1.
COMPLIATRIC WEBINAR SERIES
5 Enrollment Best Practices to
Decrease Uninsured Rates
www.compliantfqhc.com
Presented by: Jennifer Miksch
VP, Strategic Partnerships
PointCare

2.
+
Enrollment

3.
5 Enrollment Best Practices to
Decrease Uninsured Rates

4.
Alex Richmond
Sales Executive
PointCare
Jennifer Miksch
VP, Strategic Partnerships
PointCare

5.
Who is PointCare?
● Our Mission:
○ To enable health systems to discover,
secure, and manage private and public
coverage for their members
● Our Passion:
○ Creating a no barriers approach to
healthcare

6.
1. Identify enrollment best practices
2. Discover all available programs for your state
3. Build strategies for increasing approval rates
4. Learn how to collect and interpret enrollment data
5. Directly connect your O&E staff to Clinic revenues
Learning Objectives

7.
Poll
How Many of Your Members Do You Think
Drop from Medicaid Coverage Each Month?

8.
5%
or 3.8 Million Medicaid patients
drop from public coverage every
month.

9.
$550-$750
The annual value of a covered
Medicaid patient

10.
Medicaid
Health System
Health System
Health System
Current State
Bidirectional Unidirectional

11.
An epidemic of uninsured patients visit
your FQHC constantly
But most qualify for reimbursable
programs. The key is to identify who

12.
Poll
What Percentage of Your Self-Pay Population
Qualifies for Medicaid Today?

13.
We analyzed 235,000 uninsured
patients screened using our
PointCare Qualify tool.
Most qualify for Medicaid and
are not being enrolled

14.
Illinois Programs
Private Plans
● HealthCare.gov (Subsidized & Non-Subsidized) Individual Plans
● Job-Based Options (e.g. Group Plans, SHOP, COBRA, HIPAA, etc.)
● Illinois Comprehensive Health Insurance Plan (ICHIP)(HIPAA Plans)
● Parent Group Plans for Dependents
● Car Insurance Coverage (Personal Injury Protection (PIP)/No-Fault or
Liability)
● Community Care Program (formerly Veterans Choice Program)
● Workers’ Compensation
● Black Lung Program
Additional Benefits
● Women-Infants-Children (WIC)
● Head Start Program
● AIDS Drug Assistance Program (ADAP)
● Illinois HIV Care Connect
● CHIC-Premium Assistance Program
● Supplemental Nutrition Assistance Program (SNAP)
● Commodity Supplemental Food Program (CSFP)(8 Counties)
● Temporary Assistance for Needy Families (TANF)
● Child Care Assistance Program (CCAP)
● Refugee Resettlement Program (RRP)
● Aid to Aged, Blind, & Disabled (AABD)
● Health Insurance Premium Payment (HIPP) Program
● OSF HealthCare Financial Assistance Program
● Senior Health Insurance Program (SHIP)
● Medicare Extra Help Program
● Qualified Medicare Beneficiary (QMB) Program
● Specified Low-Income Medicare Beneficiary (SLMB) Program
● Qualifying Individual (QI) Program
● Qualified Disabled and Working Individuals (QDWI) Program
● Low-Income Home Energy Assistance Program (LIHEAP/LIEAP)
● Lifeline

15.
Illinois Programs Continued
Public Programs
● Medicaid
● All Kids Assist
● All Kids Share
● All Kids Premium Level 1
● All Kids Premium Level 2
● Emergency Medical Coverage for Non-Citizens
● Health Benefits for Workers with Disabilities (HBWD)
● Medicaid Long-Term Care
● Medicaid Spend Down Program
● Medicaid Presumptive Eligibility (MPE)
● Moms & Babies
● Presumptive Eligibility
● Family Planning Program (Title X)
● Illinois Breast & Cervical Cancer Program (IBCCP)
● Illinois Comprehensive Health Insurance Plan (ICHIP)
● Refugee Program
● Illinois State Chronic Renal Disease Program
● Family Planning
● Community Care Program
● Crime Victim Compensation Program
● Veterans Care Program
● Vaccines for Children (VFC)
● Vaccines for Adults (VFA)
● Medicare
● Social Security Disability Insurance (SSDI)
● Veteran Affairs (VA) Medical Benefits
● Supplemental Security Income (SSI)
● Health Benefits for Immigrant Seniors
County-Based Public Programs
● Women's Health (Lake County)
● Ryan White AIDS/HIV Part A Program (Serves 9 Counties)
● WISEWOMAN (Serves 15 Counties)
● CEDA - Energy Assistance Program (LIHEAP)(Cook County)
● CEDA - Energy Assistance Program (STW)(Cook County)
● CEDA - Family Support and Community Engagement (FSACE)(Cook
County)
● CEDA - Home Weatherization Program (Cook County)
● CareLink (Cook County)
● Dental Referral Program (DRP)(Champaign County)
● Carle Financial Assistance Program (Champaign County)

16.
5 Enrollment Best Practices

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What is
Coverage
Management?
Coverage Management means
tracking and preventing lapses
in your member’s coverage.
With the right data and the right
management platform, your
uninsured patients can become
covered members and stay that
way!

