[00:00:00] Monique Lappas (Moderator): Good morning everyone. Thank you for joining us today. Just to get started here, a starting point is: Did you know that 25% of patients skip treatment due to costs? Today we’re going to explore how leading hospitals are transforming this reality through innovative financial assistance automation. I am Monique Lappas, the founder and CEO of Qualify Health, and I will be your moderator today.

[00:00:30] Monique Lappas: We have a fantastic panel of healthcare leaders joining us from Baptist Health. We have Philip Boyce, he is the SVP and Chief Revenue Cycle Officer. We have Michi Bird, the Executive Director of Revenue Cycle over the Contact Center, and Petra Estep, the Director of Pharmacy at Baptist Medical Center.

[00:00:55] Monique Lappas: In the next 30 minutes, we are going to cover three key areas. We are going to cover how current challenges in healthcare financial assistance world are affecting patient care, how automation is transforming patient care and operational efficiency, and we are going to look at some real results and implementation insights from Baptist Health’s experience. At the end, we’ve also got some time for you to ask questions.

[00:01:28] Monique Lappas: I am going to get started here with a few panel questions, really discussing the current state and some of the challenges that hospitals face with both uninsured and underinsured patients. So Philip, let’s start with you here. We have healthcare costs that are projected to reach $6 trillion by 2027. What are the most pressing financial challenges hospitals are facing regarding patient financial burdens and how they relate to patient assistance programs? And also, how is it affecting Baptist Health?

[00:02:02] Philip Boyce: Yes, well, thank you for including me in the panel. It’s a really great question. Obviously, the first thing is we’re seeing deductibles increase, so more and more is being pushed to the member, to the patient from their coverage, and deductibles that are very difficult for patients to meet. If they can’t meet those, that now becomes a debt for the hospital.

[00:02:26] Philip Boyce: We’re seeing deductibles grow. We’re seeing patient financing—and we do patient financing at 0% interest—but we’re seeing those terms stretch out longer. In terms of the present value of the dollar, it’s a longer time of payment at 0% interest. Just collection difficulties—I think that’s the biggest challenge.

[00:02:48] Philip Boyce: The Affordable Care Act is growing and those deductibles are significant. Employers are just struggling, so they tend to increase the patient’s responsibility. That’s really the biggest thing that we deal with on a day-to-day basis.

[00:03:05] Monique Lappas: Hey Michi, I know you were the director of the patient access team at the MD Anderson Cancer Center of Baptist. Could you paint a picture of what a typical day of managing financial assistance processes looked like before automation, and what were some of the biggest pain points for your team?

[00:03:24] Michi Bird: Sure, thanks Monique, and thanks for having me. So previously, our financial counselors do a little bit of a different job than I think a lot of financial counselors do. We wanted to make sure the patient experience was the best it could be. No one wants to be diagnosed with cancer and come to our center, right? So we wanted to make sure that we were creating a pleasant environment as best we could.

[00:03:50] Michi Bird: Although they are financial counselors, one of their main responsibilities is also registering and finalizing the first appointment for that patient, sitting down with the patient, explaining to them what their benefits are, where they’re at within their benefits, and then letting them know that we had services such as copay assistance and different grants and foundations.

[00:04:13] Michi Bird: Coupling that with meeting with a growing center and seeing more patients, and then having to find the time to comb through schedules, look for copay assistance, look for financial assistance grants and foundations is burdensome. It is time-consuming for someone who has other responsibilities.

[00:04:34] Michi Bird: As you are well aware, some of those foundations—you end up getting waitlisted, and when they open them up, it is gobbled up in seconds. You have to be able to respond immediately. Well, our counselors were missing those opportunities because they most likely were meeting with patients. So we were missing out on really huge opportunities to get them additional assistance by not utilizing your group to come in and help us.

[00:05:02] Michi Bird: We were really able to capitalize on bringing not only more money into the healthcare system by helping the patients, but helping the patients find more money as well, which can then turn around and help us. It really was a laborious process, and so we were excited to partner, to have someone help us in this aspect because our main focus is the patient and taking care of them—not only their health, but we want to take care of their financial wellbeing as well.

