HL20: Gerilynn Sevenikar—Helping Patients Navigate the High Cost of Care

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Gerilynn Sevenikar.

This profile was published in the December, 2012 issue of HealthLeaders magazine.

 "We're getting more cash back from our patients, but the better news we're getting letters from our patients saying how much they appreciate this."

Gerilynn Sevenikar, vice president of patient financial services for the 2,092-licensed-bed Sharp HealthCare System in San Diego sees herself as upbeat, but her optimism was surely tested in 2009. The balance sheets weren't looking good: Collections from the uninsured population were decreasing, while unemployment was increasing in San Diego County. There was so much uncertainty it would not have been surprising if Sevenikar may have wondered if should have chased her early dreams of becoming an airline pilot. Instead, she was juggling so many things as a financial leader at Sharp it was not unlike being an air traffic controller.

Indeed, back in the 1970s, when she started her career at Sharp, she had been thinking of becoming an airline pilot, and in fact, has a pilot's license. Those vocational plans changed, however, as work at Sharp became more fulfilling, and certainly challenging.

When the fiscal climate appeared dire a few years ago, Sevenikar found ways to help the uninsured, or self-pay patient population gain federal or state funding, and also opened the door for Sharp to obtain millions of dollars in payments it would not otherwise obtain. She also has tried to make the bureaucratic process more manageable for patients and more efficient for providers.

One of the key actions that Sevenikar took was helping Sharp team up with Foundation for Health Coverage Education, a San Jose, Calif.–based nonprofit that assists in helping people understand their healthcare eligibility status. Under the collaboration, Sharp initiated the FHCE's eligibility quiz (www.CoverageForAll.org) into the emergency department registration process to reduce the numbers of self-pay patients by finding public and private health insurance eligibility information to help them access to coverage. The effort has resulted in helping more than 32,000 self-pay patients "navigate through a maze" of government health coverage programs, Sevenikar says. Over three years that Sharp has partnered with FHCE and through other internal initiatives, it's recovered $4.7 million in revenue, according to Sevenikar.

As she wades through paperwork and balances the needs of patients and demands of the hospital system, Sevenikar says she understands providers must be tough yet sensitive while seeking payments. Along the way, patients have sent her heart-felt emails expressing "thanks," and some surprised her.

Sevenikar recounted the story of a patient lacking insurance who wondered the kind of reception she would receive at the hospital. Sevenikar and her staff made her feel comfortable. "Upon arrival I was so afraid I would not be seen because I was uninsured; not only was I not turned away, I wasn't treated differently than anyone else," the woman wrote to Sevenikar. "Everyone in the department was very nice, and skilled at their profession."

Such comments make her feel terrific, says Sevenikar. "It means we're making a difference!" she exclaims.

Not every patient is happy, of course, nor would Sevenikar expect that. "There's not going to be a 'thank you, Sharp, for sending me the bill,'" Sevenikar says. "That's not happening. There's always going to be some dissatisfaction."

Still, she takes the lessons from 2009, and is carrying them forward. That year, during the economic downturn, Sharp was tested, like many healthcare organizations. Sevenikar says she started seeing steep declines in self-payments, about $3.4 million in one year. At the same time, there was an increase in self-pay volume, about 7%. That coincided, not surprisingly, with a significant rise in San Diego's unemployment from around 8.7% to 12%.

"I did the analysis and it was truly a reflection of the economy," Sevenikar recalls. "People were just feeling the pain. We looked at how we were handling the process with our patients. We wanted to be sensitive to what they were going through. How were we going to bridge the gap for them? What's the right thing to do? What's the reasonable thing to do." Eventually, she says, "We're partners in this process."

One of the ways that Sevenikar believed Sharp could improve payments was to help patients navigate the system better. She began working with Foundation for Health Coverage Education to help patients consider their coverage options. After reviewing data, Sevenikar says that more than 80% of Sharp's uninsured patients are eligible for some assistance.

"We did the research for patients and we asked what sort of funding programs they could be eligible for," Sevenikar says. "When they came into our emergency rooms, we gave them the information and application and everything they needed to apply for funding, so they can move forward with some kind of assistance."

That focus paid off, Sevenikar says. Within the first two years, payment collections increased 6.5% and 4.4%, Sevenikar says. "We're getting more cash back from our patients, but the better news is that we're getting letters from our patients saying how much they appreciate this," she says.

While Sevenikar already has faced some tough economic hurdles, more financial cutbacks loom. Healthcare reform offers more challenges, including anticipated increases in the uninsured population, Sevenikar adds. For the most part, Sevenikar says, technology will be of overwhelming importance as hospitals confront any potential problems.

"We are moving toward stronger automation, that's what I tell my employees," Sevenikar says. "I tell them embrace technology, become an expert at it, and become invaluable to the organization."

More and more, though, she's knows that patient satisfaction is a crucial element of what she does. "When you are thinking about patient billing and collections, the bottom line is, 'Are you doing the right thing?' "