Author: Qualify Health

Did you know that your environment affects your health and well-being? Social determinants of health (SDOH) are the conditions where we live, learn, work, and age. Access to housing, education, employment, food, transportation, and social services are all factors that impact our health outcomes and risks. SDOH also includes resources and services that prevent, diagnose, treat, and manage diseases. By recognizing these social factors, we can take steps to address the root causes of health issues in our nation. So let’s start by understanding SDOH to improve our health and quality of life! 

The five domains of SDOH:

1. Economic Stability

2. Education Access and Quality

3. Health Care Access and Quality

4. Neighborhood and Built Environment

5. Social and Community Context

This article will focus on understanding issues with Health Care Access and Quality.

The Uninsured Population

Did you know about 1 in 10 people in the United States don’t have health insurance? A consequence of this is that the uninsured only seek care when they have a problem. As such, this population rarely receives early detection screenings by primary care providers. Without these screenings, they face late diagnosis and poorer health outcomes. In addition, as patients become ‘sicker,’ they become an increased burden on health systems.

The Impact on Health Systems

Due to the inability to pay providers, the uninsured will utilize the hospital when seeking medical treatment. Hospitals are obligated to treat patients, whether or not they have insurance. Therefore, they must care for patients without insurance regardless of the associated costs. This issue negatively impacts the hospital and the patient: The hospital is rarely paid. Instead, they write the patient’s expenses to bad debt and send them to collections – thereby exacerbating the cycle of unaffordability.

The Underinsured Population

As healthcare costs continue to soar, many companies are turning to high-deductible plans to save money. Unfortunately, this means employees are burdened with higher out-of-pocket expenses for medical services. Those with high deductibles and high out-of-pocket costs relative to their incomes are known as underinsured. Some individuals may delay or even skip necessary treatment due to cost concerns. One survey found that 25% of Americans have missed medical appointments or put off care because of financial worries. For those with chronic conditions, the added expense of medications can easily reach thousands of dollars per year, causing undue strain on families and the healthcare system.

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Transportation Issues Limit Access

Getting to the doctor can be challenging, especially if you live in a rural or low-income area. Some people miss appointments and miss out on crucial healthcare because they don’t have reliable transportation. This issue can be dangerous – not getting the proper treatment quickly can lead to more significant problems. But transportation isn’t just important for doctor visits. It can be hard to get healthy food or exercise if you can’t get around. That’s why better public transportation is vital to helping everyone get the healthcare they need and deserve.

Quality Resources that Can Help

Everyone deserves quality healthcare, but unfortunately, not everyone can afford it. That’s where Qualify Health comes in. The organization works with hospital systems, cancer treatment centers, specialty pharmacies, and physician offices to help uninsured and underinsured patients afford needed treatment.

The focus is on patient financial advocacy, which involves reducing the financial burden on patients with chronic and life-changing illnesses. By finding funds for out-of-pocket healthcare expenses like co-pays, premiums, and even transportation, Qualify Health ensures patients get the care they need without worrying about the cost.

For more information about Patient Financial Advocacy Solutions, contact Qualify Health at (888)770-7191.

How to wrap your head around health disparities, health equity, and social determinants of health!

The latest report from the nonprofit Commonwealth Fund confirms what we already knew: that the United States is leading the world in people who suffer from multiple chronic conditions and obesity. This distinction means American citizens have almost double the obesity rates compared to the average of the other 36 countries in the Organisation for Economic Co-operation and Development (OECD). The gravity of this alarming news should not be overlooked. Instead, it should inspire us to take immediate action to address the current state of our nation’s health. But you may wonder, “What can we do to drive change?”

The Healthy People 2030 Initiative

In 1979, the HHS and Office of Disease Prevention started a mission to make us all healthier with the “Healthy People” initiative. For over 40 years, they have created strategic plans to make this a reality. In this latest iteration, they’ve focused on five areas to develop a framework for healthier living. You might’ve heard these buzzwords thrown around by healthcare executives, the government, and the media, but do you really know what they mean? So, let’s dive in and get a clear understanding.

The Framework:

1. Health Disparities
2. Health Equity
3. Health Literacy
4. Well-being
5. Social Determinants of Health
6. Health Disparities

Health disparities are not only mere differences in health among individuals but also health gaps linked with social, economic, and environmental factors. They can relate to gender, age, mental or physical disability, sexual orientation, gender identity, geographic location, or other characteristics associated with discrimination or exclusion. The goal is to reduce disparities between different demographics (using the ideas discussed below), improving our nation’s overall health.

