Eligibility and enrollment programs at hospitals and health systems are often a costly mess. Fixing these problems can come down to setting the right metrics and monitoring the data in real-time.
Centra Health, a three-hospital system based in Lynchburg, Va., took control of its eligibility and enrollment data, and as a result cut uncompensated care by $9.1 million and saved a total of $11 million.
Many organizations use multiple, disparate data silos that span departments and in some cases multiple hospitals. That makes it challenging for healthcare leaders to get at accurate and actionable performance data. Some organizations rely on in-house departments to screen self-pay patients and enroll them in Medicaid or other assistance programs, while others use third-party vendors.
Four years ago, Joseph Koons, Centra Health's managing director of revenue cycle, sought to change how the organization approached its insurance eligibility and enrollment program. Uncompensated care had reached 7% of Centra Health's gross revenue.
He pushed to have all eligibility and enrollment data centralized. That would give the ability to pull together, in real-time, the needed data: stats on payer, provider and hospital performance measures, outside referrals, and hospital incurred expenses. From there, Centra Health could benchmark against goals and targets that prevent small revenue leaks from turning into huge ones.