Author: Qualify Health

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.

West Palm Beach, FL— October, 12th 2022. Monique Lappas, Founder and Chief Executive Officer, Kapra Lott, Chief Business Development Officer and Kelly Sanders, Chief Operating Officer represented Qualify Health at the recent Association of Community Cancer Centers at their 39^th National Oncology Conference.

The conference was held at the West Palm Beach Convention Center , in West Palm Beach FL

The event was attended by over 200 representatives for oncology provider practices, hospitals and industry.

The Qualify Health booth drew participants to their booth, who enjoyed the espresso and cappuccinos on offer at the booth, from as far away as Seattle, WA and North Dakota, all the way through to local Florida based practices. The conversations ranged from the prior authorization services and overcoming internal hurdles at understaffed practices, through to the financial and patient benefits of a wide-ranging and robust financial advocacy service.

The Association of Community Cancer Centers (ACCC) is a powerful community of more than 28,000 multidisciplinary practitioners and 2,100 cancer programs and practices nationwide.

Founded in 1974, ACCC brings together healthcare professionals across all disciplines in oncology to promote quality cancer care. It is estimated that 65 percent of the nation’s cancer patients are treated by a member of ACCC.

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.