[00:05:32] Monique Lappas: Thank you, Michi. Okay, moving on to the clinical side now with Petra. We have about 55% of cancer survivors that face medical debt of over $10,000. How do you find that these financial barriers affect medication adherence and patient outcomes based on what you’ve seen and your overall experience?

[00:05:55] Petra Estep: Monique, I think that we’ve all seen patients that are coming in for chemotherapy either before or after work, or those that have completely exhausted all of their vacation time in order to try to maintain a normal life. But the reality is that even though they work to keep things as normal as possible, that can’t always happen.

[00:06:16] Petra Estep: Many stop working or they need to hire additional help to care for children or their homes, and they find that they ultimately see a loss of insurance coverage and expendable income overall. This influences the treatment decisions that they make.

[00:06:32] Petra Estep: The emotional burden that presents is really dramatic. For us to be able to provide free medication—and not just free medication, but the one that they’ve worked with their provider to decide is right for them—is accessible. The peace of mind that provides them in a really stressful time, and their sentiment that they’re not placing a burden on their family and their loved ones, is tremendous.

[00:07:00] Monique Lappas: That’s great. Thank you for all of your insights on that. Now we’re going to talk a little bit about how innovation can provide new solutions to serving your patients, reducing both workload and the number of cycles in chasing patients for payments. Michi, I know over the contact center you probably have a lot of that. Do you have any specific examples of how administrative efficiency has improved, perhaps in terms of time saved or number of cases processed, number of calls made, things like that?

[00:07:35] Michi Bird: Sure. Obviously, the financial counselors that are on the front end meeting with these patients no longer have to do the work that your team is doing. So it frees them up—as the cancer center continues to grow—to meet those patients. And those patients don’t just come once, right? Sometimes they have questions about their bills that they’re receiving, so they might pop in and say, “I have a question.” It allows us to dedicate that time to face-to-face interaction.

[00:08:04] Michi Bird: On the flip side of that, when we’re looking at patients who are maybe going on a new regimen or being provided a new drug, we call them to let them know what their cost is going to be. If it becomes something very burdensome for them, we can then start working with a provider and with you guys to say, “Do we have copay assistance on this? What can we get?” And look and see if we can switch those drugs so that the patient doesn’t have that out-of-pocket that they would have had.

[00:08:33] Michi Bird: We have been successful in doing that and partnering and working together, and what otherwise might have just been a patient saying “I can’t afford to come” or “I’m not going to get those services”—which is detrimental to their health. So it has been a win-win for our organization to partner with your company in order to successfully treat our patients efficiently and effectively.

[00:08:57] Monique Lappas: Great. And Petra, have you seen any improvement in things like medication access rates and what it could mean for patient outcomes?

[00:09:07] Petra Estep: Yeah, absolutely. The financial support that our patients have been able to get through Qualify has allowed them to pursue the right therapy. We’ll see patients that are looking to explore a different regimen due to a failure, or even worse, patients who are on something that’s working for them but due to financial pressures, they’re asking their providers to make changes.

[00:09:30] Petra Estep: We’ve seen that those are not discussions we’re having anymore. We’re focusing on the right questions, like “What is the cure rate? How am I going to tolerate this therapy?”—relevant clinical factors—rather than saying “Is this worth it?” So we’ve seen a great shift in those conversations.

[00:09:50] Monique Lappas: That’s great to hear. And closing out this segment, Philip, do you have any numbers or are you able to quantify the revenue cycle improvement that you’ve seen since implementing Qualify? And what motivated you to even look at a solution like Qualify?

[00:10:08] Philip Boyce: I think the latest numbers, the value to Baptist is over a million dollars a year. More than a thousand patients have received assistance, so that’s significant. However, we’re a three billion dollar organization.

