Transcript PowerPoint Template 1 - Western Michigan University

Managing Your Uninsured Population
Under Healthcare Reform
Chris Milligan & Joe Farago
Objectives
 Current State of Uninsured
 Future of Uninsured with Healthcare Reform
 Healthcare Coverage Under Affordable Care Act
 Insurance Plans
 Best Practices – Patient Access
 Best Practices – Patient Financial Services
 Timing is Important
What We Know
 Americans will qualify for insurance
– Beginning 12:01 a.m. January 1, 2014
– Sign up begins fourth quarter this year
 Financial counselors will become more important
 Insurance pays better than Medicaid and Charity Care
– Pre-existing conditions will not impact insurance coverage
Health Insurance Marketplaces will change
the way people buy coverage.
STATE OF UNINSURED
State of Uninsured – National
48.6 Million (January 2013)
 48.6 Million = 16.3% of Americans are Uninsured
 1.006 x Bush vote total in 2000
 1.8 x the number of Twitter users
 1.12 x the number of smokers
 1.537 x the attendance of the London Olympics
Managing the uninsured cost providers
over $49 billion a year!
Future of Uninsured
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Reduce Uninsured by 37.6 Million (74%)
17 Million – Medicaid Eligible
16.3 Million – Subsidies
4.3 Million – Individual Mandate
Medicaid DSH Payments Reduced
Medicare Payments Flat Line
HEALTHCARE COVERAGE UNDER THE
AFFORDABLE CARE ACT (ACA)
Healthcare Coverage Under the ACA
Healthcare Coverage Under the ACA
Where Applicable – Apply for Medicaid
Healthcare Coverage Under ACA
The Family is
guaranteed, at a
minimum, access to
unsubsidized insurance
through a marketplace
or in the non-group
market.
Healthcare Coverage Under ACA
An Employee should
choose coverage in their
employer plan unless it
is more than 9.5% of
their household
income.
INSURANCE AFFORDABILITY PROGRAMS
Subsidized Insurance Plans
Plans will cover a standard set of “Essential
Health Benefits” including hospitalization,
doctor visits, prescriptions, emergency room
treatment, maternal and newborn care,
and prevention.
Subsidized Insurance Plans
Middle-aged and older adults cannot be
charged in excess of three times what
young people pay. Smokers can have a
penalty. Insurers cannot turn away the
sick or charge them more.
Subsidized Insurance Plans
Level
Bronze
Silver
Gold
Platinum
Coverage
60%
70%
80%
90%
Benefits are similar with the biggest difference being
the share of expected health care costs the plan will
cover “Actuarial Value”
Subsidized Insurance Plans
 The tax credit will go directly to the insurer
– Lower level save on premiums but increase
copayments and deductibles
 Increase pressure on financial counselors
 Increase self pay collections
 The government’s help is reduced as
household income increases
 The Government’s subsidy will be tied to the premium for the
second lowest cost plan at the Silver coverage level available
in your area
Example One
 Family of four headed by a
40 year-old making $35,000 per year
– Annual Premium $12,130
– Tax credit of $10,742
– Will pay $1,388/year or about 4% of
income (about $115 per month)
Example Two
 Family of four headed by a 40 year-old
making $90,000 per year
– Annual premium $12,130
– Tax credit of $3,580
– Will pay $8,550/year or about
9% of income (about $712 per month)
BEST PRACTICES: PATIENT ACCESS AND
REGISTRATION
Best Practices – Patient Access
Present and Future
 Evaluate Current Staff
 Establish Consistent, Patient-Friendly
Process
– Make sure you get guarantor information
 Initial Standard Application
 Does this need management review?
 Evaluate System Capabilities
 Clearly Define Follow-up Process
Best Practices – Patient Access
Evaluate Current Staff
 Capacity of Staff
 Initial Screening will need to be different
– Obvious if self pay
– Are they underinsured
 Comprehensive Assessment
 Training of Staff
 In-source or Outsource
– Currently, you probably do not have enough
staff
Best Practices – Patient Access
Consistent Patient Friendly Experience
 Common Process
 Eligibility needs to be checked
immediately
– Coverage needs to be evaluated
– Coverage could be added
 Capture Critical Information
 Share Information
 In / Out of Network
Best Practices – Patient Access
Standard Application
 Capture Information For All Programs
– Review and create new forms
– Where applicable, help apply for insurance
– Look at insurance coverage level
 Improved Efficiency
 Incorporate Scanning Capabilities
Best Practices – Patient Access
Evaluate System Capabilities
 Online / Electronic Assessment
– Assessment needs to include level of
insurance if from Marketplace
 Information Sharing / Integration
 Scanning Capabilities
 Community Benefit / Cost Report Data
 Complimentary Systems
Best Practices – Patient Access
Follow-Up Process
Financial Counseling
Patient Registration
Emergency Department
Follow-Up
Maximize Reimbursement
In-source/Out-source
PATIENT FINANCIAL SERVICES
Patient Financial Services
 Patient Advocate
 Critical Process
 Determine Who Will Manage Process
 Balanced Approach
– Might need to be involved earlier
– Collections / Patient Advocate
– Coverage always needs to be reviewed
– Out of Network coverage could be a problem
Best Practices – Patient Financial Services
Management of Process
 Utilize Experts
– Self-pay Collections
 Will change in focus
 Will Increase
– Medicaid Enrollment
 More will qualify
– Charity Care Enrollment
 Could change based on increase in Medicaid
– Insurance Enrollment
 In-Source / Out-Source or Hybrid Approach
Best Practices – Patient Financial Services
Balance Approach
 Point-of-Service Approach
 Clearly Define Patient Expectations
 Patient Advocate vs. Collections
 Define Your Approach
– Management needs to consistently review
– Employees need to work quickly
– Will you suggest more coverage?
FINANCIAL IMPACT
Financial Impact / Opportunity
 Medicaid FFS
 Charity Care
 Insurance
 Disproportionate Share
– Will be reduced
 340B
Financial Impact – Insurance
 Most Attractive Long-term Option
 Average Distribution: 65% of cost
 New Application Process
250 Bed Facility
Insurance Eligible
Percent
Average
Insurance
Insurance
Volume/Month
Charges Eligible
Cost
Distribution
Impact
65
65%
$4,200
$1,911
$33,968
$407,610
Out of Network – Alert
 Many out of Network plans pay similar to Medicare
 Average Distribution: 70% of cost
 New Application Process
Out of Network Patient
Medicare Reimbursement
$958
Commericial Reimbursement
$12,292
Out of Network
$838
Difference
$11,454
Charity Care
 Levels will need to be Re-evaluated
 More will qualify for Medicaid
 Look at Insurance Tax Credits
HEALTHCARE REFORM IMPACT
Future of Uninsured – Impact on Providers
 Expanded Process – Assessment / Enrollment
 Increased Compliance – Data / Cost Report
 Staffing Efficiencies
 Changes To Reimbursement
 State / Federal Process Delays
Things to Do Now
 Make a Plan
– Realize it will change
– Is the hospital going to be in business of
purchasing Insurance
 Everyone needs to be trained to be a
patient advocate
 Financial Counselors will become more important
– Train for now
– Plan training for Healthcare Reform
Objectives
 Current State of Uninsured
 Future of Uninsured with Healthcare Reform
 Healthcare Coverage Under Affordable Care Act
 Insurance Plans
 Best Practices – Patient Access
 Best Practices – Patient Financial Services
 Timing is Important
Thank You
Chris Milligan
Associate Vice President
[email protected]
216.426.5501
Joe Farago
Senior Client Executive
[email protected]
216.431.5201