2. Health Equity

Health equity is achieved when all patients have access to resources needed for optimal health. A person’s race, ethnicity, gender identity, or any other demographic factor should not influence a person’s health. This includes access to quality healthcare services and social support systems such as education and employment opportunities. By addressing access to quality healthcare, employment opportunities, and education at a systemic level, better overall health outcomes for all are attainable.

Learn How Qualify Health Can Help

3. Health Literacy

Health literacy is more than just understanding medical jargon- it’s about comprehending and applying that information to make informed decisions for our well-being. To achieve this, health organizations must offer resources that are user-friendly, easily accessible, and doable. By doing so, people can make empowered choices related to prevention, diagnosis, treatment, and ongoing care, leading to a healthier population overall. In addition, prioritizing health literacy puts the power of information in everyone’s hands.

4. Well-being

Well-being is about the perception of one’s overall life satisfaction. It can be different for everyone, but the goal is to lead healthy and fulfilled lives across the lifespan. Achieving overall mental and physical health, having a purpose in life, feeling secure, bouncing back from stressors when needed, and garnering access to vital healthcare resources all play a role in well-being. It combines subjective elements, such as satisfaction with life, and tangible components, like income or education. Focusing on well-being across all demographics helps build healthier communities and improves the quality of living for everyone.

5. Social Determinants of Health

The conditions in which we live affect our health and well-being in more ways than we might realize. These are known as social determinants of health (SDOH), encompassing many factors that can impact our lives. For example, having safe housing and transportation, living in a clean environment, and having access to healthy food and exercise opportunities can all positively affect our health. Conversely, experiencing discrimination and violence or living in polluted areas can negatively affect our well-being. In addition, education, job opportunities, and income are essential factors in determining our overall quality of life. By understanding and addressing these social determinants, we can work to create healthier and more equitable communities for all.

Summary

We cannot ignore the nation’s health status, and there are steps we can take to move forward. Educating ourselves about Health Disparities, Health Equity, and Social Determinants of Health will help us understand what improvements need to be made in our communities today. There are various initiatives underway to address these issues. 

Qualify Health is an organization that prides itself in promoting health equity and impacting health disparities. By partnering with hospital systems, cancer treatment centers, specialty pharmacies, and physician offices, Qualify Health provides innovative patient financial advocacy solutions to minimize the financial burden on patients with chronic and life-changing illnesses. Patient Financial Advocacy solutions, like those provided through Qualify Health, are essential to improving all people’s overall health and well-being, regardless of socioeconomic status.

By implementing changes, we can create healthier communities and improve the quality of life for everyone.

For more information about Patient Financial Advocacy Solutions, contact Qualify Health at (888)770-7191.

Health equity has become a key focus in healthcare, and it’s making headlines and hospitals across the country are being tasked with playing a critical role in the health equity movement. As anchors in their communities, hospitals can harness their economic power and community linkages to shape change.

The CDC has defined ‘Health Equity’ as “The state in which everyone has a fair and just opportunity to attain their highest level of health” and has highlighted that the following societal efforts need to occur

1. Address historical and contemporary injustices;
2. Overcome economic, social, and other obstacles to health and health care; and
3. Eliminate preventable health disparities

The one area that healthcare organizations can make the fastest and most significant impact is by addressing #2: Overcoming economic, social, and other obstacles to health and health care; which we will be addressing in this blog through three avenues that are at a hospitals fingertips.

1. Food Insecurity 

Food insecurity is a major issue for many individuals and families in the US, and it has been estimated that more than 37 million Americans are food insecure. This means that they do not have reliable access to enough affordable, nutritious food to lead an active, healthy lifestyle. Food insecurity can lead to health issues such as obesity, diabetes, heart disease, and even mental health conditions due to the lack of proper nutrition.

2. Transportation

Another significant barrier to care for many individuals is transportation, especially those in need of medical care. The geriatric population and those suffering from chronic illness are particularly vulnerable to this issue due to their limited mobility and financial resources. Without access to reliable transportation, these individuals may have difficulty accessing the necessary health services they need due to time or distance constraints. This can lead to delayed diagnosis or treatment, resulting in poorer health outcomes overall. 

3. Housing Instability

An estimated 18 million Americans, face issues with housing instability. Housing insecurity can lead to poor health outcomes due to inadequate living conditions, lack of access to medical care, and increased stress levels caused by financial difficulty.  