[00:10:22] Philip Boyce: When Michi first brought the idea to me and her boss brought the idea to me, we had just gone live on Epic. Our hair was on fire, we had changed the clearinghouse, we had some new business partners we were implementing, and I was like, “We can’t do this. This is chump change. This is just not material dollars to Baptist. We had these other initiatives that have significant financial implication. We can’t bring Qualify to the front of the line.”

[00:10:52] Philip Boyce: And they were just relentless. You can tell Michi’s passion—they just wouldn’t let it go. It was impressive. Of course, I want patients to be helped, but I’m not dealing face-to-face with patients, so I just didn’t feel it like our staff did that dealt with the patients.

[00:11:10] Philip Boyce: It was in the back of my mind, but there wasn’t any way I was going to slow down our other initiatives for this. And then I met you at a conference and I heard what you were doing, how you were doing it, the culture you had created with Qualify, and it was very impressive. It changed my mind.

[00:11:28] Philip Boyce: As I thought more about it, I realized we really should be doing this. And just how Qualify goes about it was impressive, so I thought, “Okay, let’s move forward. We’ll be fine on Epic. We’ll make it, but this is really meaningful.”

[00:11:44] Philip Boyce: What really surprised me then was—okay, it represents some dollars and patients are being helped—but the social media impact was phenomenal. That’s just a kind of downstream benefit I didn’t even think about.

[00:12:00] Philip Boyce: To me, it’s the only win-win-win that I’ve seen in healthcare, where the provider wins, the patient wins, Qualify wins. It’s all positive all the way around. We’re in a tough environment, we’re in a tough business, there’s challenges and headwinds that everybody talks about every day. This is just really a bright spot, and I appreciate my leaders that just wouldn’t let this go, and for them to be able to see how it helps our patients is really awesome.

[00:12:30] Monique Lappas: It’s great to hear. Okay, Petra, in our final segment before we hit our Q&A—I know we’ve touched on this a lot, and it’s really about the patient experience from the clinical side versus the financial side. It sounds like being relieved of financial burdens really helps clinical outcomes, but is there anything that you’ve observed in a patient’s experience when approaching and understanding treatment options?

[00:12:58] Petra Estep: So I think the main thing there is really as they’re exploring the treatment options, my pharmacists are trained to have discussions about how the therapies work and to alter perceptions of therapy. We see a lot of misconceptions. But what we’re not as well versed on is how to address some of the paperwork and the administrative burden that’s there with Qualify.

[00:13:24] Petra Estep: From our perspective, we’ve been able to see that we have somebody that we can refer our patients to. We can dedicate our time appropriately to talking about those clinical factors. And with that, between making sure they understand their therapy and that their therapy is accessible to them, we see much better adherence rates whether it’s oral chemotherapy that they’re taking at home or the infusions themselves in the clinic.

[00:13:51] Monique Lappas: Philip, do you have any advice that you’d give to other healthcare leaders considering these kinds of solutions?

[00:13:59] Philip Boyce: I would really encourage healthcare leaders to look into this. From a financial perspective to the organization, they’re probably dealing with much larger initiatives, much more significant types of implementations and challenges.

[00:14:14] Philip Boyce: However, what this does for thousands of patients and how it impacts them and how it encourages your staff—they’re on the front lines dealing with patients. If I was on the front lines registering and trying to help financially patients going through chemo treatment, I would have come at this differently. But I don’t live in that world.

[00:14:35] Philip Boyce: But really seeing it and what it does for your staff is wonderful. And again, how it really is helping people and the positive feedback your organization gets from that is a plus.

[00:14:50] Monique Lappas: And this doesn’t have to relate to Qualify, I’m going to ask one last question here. I don’t want to surprise you too much, but we’ve got a few extra minutes. Petra, let’s start with you. We’ve got a lot of healthcare leaders on the call today. Any advice from your perspective about how they might change their overall financial assistance process to deal with shrinking budgets? I know you’ve got a lot of 340B pressures in pharmacy, overloaded staff, and greater patient need.

