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How IU Health Slashed Self-Pay by Adding Financial Advisers

News  |  By Christopher Cheney  
   January 05, 2018

Indiana's largest health system has used a 13-fold increase in its financial-adviser staff to drive down the number of uninsured patients by helping them acquire health insurance.

IU Health has slashed the percentage of gross patient revenue that comes from self-pay patients in half over the past six years in large part by increasing the health system’s financial-counselor ranks from 12 to 158.

In 2012, self-pay as a percentage of gross patient service revenue at the

Indianapolis-based health system was 5.46%. In 2016, self-pay had plummeted to 2.85%.

In large part, the counselors help eligible patients navigate a confusing array of possibilities to find a commercial insurance product or government program for which they qualify.

"Ideally, you are reducing the number of self-pay patients and converting more to an insured product, an insured plan, Medicaid payer plans, or Marketplace payer plans," says Angie Church, program manager of individual solutions at IU Health.

At IU Health, the Individual Solutions Department is part of the health system’s revenue cycle corporate division. Its 158 individual solutions senior associates must be state-certified as financial navigators, and they work in several settings across all 15 of the health system's acute-care hospitals, including:

  • Emergency room and inpatient facilities
  • Business offices where uninsured patients are screened for coverage options prior to hospital services, with the screening conversations held via phone calls or at the business office
  • “Back-end” billing offices, where financial advisers help patients try to qualify for coverage after receiving services

Qualifications and Training

When hiring new individual solutions senior associates, compassion is an essential quality that candidates must be possess because the financial advisers collect sensitive personal information, Church says.

"We are getting the medical history, the household size, and family member information. To build a relationship and trust with a patient, where they want to open up to you, there is a certain type of personality that is well-suited to the position."

Communication and assessment skills also are crucial, she says.

"They need to be agile. They have to be able to quickly assess the patient's eligibility, circumstances and what the patient may qualify for."

Once financial advisers are hired, they undergo pre-certification training for the state department of insurance navigator license examination. IU Health trainers guide new hires through the pre-certification course, including about 500 pages of study material, Church says.

Licensing for individual solutions senior associates at IU Health requires passing the Indiana Navigator Certification Examination.

The 60-question test covers three areas:

  • Consumer assistance basics such as conflicts of interest, confidentiality rules, and reporting requirements
  • Medicaid basics and Indiana health coverage programs, including benefit packages and available services, Medicaid eligibility requirements, and state-based assistance program terminology
  • Health insurance basics and the federally facilitated Marketplace, including open enrollment periods and special enrollment periods, the application process for health plans obtained through the Marketplace, and minimum essential coverage

IU Health, which posted $6.2 billion in total operating revenue for the2016 fiscal year, also trains its financial advisers to use an in-house healthcare-coverage eligibility tool.

"The tool takes the patient from initial eligibility determinations to determining their eligibility results, then takes the patient all the way through the application process, being enrolled and, hopefully, to being approved for active coverage," Church says.

Working with Patients

Best practices for having financial conversations with patients involve both preparation and good judgment, she says.

"The scripting helps start out the conversation with the patient, then the navigator uses best judgment to take it from there."

Much of the scripting is related to the different coverage plans that are available.

"We are constantly working to make sure it is up to date," she says, noting the significant effort needed to stay abreast of changes to Medicaid, Medicare and other government programs.

For hospital patients who are not seriously ill, individual solutions senior associates start conversations in a manner that helps build trust, then try to determine whether patients qualify for healthcare coverage, Church says.

These conversations begin with an introduction, with the financial adviser explaining the navigator role. Patients also are told approximately how long the interaction will take and what to expect such as the eligibility screening process.

For seriously ill hospital patients, financial advisers often enlist members of the clinical care team to help collect and process information, she says.

"We work closely with case management, care managers and social workers. For patients who have been in and out of the hospital for multiple treatments, being able to work with the case management team is beneficial because they often have an existing relationship with the patient."

Working closely with the case management team can ease the collection of documents, Church says. The case management team often helps secure physician signatures on financial forms and connects financial advisers with family members who can get copies of documents.

In all cases, financial advisers strive to improve the patient experience, she says.

"After that initial introduction, [patients feel] a sense of relief because you can help them through the process," Church says.

Christopher Cheney is the CMO editor at HealthLeaders.


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