tennessee trains on tuesdays 07.14 · what does the king v. burwell ruling mean for tennessee...
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Solving the Problem of Uncompensated Care
Tennessee Trains on Tuesdays07.14.15
Presented by Bernard Health
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After graduating from Southern Methodist University, Lindsey worked in a traditional insurance office before deciding to make the move to Bernard Health. At Bernard, she helps hospitals reduce
uncompensated care by connecting their patients with new coverage options. She is currently working on a Master's of Healthcare Informatics from Lipscomb University. Outside of work you can find her
volunteering, working at a local food truck, or taking her two dogs for a run.
A 2007 graduate of the University of the South, John started his career in healthcare with Bernard Health in Nashville, TN. Bernard Health's mission is to be the world's most
trusted advisor when it comes to helping people plan for their healthcare, and John's professional goals are all related to helping Bernard achieve that mission. More
specifically, he helps hospitals reduce uncompensated care by connecting their patients with new coverage options. Before joining the team at Bernard Health, he rode his
bicycle across the country and worked on a cattle farm.
Jim graduated from the University of Tennessee, Knoxville. He has a broad spectrum of experience in both the Financial and Healthcare sectors, most recently serving a CEO of
Stellar Care, a home health provider in Memphis, TN. Jim joined Bernard Health to be part of the team that helps healthcare providers reduce uncompensated care and increase
revenue. Additionally, Jim serves on the Board of Governors of St. Jude Children's Research Hospital in Memphis.
Lindsey Van Cleave
John Whaling
Jim Naifeh
Today’s Objectives
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1. What is the uncompensated care problem?
2. Top 6 ways hospitals are solving it.
Background of the ACA and its effects on hospitals
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In 2013, 72 million non-elderly adults went uninsured for at least part of the year. The cost of uncompensated care provided to these uninsured patients was $84.9B.
Federal and state reimburse
ments, $53,300,00
0,000
Written off to charity
or bad debt,
$31,600,000,000
This huge $30B+ problem was a major reason why Congress passed the Affordable Care Act.
How much did Tennessee spend on uncompensated care in 2013?
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$4,791,539,893
$353,725,237
$0
$1,250,000,000
$2,500,000,000
$3,750,000,000
$5,000,000,000
$6,250,000,000
Self pay charges Collected
Only 7% in payments collected by providers
Background of the ACA and its effects on hospitals
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The ACA also sought to control costs, in part by cutting Medicare reimbursements.
1. Medicare is the biggest source of payment for many providers.
2. This led to anxiety among hospital CEOs and CFOs, who expressed concern to lawmakers.
Background of the ACA and its effects on hospitals
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Lawmakers responded by promising a reduction in uncompensated care.
1. Preexisting conditions no longer an issue.
2. Medicare cuts will be offset by an increased number of uninsured patients.
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And it worked!
…to a point.
And it's not going away.
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What does the King v. Burwell ruling mean for Tennesseans?
156K Tennesseans get $407M annually in health insurance subsidies through healthcare.gov, for an average of $218 subsidy per member per month.
Now they get to keep those subsidies.
Source: http://kff.org/interactive/king-v-burwell-effects/
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What does the King v. Burwell ruling mean for Tennessee hospitals?
1. Hospitals, medical providers and insurance companies all benefit.
2. Individuals keep their subsidies, so it's more likely they will stay insured.
3. This means the insurance companies get to keep their customers, and the hospitals and medical providers have less uncompensated care liability.
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How should we feel about our progress?
1. Do we celebrate the fact that over 155K previously uninsured Tennesseans now have health insurance as a result of signing up through healthcare.gov? Yes.
2. Do we lament the fact that over 850K Tennesseans are still uninsured? Yes.
3. Should providers sit back and wait for the remaining 850K uninsured Tennesseans to enroll? No.
4. Are there concrete steps providers can take to help uninsured patients find the coverage they need? Yes.
Who remains uninsured?
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Source: http://www.nytimes.com/interactive/2014/10/29/upshot/obamacare-who-was-helped-most.html?_r=1&abt=0002&abg=0
Uninsured patients Uncompensated care
How many uninsured are left in Tennessee?
14Source: http://kff.org/health-reform/fact-sheet/state-profiles-uninsured-under-aca-tennessee/
Even without Medicaid expansion, i.e.InsureTN, there are 612K
Tennesseans who are eligible for health insurance but remain uninsured.