[00:15:21] Petra Estep: I think Michi touched on it as well—we all are dedicated to specific roles within the patients’ healthcare journey, and really no one has the time to be able to sit and… we don’t have the intel of the grants that are available. We’re not there at the specific moment.

[00:15:40] Petra Estep: I think opening your mind and seeing someone like Qualify as part of your interdisciplinary team is a huge piece of it. I would never dream of going and doing anything in radiology, and so this is similar. Qualify fills a void, and they are the experts in that field.

[00:16:00] Petra Estep: So letting all of us on that team do their job really optimizes care overall and reduces the stress on everybody that feels maybe out of their element or overworked outside of their specialty.

[00:16:15] Monique Lappas: And Michi, do you have anything particularly now that you’ve moved out of financial assistance and over the contact center? Any processes that you see from a financial assistance standpoint for patients that you’d recommend people look at?

[00:16:31] Michi Bird: I’m going to go a little bit further back just because I want to highlight the reason why I brought this to Philip. I think this is important. When I met Monique, I think we were slightly out of maybe 2021, somewhere in there, and as we were talking and she was doing her presentation, she started talking about the grants that were out there.

[00:16:52] Michi Bird: I can remember her saying something about, “Oh yeah, they have grants for COVID,” and I was like, “What?” That was something that we had not even known about. Now part of it is, during COVID, I’m sure we all experienced it, but figuring out what to do with our staff—you’re not giving the same services in the cancer center. We’re still running, but you’re having to make some decisions that might impact your team members, and that’s heavy on your mind. You’re not really looking at all these other things.

[00:17:23] Michi Bird: That was probably really eye-opening for me. I was like, “There is so much more out there that I just don’t know, and I don’t have the capacity to go find it.” So I just wanted to touch on that because that was very key for me.

[00:17:37] Michi Bird: I know we’re out of—I’ll say we’re out of the pandemic now, we’re out of COVID—but that doesn’t mean that everyday life doesn’t still happen and that we are so focused on helping the patient that sometimes we don’t have the resources. Petra touched on this. You guys [Qualify] are focused on that, that is your main goal, and I don’t have to worry about it. My teams don’t have to worry about it. They [Qualify] are the ones that get to be that face that the patients have talked very highly of, even speaking with your staff. So it has been a great integration for us.

[00:18:10] Michi Bird: I will just say, some of the things that I would recommend, or even some of the surprises—I’ll start with recommendations. One of the things when we started was we did not have our acknowledgment form updated to include language that allowed a third party like Qualify to work on their behalf.

[00:18:29] Michi Bird: So it was paper. They would fax us or they would email us a PDF. We were printing it, we were giving it to the patients coming into the infusion center—not really a conversation you may want to have on their first day of treatment, even though it’s a good thing. We’re here to help you, we want to know how we can help you, but not necessarily how you may want to do it.

[00:18:51] Michi Bird: A few months into it, we did get it finalized, and patients—it’s already worked into that. We don’t have to worry about that. It’s been a very seamless process.

[00:19:00] Michi Bird: For me, I think a surprise is—we do FFA [Free Financial Assessment] work in the community, and one of the places that we work with does send a large volume of patients to us. We have been seeing those patients, and Qualify was actually able to find that some of these patients had Medicaid that we had not been billing.

[00:19:20] Michi Bird: So really, just again, not having that time or the resources to dedicate to something like that has been so beneficial to our patients and to our staff. Those are kind of the key surprises that I don’t think if you were here, we may be still servicing those patients at a different level.

[00:19:39] Michi Bird: It’s important to know that Qualify is willing to partner in different ways. I may not be in the cancer center world as much, I still touch it and have some oversight over some things, but to know that we have a resource to go to and to help us and to help the patients is really huge. It can be a game-changer for anybody in the healthcare system to look for.

