Over the past three years, the Foundation for Health Coverage Education has worked with a number of health systems—including Sharp HealthCare, Catholic Healthcare West, Daughters of Charity Health System and Sutter Health—in a series of partnerships. At no charge to participating organizations, the foundation has given patients access to the FHCE's 24/7 live counselor call center and its five-question eligibility quiz, located on its website. The quiz assists the uninsured with discovering their free and low-cost health coverage options. Taking less than three minutes, it asks:
- Current insurance and/or employment status.
- Ethnicity and sex.
- Household size and income.
- Age of applicant.
- Special health conditions.
San Diego-based Sharp has taken a unique and effective approach. For a 16-month period, Sharp administered the eligibility quiz to over 18,000 self-pay emergency room patients. Sharp was able to determine how many self-pay patients were eligible for private or government-funded programs. The quiz helped Sharp better understand its uninsured patients.
The results of the ER surveys were startling. More than 80% of the 18,000 patients participating were eligible for private (COBRA) or free or highly subsidized government insurance programs. To remedy this problem, Sharp took the resource a step further and created a patient-centered self-pay and financial screening module using the eligibility quiz. This data provided a composite view of a patient's financial status and account history, which allowed Sharp to make consistent decisions related to payment options, charity and government program referrals.
For the first time, Sharp could determine which entity was liable for services rendered at the point of care. There was an increased recognition that more aggressive steps could be taken to enroll qualified patients.
As a result of Sharp's comprehensive and strategic approach to the challenges of uncompensated care, they were able to increase cash flow by $3.4 million. More importantly, thousands in the community discovered they were eligible at point of care.
Since 2005, more than 3 million people have come to the FHCE to discover their health coverage options. In the process, the FHCE has learned much about the uninsured population across the country. Patients who have previously felt defeated because they did not understand the complex enrollment procedures or thought there was no access to healthcare have been helped.
Point-of-care eligibility relieves stress on the patient while lowering the provider's uncompensated care number. The eligibility quiz lowers the administrative cost of discovering eligibility, reducing your reliance on bureaucratic government processors.
There are free and low-cost government insurance programs available today—one or more will fit the needs of many patients who currently feel they lack access. Hospitals can help patients and their own bottom line by identifying these options.
Clearly, this is a complex issue. There will continue to be debate on how to solve our nation's quest to cover the uninsured. For now, though, point-of-care eligibility empowers the patient to understand his or her healthcare options, and helps the provider identify the liable entity, thereby significantly reducing the impact of uncompensated care on providers.
Phil Lebherz is the executive director of the Foundation for Health Coverage Education, San Jose, Calif.