Accessia Health's Unique Approach to Patient Assistance Programs Amid Shifting Dynamics and Policies

Nonprofit Patient Assistance Programs (PAPs), administered by organizations like Accessia Health, have been integral to the healthcare system for decades. Until recently, PAPs have primarily provided financial assistance for underserved patients, typically on Medicare, with an emphasis on covering copays and health insurance for families that meet financial criteria. 

Increasing costs for precision medicines and long-standing health disparities have triggered widespread challenges in healthcare access for patients and families. In response, PAP organizations must reexamine their approach to address patient needs within tight budgetary, operational, and regulatory guardrails.

Accessia Health has responded by adapting its operating model and offerings, centered around providing assistance that is: a) holistic, b) inclusive, and c) outcomes focused. This new approach recognizes that, for many underserved patients, the factors hindering access to medicines and optimal health outcomes are more than merely financial, and can vary significantly by disease and community.

Challenges in Healthcare Access and Affordability

In the US, healthcare costs create a significant financial burden for many. Consider the average household (2.4 individuals) earned $87,432 in 2021 before taxes and spent $41,874 on living expenses including housing, transportation, and food, leaving individuals with the financial worry of affording healthcare and other living expenses.

For those with insurance (~92% of the population), costs for premiums average $1,327 for individuals and $6,106 for family plans (employer-based coverage) and around $5,000 per year for those with individual plans (varies by state). Having insurance is just the beginning. Insurance premiums are just a portion of healthcare expenses.

Households without insurance, or those struggling to afford it, often delay seeking treatment until emergencies arise, leading to higher expenses and more severe health issues.

Systemic Disparities

Economic and systemic challenges are more prevalent in communities of color. Hispanic or Latino communities have among the highest percentages of uninsured at over 17%, with the African American community at over 10%. Equitable access to affordable healthcare is pivotal in ensuring individuals and their families obtain preventive care, address health concerns sooner, and achieve the best possible health outcomes while minimizing financial burdens and other stressors.

Accessia Health patients make, on average, $41,125 for a household of two, with rent and utilities responsible for about 55% of total expenses. These patients receive around $5,174 in financial assistance annually from the organization, resulting in a 13% reduction in their overall household expenditures. This is significant in alleviating the financial burden of healthcare, but is only one aspect of what Accessia Health’s evolved patient assistance model provides in order to improve access and outcomes for families.

Comprehensive Approach to Patient Assistance

Going beyond copays, Accessia Health is focused on addressing unmet needs in healthcare that other PAPs may not consider, including paying for important expenses such as diagnostic tests, durable medical equipment, dental services, and more. Operating with a patient-first approach, the organization is dedicated to providing patients with comprehensive support throughout their healthcare journey.

Particularly, Accessia Health’s new model, Your Assistance, Your Choice, allows patients the flexibility to use their assistance on the qualified healthcare expenses most important to them.

The organization’s community-based initiatives are extending the range of health and related needs that can be addressed on a local level. The Oral Health Fund, for example, is a pilot program created through a grant opportunity that offers financial assistance to Indiana residents in need of urgent oral care.

Accessia Health has also partnered with MedicoCX to improve outcomes for those living with asthma and allergies, a crucial collaborative effort that helped launch the nonprofit’s One Breath Asthma Campaign. Additionally, Accessia Health is collaborating with the Virginia Association of Free and Charitable Clinics to further expand patient access to care within vulnerable populations. These Clinics treat patients who are chronically ill and may have comorbidities, many of whom are working but can’t afford insurance.

Leading the Future of Patient Assistance

Accessia Health's innovative approach positions them as an industry leader. With 70+ disease programs and over $1.2 billion in assistance distributed to date, they provide case management, education, and financial support for health insurance premiums, medication copayments, travel, and other essential expenses.

Recently, Accessia Health was released from its Integrity Agreement with the HHS Office of Inspector General (OIG). During this transformative journey, the company upgraded its state-of-the-art technology, set new industry standards, and introduced innovative service lines. The organization continues to follow the OIG's guidance, as it serves to reliably guide patients through the complex healthcare ecosystem.

By addressing the unique needs of each patient and providing comprehensive support, the organization is setting the precedent for the PAP industry, and strives to achieve better health outcomes for households. To learn more about Accessia Health, visit https://accessiahealth.org