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● Mapping out your current process and identifying a baseline makes it easier to
track and quantify change
● We know you are making a positive impact on the community, but it can be
difficult to measure results
● Determining where you started sets you up for success
Step One: Understand Your Current
Enrollment Process

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How to Evaluate Your
Current Enrollment Cycle

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Identify
Uninsured
Patient
Manually
Qualify
Patient
Manage
Application
Unknown
Approvals
Unmanaged
Coverage
PointCare
Submit
Application
Manual
Spreadsheets
The Enrollment Cycle, Today.

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● Do we have enrollment staff responsible for
enrolling patients?
● How many patients qualify, submit, and get
approved monthly?
● How reliable is this data? Spreadsheets or
systems-based?
● What is our process for approving & actively
anchoring patients?
● What is our process for redetermining
member coverage?
● What happens if an enroller leaves the
organization?
Evaluation
Questions

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● Ensure you are up-to-date with the latest eligibility requirements
● Qualify patients for all programs and benefits, there are many options beyond
Medicaid
○ Public programs
○ Private programs
○ Additional benefits
● Develop a systematic qualification process
● All-in-all there are over 1,300 programs available across the United States and
they change constantly
Step Two: Increase Accuracy in your
Qualifications

23.
Poll
How Are You Screening Patients Today to
Determine Eligibility?

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How Do You
Screen Today?
● Limited time to reach
patients
● Keeping patients engaged
throughout the enrollment
process is challenging
● Eligibility requirements and
program information is
always shifting

25.
1461
Total Updates
This is 34% of
programs in our system
Total Programs Impacted Application Updates
Website Updates
2021 Quarter 2 Highlights
470 423 592
29% of our changes 41% of our changes
Total changes made

26.
PointCare’s
Screening Best
Practices
● Screen consistently and collect
data
● Screen for all programs, including
programs that address SDoH
● Regularly maintain your
knowledge base of rules and
program data
● Ask yourself, am I getting the 81%
of self-pay for expanded states?

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● How are you determining Medicaid approvals?
● It’s critical to anchor a member before they are assigned to another FQHC
● Need a member coverage profile that makes it easy to:
○ Anchoring
○ Recertification
○ Coverage churn
● EMRs may not always have the best tools for member management
● When reterdermination is active, 5% of members drop from coverage each
month. This makes keeping up on spreadsheets challenging
Step Three: Quickly Anchor Patients to
Your Clinic

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Anchoring Best
Practices
● Identify roles and
expectations for reach outs
based on Medicaid
verifications
● Stress the importance of
PCP selection
● Provide a script around PCP
selection and methods
● Communicate retention
metrics and wins

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● Redetermination is on the horizon, and the time to start planning is now
● Each member that drops from coverage results in financial loss to your FQHC
from both capitation payments and uncovered visits
● Members have limited visibility as to when their coverage expires
● Medicaid does not easily provide access to coverage effective dates
● If a member does fall out of coverage, it is important to have a system that
alerts you to this change. It is easier to keep someone covered than to keep re-
enrolling them when they arrive for care
Step Four: Prepare for Redetermination

30.
Important Redetermination Updates
In August CMS released an update on Redetermination
and the Public Health Emergency (PHE)
CMS announced that states will now have 12
months, instead of 6, to complete outstanding
eligibility and enrollment tasks post PHE
After the PHE lifts, states will still have up to 4
months to begin processing applications

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● Ask yourself, what numbers would you like to track?
● Who needs these numbers?
○ Do you need to share with leadership?
○ Are you reporting them for grants?
○ Do you have specific department goals you want to hit?
● How often would you like to track these numbers?
● Do you have a system in place to properly capture the data or is it manual?
Step Five: Continually Measure
Outcomes

32.
Bob Janet Kaila Mike Jill Bob Janet Kaila Mike Jill
Bob
Janet
Kaila
Mike
Jill
Qualified
Anchored
Submitted
Renewed
Approved
Reports

33.
Numbers You
Should be
Tracking
Benefits:
● Team performance transparency
● Identify areas for improvement
● Directly connect the O&E staff to
revenue
● Make better decisions based on
data

34.
Where Do You Begin?

35.
Identify
Uninsured
Patient
Manually
Qualify
Patient
Manage
Application
Unknown
Approvals
Unmanaged
Coverage
Auto
Qualify
Patient
Automatic
Approvals
Manage
Coverage
The Enrollment Cycle
PointCare
Submit
Application
Manual
PointCare
, Simplified.
Spreadsheets
Consistency, Transparency,
Transferability
, Today.

36.
Expected Outcomes
More covered lives
and more revenue
Pleasant patient
experience
Systematic member
management
High quality data
that’s useable

37.
Need help evaluating your
current enrollment process?
Contact Us
info@pointcare.com
www.pointcare.com