical, administrative and other resources healthcare organizations can't spare or simply don't have.
Prospectively
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The Answer
Retrospectively
— Increased patient adherence
— Improved outcomes
— Strengthened care team engagement and collaboration
— Considerable cost savings
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The Metrics
The Results
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These real-world examples demonstrate the level of cost savings that can be achieved through effective patient assistance programs.
Properly administered patient assistance programs can have far-reaching benefits for hospitals and health systems, including:
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worked with a consultant to better support underinsured patients and achieved
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an integrated academic health system in the Midwest saved
In another 12-month period, the consultant helped the physican group save nearly
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A 581-bed academic medical center in Tennessee
After engaging a consultant in 2013, a large physician group that is part of
The Takeaway
— 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
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Offer a comprehensive approach to product recovery, with assessment and inventory management tools that can help:
— 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
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Provide proven, automated processes to identify uninsured and underinsured patients that are eligible for patient assistance programs.
Choosing an effective consultant for a successful initiative means finding one that can:
Deliver an established, reputable program 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.
For more information on patient assistance consulting and services, contact Pharmacy Healthcare Solutions:
877-892-1254
solutions@amerisourcebergen.com
www.pharmhs.com