OWPs can help improve access to care for those who need it most and speed up reimbursement through more efficient processing.
Millions of Americans have gained health insurance coverage in the years since the Affordable Care Act took effect. However, access to healthcare services remains a concerning issue.
The Centers for Disease Control and Prevention’s Healthy People Midcourse Review indicates major gaps in access to care on the basis of several socioeconomic factors, including race, education, and family income.
In other words, while more healthcare options may exist, people are still having trouble getting to them.
An effective outstationed eligibility worker program (OWP) can help people who are struggling to access care overcome some of the barriers they’re facing. OWPs provide outreach, access, and assistance to low-income populations and people most in need of public health benefits but often least likely to pursue them.
While OWPs are designed to serve the special needs of their unique communities, resulting in an improved patient experience, they also help hospitals receive reimbursements more quickly through efficient receipt and submission of applications for assistance and by speeding up processing times.
Learn and Apply these Essential Elements of an Effective OWP
What is an OWP?
The outstationed eligibility worker program was designed to help families, pregnant women, and children have convenient access to medical assistance without going to a state welfare office. They also can help individuals who are homeless, victims of abuse, or suffer mental health issues. For many reasons, this population can be hard to reach through traditional means applied in state benefit offices. The opportunity to apply at the patient’s preferred site of care can improve their potential for enrollment in public benefits.
Where are OWPs?
The Social Security Act requires all states to place medical assistance eligibility workers in stations other than in state benefit offices. For example, workers can be placed in disproportionate share hospitals and federally qualified health centers. They also can be placed in Indian Health Service facilities or tribal clinics, and school-based or family service centers.
What do OWPs do?
Oftentimes, outstationed eligibility workers serve in communities with low-income populations, and they help patients with receipt and initial processing of Medicaid applications. They also may refer people to other agencies that might provide them with additional benefits. In some cases, the workers may handle eligibility processing in its entirety, including the eligibility determination. The workers can be state employees, hospital staff, contract workers or volunteers.
Why are OWPs important?
In many cases, people that OWPs serve are unaware of the financial assistance for medical expenses that could be available to them or don’t have access to assistance they need to apply. The process can be confusing and frustrating, which is why many patients delay seeking assistance or don’t seek it at all.
How do OWPs help?
OWPs engage with this population in an environment that is convenient and familiar. The workers help streamline communication among patients, hospitals, and government programs. Efficiency in the receipt, submission, and follow up on applications is improved when handled by a dedicated outstationed eligibility worker. As a result, the application processing time is reduced.
MedData recently studied two large health systems in similar Texas markets and found that an effective OWP can reduce case turnaround time by as much as 14 days.
To learn more about how OWPs can enhance patient eligibility solutions and dramatically reduce turnaround time, download the full white paper.