At Texas Children’s Hospital, the initiative to improve patient access generated additional clinic appointments and, in turn, patient revenue opportunities. One key to capitalizing on those opportunities was to reduce losses that arose from out-of-network insurers.
The hospital’s partnerships with health plans were analyzed to improve payments. A large Texas Medicaid health plan represented 50% of all out-of-network insurance coverage, resulting in around $12.3 million in lost payments annually. Patients with out-of-network coverage were identified and given information on in-network providers through letters, educational sessions from financial counselors and a calling campaign. One result was a reduction in gross charges of $143 million.
A health plan that covered 6,000 patients terminated its partnership with Texas Children’s in November 2017. With educational outreach, 59% of these patients switched their coverage to in-network agencies within seven months of the termination.