The challenge

Optimize patient assistance program (PAP) recovery activities for medications and devices for uninsured or underinsured patients.

Our solution

The outcome

• Recovered more than $2 million in FY 2019
• Exceeded year-one recovery projections by 195%
• Recovered $78,718 retroactively in first year for care TMC provided the year before

TMC provides care from birth through the senior years and is the primary teaching hospital for the University of Missouri-Kansas City Schools of Medicine, Pharmacy, Nursing and Dentistry. Fiscal responsibility is a must for survival and the ability to provide care; therefore, TMC strives to avoid unnecessary costs.

More than 20 percent of patients cared for by TMC are uninsured¹, double Missouri’s rate of 9 percent uninsured.² In FY 2018 alone, TMC delivered $108 million in charity care for the uninsured and underinsured in its community.³

 

The challenge: Supporting uninsured and underinsured patients in the Kansas City area

According to the American Hospital Association, hospitals in the United States have provided more than $620 billion in uncompensated care to patients since 2000.⁴ That includes figures for inability to pay, plus the cost of uncompensated drugs and medical devices.

“We’re sensitive to uncompensated care costs because we serve a relatively large population of uninsured and underinsured patients,” said Scott Zweerink, PharmD, Director of Outpatient Pharmacy Services and 340B Program Compliance. “The high cost of some medications and devices can lead patients to go without. And of course, uncompensated costs impact our bottom line and safety net mission.”

Our solution: AmerisourceBergen RecoveRx^™ Patient Assistance Program (PAP) solution

AmerisourceBergen PHS professionals recognized TMC’s recovery challenge. PHS provided a complete recovery solution that could be implemented quickly and required no TMC investment in capital or personnel.

PHS specialists worked with TMC pharmacy leadership to implement the RecoveRx™ solution. To speed the process, all applications are administered electronically. An automated workflow tracks claims and flags denials for the patient assistance representative to appeal.

“The PHS representative handles every step in the recovery process, in real time, for nearly every manufacturer’s PAP,” explained Zweerink. “That frees us to assign an FTE to other tasks.”

 

The outcome: Combining excellent safety net care with significant cost recovery 

The RecoveRx solution ramped up quickly and within 10 months helped TMC dramatically increase its recovery of uncompensated costs. The program recovered more than $2 million in FY 2019, building on year one total recovery of nearly $1.6 million – delivering a strong result for TMC leadership. In year one, the PHS representative also filed successful retroactive claims for $78,717 linked to care TMC provided the year before. 

Dedicated PHS experts run and oversee the recovery program

“Our patient assistance representative consistently receives high marks from TMC personnel, and we credit her with helping us to exceed our pro forma recovery projections,” said Hennenfent.

Hennefent also praises PHS’s PAP solution for eliminating staffing concerns, such as worrying about in-house program managers leaving or having to trim staff. The dedicated PHS representative provides reliable, ongoing program performance.

^{1, 3  Embry, David; Wilins, Karlyn, “VitalKC, The Gratitude Report, Fiscal Year 2017,” annual report for the Truman Medical Center Charitable Foundation, 2017, p. 4.
2  Health Insurance Coverage in the United States: 2017, Current Population Reports, U.S. Census Bureau, September 2018.
4  “American Hospital Association: Uncompensated Hospital Care Cost Fact Sheet,” AHA, January 2019.}