AI helps hospitals optimize their financial assistance programs 

Photo: Kiyoshi Hijiki/Getty Images

Atlas Health taps into financial assistance programs for patients to help hospitals get paid. AI connects the money, patients and health systems.

At any given time, there are more than 20,000 philanthropic medical financial aid programs that fund patient care, according to Ethan Davidoff, CEO and founder of Atlas Health. Millions of individuals – including those with government or commercial insurance – are eligible for full or partial financial aid for their medical expenses. Even those with insurance often need help with coinsurance and co-pays, he said.

Eligibility is based on clinical, financial and insurance-related criteria – which, for many people, is constantly changing. A change like losing a job, receiving a diagnosis, switching insurance providers or being prescribed medications can make individuals eligible or ineligible.

Everyone other than Medicaid beneficiaries are eligible if they meet the income criteria.

Each patient assistance and social support program has different applications, eligibility rules, enrollment policies and reimbursement processes. Many programs open and close regularly based on level of funds, number of enrolled patients and other factors.

It's Nicole Nye's job to chase down the available funding. Nye is Atlas Health's vice president of product management.

"These programs can open and shut in 15 minutes," Nye said. "Timeliness is super important."

Nye and others alert advocates and users in real time when foundations and programs become open.

Patient applications are pre-populated in the database. Atlas is able to capture signatures and take photos of supplemental documentation, and then electronically send that to the philanthropic program.

"We connect the patients with the philanthropic aid available, and hospitals tap into the technology," Nye said. 

The system is designed for the front-end of the revenue cycle, Davidoff said, from the time of the initial visit and treatment plan. Atlas intercepts the data in the EHR and then AI automatically matches patients to programs and manages workflows. 

AI can predict eligibility as information is fed back into the machine learning loop for the next set of predictions.

Patients either don't get a bill or they get a dramatically reduced bill.

"The next day we can call you on behalf of the hospital," Davidoff said, and say, "'We want to let you know there's a nonprofit that can cover the cost of treatment.'" 

Atlas gets an estimated $30 billion in funding per year from a variety of 5013C foundations to cover such medical issues as complex diseases, high cost drugs and recurring procedures.

WHY THIS MATTERS

Atlas boasts that it helps hospitals assist twice the number of patients with aid programs compared to manual patient assistance program searches.

On average, Atlas saves health systems up to 0.4 - 0.7% of their net patient revenue.

AI is helping to grow awareness of these financial programs and the ongoing need for collaboration among various healthcare stakeholders, said Davidoff, who brought the company to the market in 2019.

THE LARGER TREND

There are government programs, philanthropic programs and sometimes internal programs hospitals are required by law to administer to keep their tax exempt status, according to Davidoff.

Hospitals normally write off unpaid bills as bad debt.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org