What would the revenue impact be if I found coverage for all of my self-pay patients who were eligible for TennCare or subsidized health plans (61% of total uninsured population) ?
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100-bed hospital example My hospital
Average uninsured patients per week 208 #Average charges per uninsured patient $1,800 $
Average TennCare reimubursement (23% of charges) $414 $
Average Commercial reimbursement (35% of charges) $630 $
What is the revenue impact? $1,188,278 ?
If they’re eligible for free or low cost insurance, why don’t they sign up?
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1. Don’t know they’re eligible2. No internet access3. Uncomfortable using computers4. Health insurance just too confusing 5. Complicated application process6. Long wait times for healthcare.gov 800 number7. Inexperienced healthcare.gov staff8. Can’t verify identity online 9. Confused by number of plan options10. No one to help them choose the best option
Top 10 Reasons
How hard can it really be?
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How hard can it really be?
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106 available health plan options with Community Health Alliance.
or
36 health plan options in this example.
Considerations for patients include:
1. Metal tier (bronze, silver, etc.)2. Accuracy of subsidy eligibility estimate 3. Monthly premium with subsidy vs. w/ out
subsidy4. Deductible with cost sharing subsidy vs w/ out
cost sharing subsidy 5. Out of pocket maximums6. Copays vs. coinsurance7. Health Savings Account eligibility (and where to
open one)8. Network restrictions9. Prescription coverage 10. Insurance carrier brand name
Today’s Objectives
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1. What is the uncompensated care problem?
2. How are hospitals solving it?
Top 6 ways hospitals are solving it
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1. Direct patients to Healthcare.gov2. Navigators3. Train staff as Certified Application Counselors (CACs)4. Medicaid vendors5. Refer patients to health insurance brokers
(salespeople)6. Licensed, non commissioned advisors
Option 1: Direct Patients to healthcare.gov
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Cost to hospital
Results in best outcome for patients
Tracks patient enrollment outcomes for hospital
Reduces uncompensated care by helping patients with Qualified Health
Plans, Medicaid, and Medicare
Low or no burden on existing staff
Improves patient experience
sults in
best outcome
for patient
Results in
best outcome
for
Option 1: Direct Patients to healthcare.gov
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Patie
nt e
xper
ienc
e
Patient is treated and prepped for discharge.
1
2
3
4
Patient presents in the ER.
Registration staff determines the patient is
uninsured.
As part of discharge, patient is told to go to healthcare.gov. They may be given
information about the process but no help applying.
Option 2: Place Navigators Onsite
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Cost to hospital
Results in best outcome for patients
Tracks patient enrollment outcomes for hospital
Reduces uncompensated care by helping patients with Qualified Health
Plans, Medicaid, and Medicare
Low or no burden on existing staff
Improves patient experience
Results in
best outcome
for
v vv
v v
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Patie
nt e
xper
ienc
e Option 2: Place Navigators Onsite
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Registration staff determines the patient is
uninsured.
4
Patient is stabilized and prepped for discharge.
Navigator explains how the ACA works and shows patients the steps required to enroll on healthcare.gov, but they cannot help them pick one of the 100+ available
plans.
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Hospital has to find and place Navigators.
2
Patient presents in the ER.
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Cost to hospital
Results in best outcome for patients
Tracks patient enrollment outcomes for hospital
Reduces uncompensated care by helping patients with Qualified Health
Plans, Medicaid, and Medicare
Low or no burden on existing staff
Improves patient experience
Results in
best outcome
sults in
best outcome
for patient
sults in
best outcome
for patient
Option 3: Train staff as Certified Application Counselors
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Patie
nt e
xper
ienc
e Option 3: Train staff as Certified Application Counselors
3
Registration staff determines the patient is
uninsured.
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Patient is stabilized and prepped for discharge.
CAC explains how the ACA works and shows patients the steps required to
enroll on healthcare.gov, but they cannot help them pick one of the 100+
available plans.
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Hospital has to have staff trained as CACs.
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Patient presents in the ER.
What happens if patient meets with a Navigator or CAC, but chooses the wrong plan?
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1. Most hospitals in Tennessee aren't in the networks of every plan available on healthcare.gov.
