To cover pricey cancer treatments, a rural Georgia hospital automated its hunt for philanthropic reimbursement

Wayne Memorial Hospital is a community hospital that recently launched oncology services for its rural residents.

While the facility is relatively small at just 84 beds and 500 employees, it’s one of the few options for the locals of Wayne County and its surrounding southeast Georgia communities to receive this type of care without driving an hour or two by car.

“There are four counties that are contiguous to us that do not have a hospital at all. Prior to us starting our oncology services, patients were having to drive at least 40 miles and as many as 75 miles to get care—and that’s not something that you want after getting six or eight hours of infusions,” Greg Jones, chief financial officer at Wayne Memorial Hospital, told Fierce Healthcare.

Thanks to a partnership with Savannah, Georgia-based provider St. Joseph’s/Candler, Jones said that Wayne Memorial’s oncology has exceeded expectations. In August, the hospital will be wrapping up work on a new building for its growing infusion services.

However, the community hospital and its patients were stonewalled when it came to paying for the high-cost, specialty treatments.

Roughly 17.5% of Wayne County residents don’t have any form of health insurance, and those enrolled in Medicare or a high-deductible commercial plan frequently have trouble meeting the copayments.

RELATED: Charity plans to wipe out $278M of Ballad Health's outstanding patient medical debts

Wayne Memorial operates a financial aid department that extends the treatments to these patients but, according to Jones, could only spare a single person to seek out and review eligibility for the philanthropic aid and rebates that would cover the costs.

“A lot of [rural hospitals] lose money and fail,” he said. “Any type of financial mistake or misstep can cost the hospital its life, so we need to be able to get all of the reimbursement for our patients that we can.”

The solution, Jones said, was a tech platform already in place at its partner St. Joseph’s/Candler. Developed by a Seattle-based startup called Atlas Health, the tool integrates with a hospital’s clinical, financial and pharmaceutical systems to automate the end-to-end process of securing financial aid for patients with high-cost treatments.

“We focus on this pod of a little over $30 billion in annual aid and basically connect the dots with matching the patients with programs, enrolling them in programs and then providing them all the reimbursement tasks in terms of claims and ordering drugs,” Ethan Davidoff, founder and CEO of Atlas Health, told Fierce Healthcare. “Patients can access care and not get saddled with a debt they can’t pay—but [it] also helps our health system partners remain solvent and run a smooth business operation.”

RELATED: CHS sued nearly 19,000 patients for unpaid medical bills since start of pandemic

Atlas Health’s platform—which was a Fierce Innovation Awards 2020 finalist and according to Davidoff already in use among a handful of “large, nationally-recognized” integrated delivery networks—is designed to be an extension of an organization’s financial aid department.

Prior to signing on, the startup will conduct an ROI assessment that reviews a year’s worth of claims data to show organizations “the opportunity, what’s out there across this $30 billion, how you’re doing today [and] what’s the delta,” Davidoff explained. That process involves a turnkey sequel script developed by Atlas that a potential partner will run across its systems, he said.

“We give the health system partner the code for them to run, install, export the data and upload securely to our SFTP server. That way the health system doesn’t have to incur all this IT lift where they’re working backward and have to build all this custom code,” he said. “Once that converts to a partner like Wayne Memorial, most of the core data integration with their systems and modeling out those payers is kind of already done.”

That onboarding process was “seamless as could be” for Wayne Memorial, Jones said and demonstrated a return within their first month of deployment.

RELATED: Industry Voices—Hospitals are failing to effectively tap a valuable revenue resource amid COVID-19

According to the organizations, supplementing the hospital’s staffed financial aid department with the automation tool led to a 75% reduction time for clean claim submissions and a 50% time reduction for philanthropic aid applications. Jones also noted that his small hospital will now be able to provide an extra $1 million in additional care over the next 12 months, helping about 50 patients that would otherwise have been unable to pay for their treatments.

“We didn’t know all the different coverages that were out there—what types of philanthropic organizations there were, what types of drug rebates,” Jones said. “Now, that’s literally at [our employees’] fingertips. They enter the information in and [the software] goes out electronically and searches that. I mean, somebody could spend hours on the phone for something that literally takes two minutes electronically.”

While this type of automation is a particular boon for organizations with thin margins that “can’t afford to pay a lot of people to sit around do this work,” Jones noted that larger groups would likely see a cost and time savings from automating their financial aid processes as well.

But just as important as the organization’s short-term financial gain is the downstream benefits for patients and providers alike.

“We have a fairly large population in our area that won’t seek medical care just because they know they’re going to owe money for it,” Jones said. “Of course, that just ends up costing everyone more in the end [than] if people would just get the care they need.

“So, being able to find this care and [show] we’re an established community—that ‘Hey, the hospital has a program that helps us find this and pay for it, and I’m not having to pay anything for it?’ I think that’s very helpful, and this type of service would work across any lines that a hospital would have … not just oncology.”