What Eskenazi Health is Doing to Overcome Health Disparities in their Community 

Eskenazi Health in Indianapolis is taking diligent steps in its fight against health inequity through its latest initiative. The multifaceted approach seeks to reduce barriers for those most vulnerable and at risk for poor health outcomes due to social determinants of health such as food insecurity, transportation, and housing instability. Eskenzai Health Foundation received $36 million towards the $60 million Health Equity Campaign. Through this campaign, the hospital system intends to make strides toward creating a stronger, healthier community by addressing these issues head-on.

Eskenazi Health’s health equity initiative is an example of how communities can proactively address healthcare disparities. This campaign will not only reduce barriers for members of the community but also raise awareness of the health inequities present in our society and work towards a more equitable healthcare system. Eskenazi Health is actively working to ensure those most at risk are provided with access to necessary resources for a healthy lifestyle. By continuing its efforts, Eskenazi Health is well on its way to creating a healthier and more equitable community for all. 

How Qualify Health Can Help 

Sourcing funds for managing long-term or chronic illness is a key element needed to reduce the financial burden placed on patients. Qualify Health’s Patient Financial Advocacy solution makes it easy for hospitals to help their patients obtain financial assistance such as co-pay, premium, transportation assistance, and more. This financial assistance enables patients to pay for the treatment they need as well as living expenses instead of having to choose.

For more information about Patient Financial Advocacy Solutions, contact Qualify Health at (888)770-7191.

Cancer copayment assistance programs can be complex to manage, with various rules and regulations that must be followed. Cancer Center Executives must ensure that these programs are run efficiently and effectively in order to help patients afford their treatment and ensure that your revenue is maximized. In this blog post, we’ll explore the challenges of managing cancer copay programs and offer some tips on how to overcome them. Read on to learn more!

The first challenge of managing cancer copay programs is making sure that all of the necessary funds are available to patients. Many patients cannot afford their treatments and need assistance in order to make them financially possible. To ensure that these funds are available, Cancer Center staff must be organized and proactive when it comes to tracking eligibility, submitting necessary documentation, following program rules, and getting appropriate signatures.

Another challenge of managing cancer copay programs is staying up-to-date with the ever-changing regulations. Since laws and regulations are continuously being updated or changed, hospitals must remain aware of any changes in order to ensure that they are compliant with local and federal guidelines. Staying on top of these guidelines can be time-consuming, but it is essential for running a successful program. One of the biggest examples here is ensuring that your federally insured patients realize that they are unfortunately restricted from these programs and therefore not able to benefit the same way as commercially insured patients.

Finally, managing cancer copay programs involves a lot of paperwork and data entry. Hospitals must keep detailed records of application status, bills that have been submitted, checks that have been received and copay cards that have been loaded in order to ensure accuracy and compliance. This can be tedious work, but it is necessary for running an efficient program.

Fortunately, there are some tips that Cancer Center Executives can use to make managing cancer copay programs easier. First, hospitals should partner with an outside organization that can help them manage their program more effectively. These organizations have the experience and expertise needed to ensure that everything is done correctly and in compliance with regulations. Organizations like Qualify Health provide a fully managed service that combines a human layer of service and intelligence to streamline the process of collecting and entering data. They then continue to ensure that all bills are submitted on behalf of the patient and the funds are sent to the hospital.

The key to successfully managing cancer copay programs is staying organized and proactive in ensuring all patients are signed up and accessing the care they need. With the right tools and strategies, hospitals can ensure that their programs are running smoothly and helping as many patients as possible.

Remember, managing cancer copay programs doesn’t have to be a struggle. By utilizing the right resources and staying organized, Cancer Center Executives can ensure that their program is efficient and compliant with all regulations. If you need help managing your program, contact us today for more information. We’re here to help!

Prior authorizations are essential to make sure that a patient’s insurance carrier is going to pay for their treatment. The greatest doctor with the best diagnosis and treatment protocol is ineffective if the patient cannot afford it or if their insurance will not cover it due to a lack of authorization. What causes prior authorizations to be denied, slip through the cracks, or otherwise be left unfulfilled? Here is a case regarding a real patient with their hepatitis C medication.

Patient X had been confirmed to have Hepatitis C and the drug ordered by the prescriber required a prior authorization. The doctor who made the diagnosis recommended a protocol involving Epclusa which, through most insurance carriers, can demand quite a few clinical notes to support the administration of the medication: a check for cirrhosis, a concurrent infection of HBV (hepatitis B), whether or not the patient has tried and failed a similar medication before—just to name a few!

