Imagine sitting down for a consultation with the oncologist and learning about two fights ahead — one fight to live, and another to afford that fight. Now, imagine learning those bills are covered by philanthropic patient financial assistance programs because of the provider’s partnership with Atlas Health.
More patients than ever need financial assistance, whether they’re underinsured, uninsured due to unemployment or other issues and unable to afford COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage or facing high deductibles or unexpectedly high costs of care. The pandemic has only exacerbated this problem — an estimated 29% of Americans lost their health insurance in 2020, with more than half of those remaining uninsured in 2021, according to a ValuePenguin.com healthcare survey.
“Both myself and my wife had issues with medical bills as patients,” Atlas Founder and CEO Ethan Davidoff said. “We were in a fortunate place to be able to pay those bills. We started to see people diagnosed with cancer going on Facebook with GoFundMe campaigns.
“We found a bigger problem — all of the patients that choose to forego treatment. They are choosing to give up because they don’t want to leave their family with medical debt.”
But there are more than $30 billion in funds available for patient medical costs often associated with care for chronic diseases including cancer, rare diseases or conditions, and other high-cost therapies. Atlas Health mapped new processes to tap into the funds quickly and designed more efficient workflows to ensure funding for care delivery is made available to cover patients’ out-of-pocket medical expenses.
“Ours is a combination of algorithms and people,” Davidoff said.
Atlas Health uses a combination of artificial intelligence (AI) — which includes a database of more than 10,000 philanthropic programs — and live, human subject matter experts (from patient access to prior authorization specialists and financial navigation services, pharmacy revenue cycle management, oncology pharmacy, information systems, infusion center management, and more) to find the money and apply it to patients.
“We’re a technology company creating and deploying AI-powered tech to rethink and simplify business processes and create new workflows that were impossible just a few years ago,” Davidoff said. “In managing a patient case where significant funds are needed, we work with the clinical team on the front end, the pharmacy team on the middle steps and the revenue cycle management team on last steps. [We do all of this] to gain funding, fast-track the tasks to minimize time to therapy and administer the ordering, billing and funding correctly.”
The service integrates with providers’ clinical and financial systems in a matter of weeks, enabling partners to quickly start helping more patients.
“Healthcare organizations often have some type of patient assistance program in place, but they aren’t maximizing available opportunities,” said Tim L’Hommedieu, PharmD, MS, Atlas Health’s vice president of pharmacy. “A robust patient assistance program requires a variety of disciplines, and without the right tools and resources, success is limited. Organization leaders who recognize their current program needs restructuring allow Atlas to customize a solution that is efficient, transparent and standardized across the enterprise.”
Atlas Health’s process of finding money to cover patient expenses is designed to benefit both patients and providers. As of 2019, the American Healthcare Association’s most recent year recorded, 5,141 hospitals incurred $41.6 billion in uncompensated care costs.
“This is about access to care and the reimbursement of dollars,” Davidoff said. “The starting point is reducing uncompensated care and converting to cash. We deliver cash to the hospitals.”
Especially in the time of COVID-19, nonprofit health systems are forced to operate like corporations because they have to manage a budget, run efficient operations and make payroll. Aggressive debt collection tactics by healthcare providers can lead to public relations nightmares.
Patients need care. Healthcare providers need to be paid for that care. Neither party should have to go into debt when money is out there.
“There are two ways to solve the patient responsibility problem, either the patient pays or somebody else pays,” Davidoff said. “We’re focused on the latter.”
Atlas Health also takes the complicated legwork out of finding money for patients and getting that money to their providers. But it requires a thoughtful, collaborative effort.
“Every organization should have a staff member or team dedicated to accessing philanthropic reimbursement programs, but most struggle with the two core problems of identifying eligible patients and efficiently enrolling them only in programs they are eligible for,” said Jerilyn Arneson, PharmD, BCOP, Atlas Health’s product implementation manager. “AI-powered technology built with the help of subject matter experts in a thoughtful way is required to define efficient workflows and custom-made processes. Automating software, which holds incorrect or incomplete information, is just doing the wrong thing faster.”
Having a diverse team of subject matter experts allows Atlas to custom design workflow solutions for specific problem areas for individual health systems. That inside knowledge drives innovation to continuously improve their software and services.
Recently, after a patient learned her oral chemotherapy pill, Ibrance, had been approved, she dropped the phone and yelled, “Thank you, Jesus!” She then returned to the phone and said, “Sweetheart, you just don’t know what a blessing you are to people. You just lifted the biggest burden off my shoulders.”
This partnership between Atlas and healthcare providers gets funding to the patients so they can be provided with care quickly, and also allows the reputation and goodwill to stay with the health system.
“We understand the opportunity for revenue cycle leaders to step up and solve the problem holistically, across the enterprise,” Davidoff said. “We don’t need the glory.”
How philanthropic financial assistance looks to the patient
Consider what philanthropic financial assistance might look like for a patient who needs chemotherapy over an extended period. The prior authorization task for this treatment would be automatically activated by Atlas Health, who recognizes the insurance payer and prepopulates required forms with data housed in clinical and financial systems. Atlas Auth, an Atlas Navigator module, completes prior authorization.
Atlas technology determines the patient will have personal medical costs of $22,357, an amount the patient confirms they will need assistance to cover.
This patient is then machine-matched with the appropriate program and often-tedious enrollment forms are populated with information automatically pulled from their clinical and financial records. Once enrollment is completed, the Atlas dashboard shows this patient case (as well as all patients in process for philanthropic reimbursement).
The notification is provided to the patient through Atlas staff or the provider’s financial assistance team.
“Hello, Mrs. Smith. It’s all taken care of. Yes, ma’am, your medical costs for this care are paid for. All you have to do is come for your infusion appointment.”
The rest of the care team is notified as well. Drugs are ordered for the treatment (infusion therapy in this instance), appointments are set, and funding is administered appropriately for regulatory and reporting compliance.
What diseases qualify for funding?
Atlas Health says it’s able to find funds for the following diseases/clinical categories:
- Infectious disease
- Rare diseases
- Growth hormone
- Women’s health
About Atlas Health
Atlas Health, the leader in medical financial aid for vulnerable populations, is improving and saving lives by empowering providers and payers with an end-to-end solution for matching and enrolling patients in medical financial aid programs through its proprietary technology and AI-powered platform, Atlas Navigator. Patients receive the care they need, providers secure reimbursement for care delivered, and payers save money. Find out how no patient is left behind at Atlas Health. At www.atlas.health, you can watch a video about our services or review provider case studies. Once on our website, scroll down and click on the video, or at the top of the page, click on “Case Studies.
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