'Dually employed' case managers growing trend
Result is millions in additional revenue
The mission of eight onsite Medicaid case managers at WakeMed Health & Hospitals in Raleigh, NC, is to "focus only on patients who have been patients at WakeMed," says Heidi McAfee, director of patient access/case management.
McAfee says that she thinks this arrangement, with half of the salaries of the onsite Medicaid case managers paid by the hospital and half by the federal government, probably makes sense for any facility that sees a lot of self-pay patients, regardless of its size. "A small hospital with a large uninsured population could justify one position like this," she says.
Medicaid eligibility is determined much more quickly than in the past. "We want to get patients processed as quickly as possible," says McAfee. "This turns around revenue for the hospital. Most importantly, the patient can be followed by a primary care physician for routine health care needs."
"Patients are converted from being self-pay to having Medicaid coverage," says Maria Eason, manager of WakeMed's onsite Medicaid case managers. "The application comes directly to us. We help each other get the information from the patient. It's a very seamless process for everyone."
A number of other hospitals and medical institutions have come to look at WakeMed's process. They are often surprised at the collaborative relationship between the onsite Medicaid case managers and the financial counselors.
"The collegial relationship that we have built has been critical," says McAfee. "They are not in an adversarial relationship. They are colleagues working for the same goal. Other hospitals with the similar arrangements do not partner in this manner."
Often, there is a strained relationship, which becomes an obstacle. "People tell us, 'We don't even talk to our onsite people,'" says McAfee. "Our onsite Medicaid case managers are part of our staff meetings. If we have a function with cookies or food, they are part of that as well." Eason recently invited WakeMed's financial counselors to be part of an offsite meeting and team-building session.
"My wildest dream was to co-locate these two groups, and that happened about two years ago," says McAfee. "They are now in the same physical space."
This arrangement has resulted in approval of $5 to $7 million in Medicaid charges for the hospital on a monthly basis. "This does not include people who are already on Medicaid. This is revenue from new applications completed for people who were originally uninsured when they came to WakeMed," says McAfee. "This is very, very important for our financial health."
In many hospitals with onsite Medicaid case managers, the county and a federal program pay for the employee's salary. "The contractual agreement between WakeMed and the county is a foundation to build upon," says Eason.
Eason explains that the Medicaid case managers are dually employed and have allegiance to both Wake County and WakeMed. "Without that, it's hard to get people to be a team," she says. "It will always be 'us and them.' In other hospitals, staff may have the attitude, 'They work for the county. They may have information on a patient, but the Medicaid case managers and the hospital do not collaborate.'"
Eason says that she expects this type of arrangement will continue to grow under health care reform. "There will be more possibilities for people to be eligible for different programs," she says. "So having people onsite ahead of time, before that comes about, is a benefit. I think more people will be looking at this in the future."
The mission of eight onsite Medicaid case managers at WakeMed Health & Hospitals in Raleigh, NC, is to "focus only on patients who have been patients at WakeMed," says Heidi McAfee, director of patient access/case management.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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