[00:20:02] Monique Lappas: So everybody get your questions in while I finish off with Philip here. Philip, you deal with things—as you said, a $3 billion system. You’ve got vendors coming at you every day, every minute. You’ve got these solutions, you’ve got patients, you’ve got pressures, payers. Is there anything that you would look at and say, “Hey, this is how I think we should change or learn from financial assistance processes,” again, just with the shrinking budgets that hospitals are facing?

[00:20:32] Philip Boyce: There’s so much out there, there’s so much coming at you. I think a key for me is listening to my leaders. I can’t know everything that’s going on, and I don’t. But I have a lot of leaders that are listening. They’re out there, they’re going to conferences, meeting people, hearing what’s going on.

[00:20:53] Philip Boyce: So for me as a leader, really listening to my leadership team—I may be a little stubborn at times about something, but be persistent. Put passionate, knowledgeable people in leadership and you’ll succeed.

[00:21:09] Philip Boyce: I think it’s really a matter of our whole leadership team having their ear to the ground and hearing what’s out there and taking advantage of changes and opportunities that come along. Certainly, Qualify was one, but there’s other things out there. But it’s really the leadership team—together, all of us, we can bring more value as a team than just kind of expecting one person to know it all.

[00:21:35] Monique Lappas: Okay, alright. So we have our first question. How long—and I don’t know, I think you’ve got some numbers in front of you, Philip, and I know Petra, we did some stuff with your WEAR patients pretty early on—but how long did it take to see some meaningful results?

[00:21:52] Philip Boyce: Well, I know when we were early in, and we implemented with Epic, and we were new on Epic, so we were trying to figure out how could this work. And Michi could speak to this better than me, but how can this work within Epic so that the workflows aren’t clunky and are kind of simple to do?

[00:22:13] Philip Boyce: So it took us longer. I think we may have been the first that kind of grooved this new process in Epic that kind of became the model. So it actually took longer to get up and running.

[00:22:26] Philip Boyce: But I believe, as I said earlier, I think we’re seeing over a million dollars to the health system, not from patients but from grants and things that are given for those patients, which is awesome. Over a thousand people that you know are really helped financially, and maybe some of them wouldn’t continue treatment, couldn’t afford to continue treatment, are able to.

[00:22:50] Philip Boyce: So it took a while, but I think now it would be a lot quicker to start ramping up because we were kind of early adopter, new on Epic, and just kind of trying to find easier ways to integrate.

[00:23:02] Monique Lappas: Yeah, I think we signed the contract in either May or June, and I think it was around September that we were able to get your WEAR patients covered. Does that sound about right, Michi?

[00:23:13] Michi Bird: Yeah, about three months. Probably about right.

[00:23:15] Monique Lappas: And I mean, to Philip’s point, it probably took us longer to build it out than it did for the implementation phase. But again, we wanted to make sure that the financial assistance for the patients was going first over—once it’s built, financial assistance before any patient responsibility flips over. So we wanted to make sure we had it right.

[00:23:35] Philip Boyce: Lynn Waters did a great job actually in getting that up and running.

[00:23:38] Monique Lappas: And Petra, I don’t know if you remember?

[00:23:42] Petra Estep: I was going to say, we track all of our drug recoveries very closely as part of our value analysis team savings for pharmacy, and we were able to claim over a million and a half dollars worth of drug replacement that we pulled in for our team.

[00:23:57] Petra Estep: One of the things is, we’ve spoken to this workflow, and I’ve had the opportunity to work with other vendors in the drug replacement space. I can say that Qualify really wanted to understand our workflow and then build around that, versus in a lot of cases, us having to accommodate what their standard is.

[00:24:18] Petra Estep: With that, I think it was easier for our team. We really struggled before—just random drug would show up, we wouldn’t know what patient it was for, what to do with that, and who to credit. It was very confusing.

[00:24:32] Petra Estep: Now things show up, it’s clearly labeled, we know where it’s going, we were expecting it, we knew it was coming that day. The transparency of the work that’s being done and what’s coming in to our pharmacies and for our patients is very clear. So I don’t know if Philip and Michi paved the way in the workflow, but it’s been very painless on the pharmacy side.

