PointCare
A "No Barriers" Approach to Health Coverage

“Did you know that approximately 4 million patients drop out of the Medicaid program every month?” begins Everett Lebherz, co-founder and CEO of PointCare, touching upon a major challenge in the healthcare insurance industry today. Healthcare systems register a steady stream of uninsured patients coming in for care under public health programs, but they often lose coverage due to the lack of coverage representation. “In order to break this vicious cycle of losing publicly-covered patients, it is necessary to have an easy way of qualifying them and creating workflows to keep patients covered or re-enroll them when they fall out of coverage,” explains Lebherz. This is precisely what PointCare brings to the market with its member coverage management platform for health systems.

PointCare was created in 2012 with the intention of providing continued medical insurance to publicly covered patients by helping them find the right medical coverage program. The company reaches out to Federally Qualified Health Centers (FQHCs) across the U.S. with an aim to organize and making public coverage more accessible while simultaneously simplifying its management. “PointCare’s cloud- based platform offers tools that aid FQHC enrollment departments in delivering a pleasant enrollment cycle experience to uninsured patients,” informs Lebherz. The coverage management platform comes in with features like PointCare Qualify that proves beneficial in allowing users to qualify patients for public, private and additional benefit programs in their respective states. This feature uses patients’ zip code and a few questions to match them with all available programs in the brief span of 90 seconds. “No health system today comprises the data required to understand the exact number of patients that actually qualify for reimbursable programs,” Lebherz goes onto say. “The data has health systems wondering why they are defaulting to sliding fee so often after seeing how many patients actually qualify for reimbursable programs.”

Added to this, the PointCare Verify feature of the platform coupled with PointCare Enrollment Intelligence^™ automates the process of checking on the status of patient applications.

PointCare Verify alerts the user on the approval of an application so that the FQHC can reach out to the patient and schedule future appointments as well as help in choosing a primary care provider before one is auto-assigned by the Medicaid program. “After a hassle-free enrollment cycle, patients almost always select the FQHC that simplified the enrollment,” informs Lebherz. “The annual value of an insured patient is a major incentive to keep them covered in an ongoing way while reducing the number of patients that fall out of coverage.” PointCare Enrollment Intelligence^™ takes in verification results of patients, analyzes them, and associates the approved coverage with their set of over 1,300 managed programs nationally to identify the exact program that was approved. Together with PointCare Enroll, the platform’s all-around features work in tandem to convert uninsured patients into reimbursable health programs.

“Once an FQHC identifies an uninsured patient, they enter PointCare’s process of qualifying, enrolling, verifying, anchoring, and retaining the patient under Medicaid and other benefit programs,” says Lebherz. PointCare’s capability in keeping patients within an insurance program proved highly beneficial to a major health system in the U.S. that had a sizeable enrollment department but lacked an easy way to qualify patients for multiple medical programs simultaneously. With the use of PointCare’s product suite, the health system was able to educate and qualify patients for the right program in a timely manner. Added to that, the patients’ families were enrolled in other programs to aid finances on a daily basis. On recognizing the benefits of using PointCare, the customer purchased additional products to identify patients who dropped out of the Medicaid program and established workflows to re-enroll them. The efficient use of PointCare’s products led to a significant increase in member retention for its customer in just the first quarter.

PointCare has put together a process to continuously maintain public coverage rules and programs across states. PointCare’s coverage management platform and its extensive features have made it possible for FQHCs to manage their entire base of patients served in a simple and automated manner.