The pharmacy that was to dispense the medication noticed that the drug did require prior authorization (most prior authorizations for outpatient prescriptions start in the pharmacy!) A request was sent to the office and an initial authorization request was sent to the insurer. However, a follow-up fax was sent back with the requesting of additional clinical information – a scan that wasn’t performed yet on the patient’s liver. The staff made an appointment for the patient to come in and the scan was performed. Afterwards, though, the scan was never sent to the insurer and, thusly, the authorization was denied. A follow-up authorization was initiated and, as what happens after most denials, it was immediately denied as the initial authorization was and now an appeal is required.

An appeal is when the office staff, patient, or advocate of the patient claims that the decision to deny was in error and to have the determination overturned. This was strange to the staff because all the criteria matched, they were just trying to send the required information that was asked of them. Part of the prior authorization process is to follow the flow: even though the office staff did everything within their power to advocate for the patient, the idea of an appeal for a medication that fit the indication did not quite make sense, it should be approved!

After three months of back and forth with the insurer, Qualify Health was requested for assistance, able to intervene, find out the proper format for an appeal, accrue and compile the necessary clinical information to support the use of the drug, have a signed attestation from the prescriber that the information provided is verified, and submitted through the proper channels with an URGENT expedite for a faster turn-around! After Qualify’s assistance, the drug was approved for the patient within twenty-four hours with a gracious and appreciative patient that was finally going to get the treatment that they needed.

Ultimately, prior authorizations are, and should be, part of the clinical processes in any office. There should always be a flow, a delegate for duty, and organization for the myriad processes that every insurance carrier requires based on the drug, treatment protocol, or inpatient administration because anything beyond immediately is too long for a patient that requires treatment.

Palm Beach Gardens, FL (December 15, 2022) – Qualify Health Inc. announced that it has signed an agreement with Southwest Health to provide Financial Advocacy Services to SMRMC patients.  The agreement between the two organizations means that SMRMC patients will now have access to a team of financial advocacy experts who will work to offset a patient’s out-of-pocket costs through its proprietary software and dedicated team of advocates.  “We are proud to work with Southwest Mississippi Regional Medical Center and its patients to deliver thousands of advocacy options. The financial advocacy assistance Qualify Health can source for patients will be a win-win, providing both new revenues to SMRMC and, at the same time, helping patients cover medical expenses they otherwise can’t afford. We are excited by the opportunity we see for patients and the hospital”.  

About Qualify Health 

Qualify Health is one of the country’s leading technology and service providers for healthcare-based financial advocacy solutions and AI-driven prior authorization Solutions. Qualify Health partners with health systems with a complete end-to-end solution. The Qualify Health solution provides patients with access to thousands of advocacy programs, and the Qualify Team then manages the entire billing, submission, and payment process to ensure all eligible bills are sourced, funded, submitted and paid. 

About Southwest Health 

Southwest Health is an integrated healthcare delivery network serving residents of Southwest Mississippi. Our organization is comprised of Southwest Mississippi Regional Medical Center, Cardiovascular Institute of Mississippi, Mississippi Cancer Institute, Ambulatory Surgery Center, St. Luke Home Health & Hospice, Digestive Diseases Center, Southwest Center for Rehabilitation, Southwest Regional Women’s Center Maternity Suites, Family Practice/Internal Medicine Clinics and Lawrence County Hospital. 

Learn how financial advocacy can help reduce health equity disparities by ensuring equitable access to healthcare services for all.

Blog Introduction:Poor health outcomes due to disparities in healthcare, often based on socioeconomic factors like race and income

Palm Beach Gardens FL, October 29^th  2022. Monique Lappas, Founder, and Chief Executive Officer, of Qualify Health along with Lavonda Cravey, the VP of Revenue Cycle of Coffee Regional Medical Center presented at the South Carolina Chapter of the Healthcare Financial Management Association’s (SCHFMA) Fall Institute Conference held from October 26^th through October 28^th.

The conference was held at The Westin Poinsett Hotel in Greenville, SC.

The event was attended by over 120 hospital staff and executives from healthcare systems across South Carolina, as well as other industry representatives.

The topic of Mrs. Cravey’s and Ms. Lappas’ presentation was “Mission Impossible: How CRMC Grew Revenues and Brought their Patients to Tears (OF JOY!)”, in which they presented the CRMC case study of the impact that Qualify Health’s software and service solution has had on both patient financial satisfaction, patient outcomes, additional revenues, and bad debt reduction.

The association of South Carolina Oncology Managers is a non-profit professional organization that provides access for oncology practices to quality leadership development through continuing education, networking, and business improvement opportunities. Qualify Health is one of the country’s leading technology and service providers for healthcare-based financial advocacy solutions and AI-driven prior authorization Solutions.