[00:24:55] Monique Lappas: That’s our goal, really to work within your workflow. We try to, because the model that we have is—we don’t get paid unless you guys get paid. So we want to make it as easy as possible for you because that’s the only way that we’ll be successful. As soon as you make things hard for people that are already overworked, that’s one thing to avoid.

[00:25:18] Monique Lappas: We’ve got a couple of other questions. One of it is for me: Is Epic a requirement of using Qualify, or do you work with other EHR systems?

[00:25:26] Monique Lappas: We work with so many EHR systems, including ones that I think could be 30 years old—they’re just that clunky. We work with Epic—it’s our favorite, followed by Meditech Expanse. But we also work with I think a revenue cycle system called Paragon, another one called Well Sky, OneCentent, Athena, Cerner of course. So we work across the board with that.

[00:25:51] Monique Lappas: One of our claims to fame is we’re EMR agnostic, and really all we need is a login. Now, it really helps to be able to put a few things like Philip’s team did in place with some workflows and some billing indicators, but we don’t need them.

[00:26:07] Monique Lappas: And a question about copay: “When patients are approved for copay assistance on infusion medication and the claim is bundled, the total payment hits on the line item with the admin fee and it appears as though the drug itself does not get payment. Therefore, we can’t utilize assistance. Do you have experience with this? Yes, we do. We have reached out directly to the reps of the medications, but most don’t understand a bundled payment, nor do the program members. I’ve also gone directly to the insurance company, and they can’t change the way the claim shows. This results in the patient not being able to use the assistance.”

[00:26:42] Monique Lappas: So Angela, I’m going to ask—I’ve got your email here. I’m going to reach out to you afterwards and let you know how we do that. I’m surprised—I think you’re at an organization in Florida—that’s a bigger question or a bigger issue for our clients in Louisiana and Mississippi where the insurance companies do not provide line item EOBs. So I will happily send you an email afterwards. Maybe we can set up a call with our team that handles that because I think the answer is probably too long and very specific. But thank you so much for answering that.

[00:27:20] Monique Lappas: Okay, and we’ve got one minute here. We talked about implementation was great. Any big surprises? I don’t know if there were any big positive or negative surprises that you’d just like to touch on in 30 seconds. Petra, do you want to start with you?

[00:27:37] Petra Estep: As I mentioned, we’ve worked with other vendors in this space, and I was surprised at how Qualify went after everything and not just necessarily the $38,000 drug, but even if it’s a $100 drug. Which really just to me showed it’s not all about the money. I mean, yes, we’re all businesses here, but there’s a genuine concern for the patient and for our organization that I hadn’t felt before with other partners.

[00:28:04] Monique Lappas: And Michi?

[00:28:07] Michi Bird: I think the big surprise again was finding money or insurances that we just didn’t know existed. When you think about somebody having some other insurance, that opens up a door rather than not having any insurance at all. So just knowing how you can help someone is huge, and that was a big surprise for me. I wasn’t expecting that piece to come out of it.

[00:28:31] Monique Lappas: That’s great, and I’m gonna close it out. Philip, you are my favorite client. Baptist Health is my favorite client—oh, I shouldn’t say that, there might be other clients on the phone. But thank you, thank you so much for doing this today. It’s been a pleasure working with you. So any big surprises that you’d like to touch on?

[00:28:50] Philip Boyce: Well, as I said earlier, just the really touching and meaningful social media posts from people that were helped, and it just reflected really well on Baptist and on just what it meant for the patient. I wasn’t expecting that at all, and it was just really touching. So thank you, thank you for this opportunity. We really appreciate it.

[00:29:14] Monique Lappas: Thank you everybody. We will be sending out the video recording to everybody. Feel free to share it and reach out with questions. You should have my email, but we’ll also be reaching out to everybody that was on the call today. Have a great day and a great weekend, and thanks again.

[00:29:31] Panel: Thank you. Bye-bye.