2. If the patient chooses a narrow network plan (usually because of a lower monthly premium), she may not have in-network coverage at your hospital. The CAC / Navigator cannot legally steer them to a different plan.
3. Which option would you choose?
Option 1: $58 / month Option 2: $84 / month
What happens if patient meets with a Navigator or CAC, but chooses the wrong plan?
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Option 1: $58 / month, narrow "E" network Option 2: $84 / month, broader "S" network
27 in-network facilities in TN 126 in-network facilities in TN
What happens if patient meets with a Navigator or CAC, but chooses the wrong plan?
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If your patient chooses the $58 / month option, she may be surprised to find that when she returns for care, her hospital of choice isn't in her health plan's network.
Frustrating for the patient because she either:1. Can't get care (or)2. Gets stuck with significant out-of-network costs.
Frustrating for the hospital because 1. Even though this patient is now technically insured, she still represents high uncompensated care liability.2. She may even go to an in-network facility for care.
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Cost to hospital
Results in best outcome for patients
Tracks patient enrollment outcomes for hospital
Reduces uncompensated care by helping patients with Qualified Health
Plans, Medicaid, and Medicare
Low or no burden on existing staff
Improves patient experience
Results in
best outcome
for
Option 4: Medicaid Vendors
Results in
best outcome
sults in
best outcome
for patient
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Patie
nt e
xper
ienc
e Option 4: Medicaid Vendors
Patient is stabilized and prepped for discharge.
1
2
3
4
Provider hires Medicaid vendor to work onsite in
their ER.
Patient presents in the ER and registration staff determines the patient is uninsured and screens to see if they
might be eligible for Medicaid.
If registration staff determines the patient might be eligible for Medicaid they will sit
down with the Medicaid vendor and apply. That is where the help from the Medicaid
vendor will end.
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$$ $ $
$
Vendor shares report with hospital so they can update their billing system and submit claims for newly enrolled
patients.
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Cost to hospital
Results in best outcome for patients
Tracks patient enrollment outcomes for hospital
Reduces uncompensated care by helping patients with Qualified Health
Plans, Medicaid, and Medicare
Low or no burden on existing staff
Improves patient experience
Results in
best outcome
for pati
Results in
best outcome
for
Results in
best outcome
Option 5: Refer patients to health insurance brokers (salespeople)
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Patie
nt e
xper
ienc
e Option 5: Refer patients to health insurance brokers (salespeople)
Patient is stabilized and prepped for discharge.
1
2
3
4
Patient presents in the ER.
Registration staff determines the patient is
uninsured.
As part of discharge patient is given the business card of a broker in town and are
told to call them for help. They may or may not call. Also, the commissioned broker may try to sell the patient a policy that is not right
for their needs.
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Cost to hospital
Results in best outcome for patients
Tracks patient enrollment outcomes for hospital
Reduces uncompensated care by helping patients with Qualified Health
Plans, Medicaid, and Medicare
Results in best outcomvve for patients
Low or no burden on existing staff
Improves patient experience
Results in
best outcome
for
sults in
best outcome
for patient
sults in
best outcome
for patient
sults in
best outcome
for patient
sults in
best outcome
for patient
Option 6: Licensed, non-commissioned advisors
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Patie
nt e
xper
ienc
e
1
2
3
4
5
Provider places licensed, non-commissioned advisors onsite
in the ER.
Patient present in the ER.
Patient is stabilized and prepped for discharge.
Advisor meets with patient to identify best coverage option (Medicaid,
Medicare, or commercial plans) and enrolls patient in new insurance.
$$ $ $
$
Vendor shares report with hospital so they can update their billing system and submit claims for newly enrolled
patients.
Option 6: Licensed, non-commissioned advisors
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How do these options compare?
Cost to hospital
Results in best outcome for patients x
Tracks patient enrollment outcomes for hospital
Reduces uncompensated care by helping patients
with Qualified Health Plans, Medicaid, and
Medicare
Results in best
outcomvve for patients
Low or no burden on existing staff
Improves patient experience
x x
x
Direct patients to healthcare.gov
Place Navigators
onsite
Train staff as CACs
Medicaid Vendors
Refer patients to health insurance
brokers (salespeople)
Licensed, non commissioned
advisors
x
x
x x
x
x
x
x
Solving the Problem of Uncompensated Care
Questions?
Contact Information
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Lindsey Van Cleave
John Whaling
Jim Naifeh