Growing up, we are imbued with the knowledge that healthcare is a noble profession. Doctors and nurses are careers to aspire to – callings that parents encourage. The veil lifts a bit as we get older, and become aware that providers, while still heroic to a certain degree, are also businesspeople faced with a bottom line.
Little thought is given to healthcare vendors in this regard – at least by the general public. Sure, they develop and help to implement many of the systems providers use to deliver care, but they have traditionally remained in the background, happy to provide a product that, hopefully, produces improved patient care.
Based on my preconceived notion of vendors in the shadows, I was pleasantly surprised to learn of Chamberlin Edmonds, an Atlanta-based healthcare firm that provides patient-advocacy based eligibility and enrollment services that help providers manage their uninsured patient base and generate “meaningful, incremental cash flow,” according to the firm’s website.
It’s the patient advocacy part of this description that really catches my eye. I caught up with Ulrich Brechbühl, President and CEO of Chamberlin Edmonds, at the recent HFMA 2011 ANI show to learn more about how his firm is having a direct impact on patients’ lives.
How does Chamberlin Edmonds help providers go through the process of dealing with indigent/uninsured populations?
Brechbühl: “We form a relationship with a hospital whereby every one of its uninsured patients gets referred to us, and we have a chance then to visit with the patient and their family and understand their circumstances. We uncover any insurance those patients might have and give it back to the hospital so that they can recoup their expenses appropriately.
“There’s obviously a large percentage of those that truly are uninsured, and we then go through a fairly rigorous screening for a whole host of federal, state, local and charitable programs that might cover the patient and provide for their medical care. Not only in the specific instance that they’re in, but oftentimes we can get retroactively, and the coverage that we get, especially if it’s a disability case, will actually extend into the future. And so we end up spending time with them to document their situation and get all the medical records necessary.
“This is all done at no charge to the patient. We get paid by the hospital, and only get paid once the hospital has received its cash. We’re putting our money where our mouth is.”
Do you come face to face with patients?
“I spend a lot of time at customer hospitals. I would say once or twice a month I’m with one of our staff members that is actually in a patient’s room the majority of the time.
“The recruiting of the front-end, what we call healthcare representatives, is unique. Most people go and get folks from other competitors. We don’t do that because we’ve found the highest correlation between great job performance and patient satisfaction is actually with a healthcare representative who has had - not necessarily within their immediate family but within two degrees, so to speak - someone who is disabled. So they have an appreciation for that. And that, at the end of the day, ability to build a bond with the patient and with the patient’s family, is 90% of getting there. If you think about it, what we as Americans are taught not to do is talk to strangers about our finances, our medical situation, etc. In order to be successful here, you’ve got to get somebody to open up and to share all of that with you, otherwise you’ll be there all day trying to pull it out of them.”
What is Chamberlin Edmonds doing at HFMA 2011 ANI this year?
“I think we’re viewing ANI really as the first opportunity for the Chamberlin Edmonds team to tell the story about why Emdeon decided to acquire Chamberlin Edmonds – why those of us that have come over and become part of the team from Chamberlin Edmonds are thrilled to be part of the Emdeon family. It really goes to painting the picture of how we believe patient access can be fundamentally changed in the US hospital world where, historically, the entire revenue cycle has had its challenges and tons of technologies have been built, delivered, and facilitated to try to make that process more efficient.”
What is Chamberlin Edmonds and Emdeon working on in the near future that you might be talking to people about at the show?
“By literally being able to take the information that’s already resident in the Emdeon world and download it into the eligibility component, we end up saving 30-40% of the time that otherwise would have been required to gather it ourselves. That scenario will be demonstrated to a couple of people in pilots by early fall. We’ll demonstrate that there’s a way to fundamentally transform your front-end patient access.
“That’s where the bulk of attention is today. I think for many years there’s been a lot of hospital emphasis on always focusing on the back end, trying to collect cash. As people really get down to the root cause of why they are having to do that, six and eight months after the patient was in the hospital, the answer can always be traced back to something that didn’t happen on the front end. People didn’t get the right insurance information, they didn’t get the right addresses, they didn’t do this, they didn’t do that. So the answer is let’s focus on preventing the problems from occurring to begin with.
“Chamberlin Edmonds and Emdeon are going to help providers adjust to the near-future influx of people into the Medicaid reimbursement system.”
How are Chamberlin Edmonds and Emdeon going to help providers adjust to the near-future influx of people into the Medicaid reimbursement system?
“I think there are some basics out there that people do and don’t realize. The average hospital loses money on every Medicaid patient they see. It’s the private payer that foots the bill – the commercial insurance. The only thing worse than having a Medicaid patient is having an uninsured patient, where they get nothing. And so that’s really what this is all about. Regardless of what flavor ends up being enacted, and how it all plays out, I think it’s pretty clear there’s going to be a larger number of people that become Medicaid eligible.
“Mind you, the people we work with today are already eligible. They meet the requirements. They just have not been able to, for a variety of different reasons, hop over the hurdles that would get them qualified. If you think about it, programs are established, and then immediately a bureaucracy is established to prevent people from getting to the programs. That’s exactly the way it works. So we are an antidote to the bureaucracy.
Hospital financials will deteriorate even further as a result of there being more Medicaid-eligible patients, but if you don’t actually get them converted to Medicaid, it’s far worse. To go from providing care and getting 30% of your costs reimbursed to getting 0% is unacceptable, and so as the ranks of Medicaid-eligible grow, I think it’s critical - and hospitals will tell you this too - that absolutely every single person that can qualify get qualified. They can’t afford to let people and the associated dollars slip through the cracks.”
Jennifer Dennard is Social Marketing Director for Atlanta-based Billian's HealthDATA and Porter Research.
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