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ER Insurance Initiative Saves Millions

Sharp Pilot Program Likely to Expand Elsewhere

By Ron Shinkman

Nov 15, 2012

California Region

A pilot project to obtain coverage for uninsured patients when they enter the emergency rooms of Sharp Healthcare has saved the San Diego-based hospital operator $5 million, prompting its permanent adoption.

The pilot, launched in 2010 in conjunction with the San Mateo-based healthcare finance firm PointCare, was expected to run for just two months. It ran for slightly more than two years, and officials say the software will likely be installed at other hospitals outside of the four-hospital Sharp system.

PointCare installed cloud-based applications on Sharp’s desktop and tablet computers that allowed ER personnel to survey patients to determine whether or not they could be enrolled in state or federal insurance programs. Staffers could determine this by asking five specific questions regarding age, health conditions, past insurance status and other demographic information.

Of the 32,000 uninsured patients surveyed, more than 80% were found to be qualified for some form of free or subsidized insurance by matching their demographics against a database of available state and federal insurance programs and the hospital’s reimbursement rates. A third-party vendor worked with the patients to shepherd them through the application process.

“We are excited about moving forward with this program because it improves our relationship with the community and assists us with bringing more people to coverage,” said Gerilynn Sevenikar, Sharp’s vice president of patient financial services.

PointCare Chief Operating Officer Ankeny Minoux said that many of the patients screened at Sharp were retroactively eligible for Medi-Cal and coverage in San Diego County’s Medical Services plan, saving Sharp about $200,000 a month in uncompensated care costs during the life of the pilot program.

About 18% of San Diego County’s residents lack insurance, according to data from the Center on Policy Initiatives. That is marginally better than the statewide average of 20%, but it is by far the largest urban are in the United States without a public hospital.

Minoux said in light of the results at Sharp, her company’s software would be provided to hospitals in a lieu of a monthly fee based on each hospital’s bed size. She added that the company is currently in negotiations to install the software at seven different hospital systems nationwide, which she declined to name.

 

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