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Boosting Revenue Sources for Tribal Health Organizations

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As IHS and Tribal Health Organizations continue to face number of challenges resulting from rising costs and disproportionate underfunding – not to mention the impacts of COVID creative solutions like automated Health Coverage Discovery can help fund the path to self-determination and improved care for AI/AN populations. 

 
Monday, March 1st, 2021

 
As Tribal Health Organizations strive to improve care and pursue self-determination, they encounter both opportunities and challenges while serving their communities. Despite myriad issues such as legacy systems, understaffing in both clinical and clerical roles, and high demand, tribal healthcare leaders are challenging the status quo in order to improve the health of their communities. Driven by their mission to advance care and reach out to their constituents, Tribal Health Organizations (THOs) are taking a more progressive view of their funding sources and seeking ways to augment revenue to meet the needs of their communities.

Optimizing insurance coverage discovery is important for any healthcare organization, but especially for THOs that rely on other forms of coverage beyond the Indian Health Service (IHS). The manual processes required to check all forms of insurance coverage have often posed challenges for tribal health who may lack the staff resources to find alternative types of coverage – even when the resultant revenue could be used to fund vital care programs, specialized staff and services, and local educational initiatives.
 
Tribal Health Organizations face unique challenges compared to other healthcare organizations. While they must comply with the mandate to exhaust all forms of coverage before writing off expenses, THOs have a patient population that may not be aware of the various coverage options available to them beyond the IHS, and in some cases may not know that they should present other forms of coverage. The combination of understaffed tribal health financial offices, unaware patients, funding shortfalls, and increased care needs lead to financial and compliance issues for these organizations.

To address these challenges, THO leaders are focusing on a variety of fronts. From launching education initiatives to counseling patients on financial support options and leveraging alternative sources of insurance coverage discovery to generate revenue, these healthcare leaders are able to maintain and grow quality healthcare services in their communities. Automation tools further support this coverage discovery process to help address financial gaps while minimizing busywork for already overburdened staff.
 

 

The Impacts of COVID-19 Only Exacerbate Tribal Health Funding Issues 

 

With the events of the last year and 2021 already revealing new challenges, many government agencies are struggling with funding, and the IHS is no exception. As COVID-19 continues to rage unchecked throughout Native American communities – and widespread unemployment  persists among Native populations – American Indians and Alaska Natives (AI/ANs) often have little choice but to seek recourse in other revenue sources. Whereas Medicaid and Medicare budgets have continued to rise in recent decades, funding for the IHS has dwindled in proportion to the needs of those it serves.  

The truth is there simply aren’t enough IHS dollars to meet the health demands of Native communities, especially not in an unusual year like this. With funding stagnant and costs and care needs rising, THOs must find alternative sources of insurance coverage and revenue to continue growing invaluable community health and outreach programs. For the financial health of IHS organizations, it is important to explore automated tools that can help identify additional forms of coverage for patient encounters without the burden of manual coverage discovery processes.

 

Embracing Automation in Health Coverage Discovery


Many Tribal Health Organizations have likely already implemented processes or programs and even added staffing for the purposes of addressing the issues of patient insurance coverage and submitting eligible claims. However, shifting Medicaid rules and retroactive Medicaid coverage options as well as a growing number of employer insurance programs means these organizations often see tremendous benefit from automated coverage discovery solutions to ease the burden of manual coverage checks.

While manual checks only address coverage eligibility in a single point in time, an automated solution can check continuously and find eligible encounters if or when retroactive coverage comes into play. While THOs certainly cannot automate everything, leveraging technology solutions in key phases of the health insurance process like coverage discovery can ease the burden of time-consuming busywork and enable staff to focus on the lifeblood of your organization: building relationships and supporting education initiatives that are so vital in the community.

The best part about an automated coverage discovery solution, however, is that it can yield almost unbelievable results for THOs. Databound has partnered with multiple Tribal Health Organizations to automate coverage discovery and helped them find a staggering number of eligible encounters. In fact, one THO in Alaska was able to generate $30 million in revenue from the found coverage. (Watch the webinar to learn more about ANTHC’s story). Other THOs have found seven-figure annual opportunities from coverage discovery.

 

Removing the Obstacles for THOs to Benefit from Additional Revenue

Why, when there is so much to gain, would any Tribal Health Organization not embrace automated coverage discovery? We have had the opportunity to speak with a number of THO leaders who have shared similar concerns, including lack of time for process change, lack of resources for an IT implementation project, and skepticism of the costs versus benefits.

These are fair and reasonable concerns, and over the years we have had to address each one in partnership with our other THO customers:

  • Time to Implement: We have simplified the process to leverage our coverage discovery solution to be “file in/file out.” This means that THOs can export a simple Excel report of their encounters on a regular cadence and receive the results back in the same format. For most of our clients, this is an exercise that takes 15 minutes or less once it becomes routine.

  • IT Resources: While we can certainly integrate with any platform, many Tribal Health Organizations face shortages in IT resources and want a process they can operate without any technical requirements or integrations. As a result, THOs can utilize our coverage discovery solution without any IT involvement. It is simply a matter of exporting and exchanging reports using your current software.

  • Costs versus Benefits: Given the strain on THO resources, we felt it was important to introduce a contingency model where customers only pay if we find eligible coverage. There are no initial fees required to engage Databound’s automation solution, which is called Boost.

To demonstrate the revenue potential of BOOST’s coverage discovery capabilities without any commitment or resource investment on the behalf of THOs, we knew we had to provide a proof of concept. As a result, we are pleased to offer a no-obligation trial of Boost that includes 5,000 encounters. This enables tribal health leaders to evaluate the solution and understand firsthand how their organization, patients, and community can benefit from the results.

 

Safeguarding AI/AN Health Support and Improving Patient Care 

In the path to self-determination and improved care for AI/AN populations, visionary leaders are considering various initiatives. While automating coverage discovery is likely only a part of the solution to the challenges facing THOs, it can provide an important building block to making many other programs possible as well as addressing the pain of last resort concerns. To learn more about Boost or request a proof of concept of our automated coverage discovery solution, contact us today.

 

Written by Rachel Bowles - BOOST Product Manager

Rachel Bowles - BOOST Product Manager

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