Covenant Health sees a 4.6-fold ROI by automating workflows for philanthropic medical financial aid programs

Today’s healthcare financial leaders continue to look for ways to offset revenue loss stemming from the COVID-19 pandemic and the return of sequestration that will reduce all Medicare fee-for-service claims by 2%. Philanthropic medical financial aid may be one solution. With more than $30 billion in philanthropic funds available for patient medical costs associated with cancer, chronic diseases, rare diseases and other high-cost therapies, this often-untapped resource can potentially help organizations reduce uncompensated care and provide better support for the communities they serve.

That is exactly what Covenant Health, an integrated system based in Tewksbury, Massachusetts, strived to do in early 2021 — a time when approximately 31 million people in the United States had no health insurance, and uncompensated care was at an all-time high for hospitals nationwide.

Stephen Forney, FACHE, MBA, CPA, Covenant Health CFO, wanted to explore philanthropic medical financial aid as an alternative revenue source. However, he estimated it would take as many as 10 full-time staff members to manage the resource-intensive process associated with tracking thousands of dynamic philanthropic medical financial aid programs.

“Many hospitals and health systems aren’t even aware of these programs, and those that are aware typically aren’t maximizing available opportunities because they just don’t have the technology and resources to do it efficiently,” said Ethan Davidoff, founder and CEO of Atlas Health.

Atlas Health offers a solution that combines artificial intelligence (AI) with live, human patient advocates to find philanthropic programs, appropriately match and apply those programs to patients and convert uncompensated care to cash.

“It’s nearly impossible to identify eligible patients as these programs change and evolve,” Davidoff said. “Some programs open and close rapidly based on availability of funds. To complicate matters, today’s hospitals are trying to reduce labor costs. Hiring more people isn’t the answer.”

“Our hospital president felt that Atlas’ solution would directly align with our mission that focuses on compassion, integrity, collaboration and excellence,” Forney said. “We also wanted to keep driving our health system’s own financial improvement, and philanthropic medical financial aid could help us do that.”

Partnering with Atlas Health

The first step was for Atlas to perform a comprehensive retrospective analysis of Covenant Health’s visit- and claim-level data. The goal? To understand how many patients would have qualified for philanthropic medical financial aid during a specific period of time had the health system pursued relevant opportunities — as well as the reimbursement associated with those opportunities.

“The ROI process was very robust,” Forney said. “It was clear we were leaving money on the table.”

In March 2021, Covenant Health decided to launch Atlas Health at St. Joseph Hospital in Nashua, New Hampshire. In the summer of that year, it expanded to two additional hospitals.

Leveraging EHR data to improve patient care

Here’s how it works: Atlas securely accesses specific clinical, insurance and financial data in Covenant Health’s EHR. Using that data, patient accounts are automatically matched to philanthropic medical financial reimbursement opportunities for upcoming patient appointments and past encounters.

If a patient qualifies for a program, Atlas’ patient advocates contact the patient, educate them about the financial aid for which they are eligible and why, and facilitate the entire application process to secure the funds.

With Atlas, no financial opportunity is overlooked. That is because Atlas analyzes Covenant Health’s ADT data every time a patient presents for an appointment. Smart web crawler technology also sweeps all medical financial aid programs every few minutes, triggering real-time alerts when a program becomes open for enrollment. This means the health system can easily and quickly identify newly qualified patients pre- and post-visit.

In addition, Atlas’ eligibility matching engine accounts for each financial aid program’s coverage window, which can be up to 365 days retroactive, enabling health systems to capture revenue they might have otherwise lost — all using an AI-driven workflow.

Recouping lost revenue

Being able to easily pursue philanthropic medical financial aid programs helped Covenant Health recoup revenue that it might have otherwise written off as bad debt or charity care.

“Patients shouldn’t have to go into medical debt to receive the care they need, but neither should providers,” Davidoff said. “Atlas makes sure neither of those things happen.”

More specifically, during 2021, Covenant Health saw a 4.6-fold ROI across free drug, copays, foundation and external charity funding thanks to philanthropic medical financial assistance.

Containing labor costs through automation

As today’s healthcare leaders strive to contain labor costs, automation becomes critical. An AI-driven process for pursuing philanthropic medical financial aid opportunities enabled Covenant Health to identify and pursue all potential programs. Without this process, Forney said the health system would have likely devised a manual process focusing only on a handful of high-cost drugs.

Reducing healthcare worker burnout

As healthcare worker burnout continues to make headlines, healthcare organizations must find ways to alleviate the pressure.

“Tasking a patient registrar or financial aid counselor with researching and enrolling patients as well as submitting claims in philanthropic medical financial aid programs isn’t going to work and will probably only backfire in the form of turnover,” Davidoff said. “Leveraging Atlas Health to augment existing resources means organizations can easily manage thousands of programs without an additional burden on existing staff.”

Improving patient outcomes through value-based care

When patients cannot afford the care they need, they delay that care or forgo it entirely. This, in turn, can lead to poor outcomes resulting in hospitalization and a higher cost of care. By connecting patients with philanthropic medical financial aid, organizations can begin to move the needle on value-based care, Davidoff said.

“Atlas helps us help our community become — and remain — healthier,” Forney said.

Enhancing patient satisfaction

Atlas’ patient advocates, many of whom have years of experience working in patient access and patient financial services, also have two primary characteristics: Empathy and tenacity. As the cost of specialty medications continues to increase, patients appreciate having a savvy advocate on their side helping to match them with financial aid opportunities and create a compelling case for why they are eligible for that money.

“Our competitors don’t do this,” Forney said. “I actually view it as a differentiator.”

Promoting health equity

Health inequities occur when individuals don’t receive the care that they need due to barriers related to social determinants of health. When healthcare organizations address these barriers by connecting patients with philanthropic medical aid, they can potentially improve outcomes, enhance medication adherence and promote overall health and well-being. An AI-driven solution helps Covenant identify specific opportunities for the diverse community it serves.

Conclusion

To maximize financial aid opportunities, hospitals and health systems should explore an AI-powered patient advocacy solution, said Forney. “Learn what this space is about,” he added. “Any hospital should consider whether they can benefit from partnering with Atlas Health to reduce uncompensated care and improve free cash flow.” 

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Did you know?

More than 20,000 philanthropic medical financial aid programs fund $30 billion of patient care, and the volume of programs and funding continues to grow every year. Atlas Health takes the complicated legwork out of finding money on behalf of patients and puts that money directly in the hands of providers.

What is your philanthropic opportunity?

Atlas Health partners with hospitals and health systems to ensure patients can access and afford care from more than 20,000 philanthropic medical financial aid programs. Discover how our AI-powered advocacy solution will impact your revenue and patient lives. Request a complimentary ROI assessment to determine your total addressable opportunity today. Visit https://atlas.health/ for more information.

About Atlas Health

Atlas Health, the leader in philanthropic medical financial aid, saves and improves lives by empowering hospitals and health systems to match, enroll, and collect from over 20,000 patient assistance and health equity programs through Atlas Navigator, an end-to-end AI-powered patient advocacy solution. Patients access and afford the care they need, and hospitals and health systems secure reimbursement for care delivered. Find out how no patient is left behind at https://atlas.health.

This published piece is provided solely for informational purposes. HFMA does not endorse the published material or warrant or guarantee its accuracy. The statements and opinions by participants are those of the participants and not those of HFMA. References to commercial manufacturers, vendors, products, or services that may appear do not constitute endorsements by HFMA.