Mon Health's patient advocacy program and pre-access service center work in tandem to help people in its rural West Virginia communities to receive fast and affordable care.
High-performing patient access departments can help pave the way for smoother collections and increased patient satisfaction. But in rural areas, they take on an even more important function by enabling healthcare delivery for people who might not get it otherwise.
That's been the case at the West Virginia–based health system Mon Health, where the revenue cycle is about much more than dollars and cents.
"Really, it becomes a higher purpose, particularly in connecting the population with healthcare providers and then also connecting them with resources," says Candice (Candi) Powers, MBA, CRCR, CRCA, Mon Health's chief revenue cycle officer.
She says that in West Virginia, there's a perfect storm of a lack of healthcare access, poverty, and chronic illness.
"West Virginia is not the healthiest state," Powers notes.
When compared with other states, it's ranked highest nationally in the prevalence of heart attack and coronary disease, and second-highest nationally in the number of overweight or obese adults. It's second-highest in the prevalence of adults whose general health is either fair or poor, according to the state's Department of Health and Human Resources.
It's also among the poorest states, with 17.8% of people living in poverty in 2018, the fourth-highest percentage in the country, says the West Virginia Center on Budget & Policy.
Add to that the spate of rural hospital closures across the country—176 since 2005, according to the Sheps Center at UNC—and accessing healthcare becomes even harder.
"We've got lots and lots of chronic conditions that [patients] are trying to manage, so it becomes even more critical to help folks find resources," Powers says.
That's where the revenue cycle comes in.
"Financial counseling and patient advocacy become [a] critical … community health benefit in the rural setting," Powers says.
At Mon Health, the focus on community health and patient access has taken shape in two main ways, both of which involved working with the firm PatientMatters, which also recently launched a pre-access tool called IntelliRural specifically for rural hospitals.
Those efforts include a pre-access center at Mon Health Medical Center, as well as patient advocates who are employed by PatientMatters and work at all three of Mon Health's campuses: Mon Health Medical Center, Mon Health Preston Memorial Hospital, and Mon Health Stonewall Jackson Memorial Hospital.
The pre-access and patient advocacy efforts work in tandem to help enable patient access, says Gordon Jaye, vice president of operations at PatientMatters.
"The advocacy program … really is about getting people access to care, and the pre-access service center is making sure people get to the care quickly," he says.
A centralized hub
Mon Health has set up a pre-access center at Mon Health Medical Center to not only streamline and centralize patient access, but also to proactively reach out to patients before their service. Eventually, the pre-access center will be systemwide. Mon Health Medical Center centralized registration at the same time.
"We have a central hub where the revenue cycle validates orders, schedules patients, [and] makes sure services are authorized before they arrive," Powers says. "We validate insurance, communicate [what] estimated balances are going to be, so that [patients] can have a more seamless transition to [the] point of care."
Once a physician has ordered a service, the pre-access center will reach out to the patient regardless of any action from patient. That's important if a healthcare system has a disengaged patient population that might not act on a physician's orders right away.
The pre-access center also does prior authorizations, which is another important part of patient access.
"People defer their care until an authorization has been obtained from their payer by the service line, and when you centralize all of this work, the patient doesn't get bounced around all over the institution looking for this information," says Jaye.
Powers notes that although "the pre-access service model isn't anything new," many institutions struggle with how to tackle it because it's so fragmented. That's why Mon Health used a partner to help streamline it.
"When it is decentralized, it is such a large undertaking, particularly if you employ a lot of physicians," she says.
That work has already started to pay off. In the first six to seven months of the pre-access center being in place, Mon Health reduced no-authorization denials by $600,000, which Powers says is "directly attributable to the pre-access service centers."
In addition, Mon Health's average registration time dropped to six minutes, and average wait times were under five minutes.
Mon Health has also added patient advocates, who work at all three of its facilities. The advocates help schedule appointments and proactively reach out to uninsured patients to screen them for Medicaid or Medicare eligibility, or help them enroll in a health insurance exchange plan. They also help patients apply for these programs, aiding with paperwork and gathering documentation.
"It's a pretty labor-intensive process for John Q. public to get through," Powers says. "It only takes one event, and, without coverage, these folks would be facing some really difficult choices … choices that we don't want the community that we serve to face."
That's especially true for Mon Health's rural population, which Powers notes might be willing to be seen in the emergency department if it's "an absolute emergency," but often doesn't proactively manage health issues because of cost or lack of coverage.
In fact, the average monthly referral volume from the combined facilities is more than 500 self-pay referrals monthly, and the two smaller facilities service more than 60% of their self-pay volume through the emergency department.
Mon Health also helps facilitate pharmaceutical assistance, helping patients to apply for financial assistance programs that pharmaceutical companies offer.
Powers says that the patient advocacy work makes her the proudest.
"That's really where I feel like we're doing community-based, noble work and getting people connected with resources that maybe they would never even seek medical treatment without," she says.
Alexandra Wilson Pecci is an editor for HealthLeaders.
Rural providers can offer financial counseling and advocacy to help patients get healthcare they couldn't access or afford otherwise.
A pre-access center streamlines and centralizes patient access and proactively reaches out to patients before their service.
Patient advocates can help schedule appointments and screen uninsured patients for Medicaid or Medicare eligibility.
Advocates can also help patients enroll in financial assistance programs.