Laura McIntire-Hansel, RN, director of Cardinal Health™ Reimbursement Solution, still lives in the same small, rural Missouri community where she grew up.
“I was a hospital nurse for many years,” she said. “I repeatedly encountered challenges and barriers in the treatment of patients. One of these, not surprisingly, was money. Though not all or even the majority of patients struggle with finances, there were and still are patients who are making daily decisions to not pursue the health care they need due to actual or perceived costs. Some patients just couldn’t afford to pay their medical bills and put food on the table, too. Even all those years ago this had a staggering impact on me: These patients were people I grew up with, and I felt driven to find solutions for them.”
She started looking more carefully at how the hospital billed its patients. “I learned that providers often don’t know what medicines or services will cost the patient. In addition, how much, if any, of that cost is reimbursed depends on the patient’s insurance.”
This lack of transparency creates a costly burden for hospitals, as well as patients. Denied or rejected claims result in bad debt write-off for many hospitals, with an average of $5 million lost per hospital per year, according to a Becker’s Hospital Review CFO Report. “Especially in small, rural areas like where I live, hospitals can be forced to shut their doors,” said McIntire-Hansel. In fact, 180 rural hospitals have closed since 2005 and the number of closures has increased steadily. According to another Becker’s article, in 2020 – a record year for closures – 20 rural hospitals shuttered.
Finding a solution
McIntire-Hansel later transitioned her career to specialty outpatient insurance and advocacy, building and leading a team of financial counselors servicing a multi-state oncology system. As she witnessed how much debt hospital, systems and their patients were absorbing, it was a particular patient who changed the trajectory of her career, McIntire-Hansel said.
“There was a wonderful lady who had a particularly big impact on me. My experience with her became a landmark moment in my life that altered my course. She was suffering from later-stage cancer and was making the decision whether or not to continue treatment – cost was a factor. She said to me, ‘I’ve had a good life. It’s been a good run. We don’t have to do this.’
“I found another way to address and remove these barriers, so she could receive her cancer treatments,” McIntire-Hansel said. “In my mind and in my heart I knew money couldn’t be the reason patients didn’t receive care.” This became her mission and passion – ensuring patients can afford care.
Using technology to help more patients
McIntire-Hansel’s long-term clinical knowledge as a nurse and her operational knowledge of health care were strong cornerstones, but she needed more.
“I learned that there is almost always a way to pay for care if you’re willing to dig hard enough. So, I dug. I wanted to make sure that, whatever the doctors prescribed, we could help support when available.”
She educated herself on available advocacy resources, like patient assistance programs (PAPs), including grants and co-pay assistance, that may help pay for prescribed treatments. Over time, she amassed extensive knowledge on program requirements and usage, which allowed her to provide alternate pathways for patients experiencing financial roadblocks to care.
This investigative research is something that most hospital systems can’t do because it’s so time-intensive. It’s difficult to keep up with continually changing payment and reimbursement requirements. That’s why McIntire-Hansel decided to become certified in medical billing and coding. “I wanted to really understand the challenges my patients were facing,” she said.
McIntire-Hansel began a new career to advocate for patients’ reimbursement full time. She started a business and began marketing her services to other hospitals.
Launching the Cardinal Health™ Reimbursement Solution
In 2020, Cardinal Health recruited McIntire-Hansel to help build this expertise in-house. In partnership with our clinical pharmacy experts and the digital team at Fuse, the innovation engine for Cardinal Health, she helped launch Reimbursement Solution. This comprehensive service is designed to minimize claim rejections and denials for hospital and system outpatient infusion clinics, while improving internal remittance workflows and uncovering programs for patient financial support.
It centers on a proactive approach by rethinking the reimbursement process, enabling the identification of critical opportunities for cost savings upfront, before treatment is performed, instead of trying to resolve remittance issues after the fact. The service is fully HIPAA-compliant and complements electronic health record (EHR) systems.
“We know where hospitals spend the most money and have the highest risk of claims rejections or denials,” McIntire-Hansel said. “The greatest expense is on patients with critical oncology, rheumatology and cardiology conditions. That’s where we can make the biggest impact.”
The proprietary digital platform is a key component that expert analysts use to see all of the latest requirements of patient support programs. Based on the patient’s health issues and insurance coverage, it includes intelligence used to identify alternate treatment rules and requirements for specific drugs or procedures coverage, as indicated by the payer. Analysts then take a hands-on approach to uncover all additional opportunities available to the patient.
By innovating with the Fuse team at Cardinal Health, McIntire-Hansel has found a new way to fulfill her mission of caring for patients – connecting them to the resources they need to help them pay their expenses and stay on their treatment regimens.
“I know from experience just how critical this service is to hospitals and to patients,” McIntire-Hansel said. “It goes to the core of who I am as a nurse. I’m always going to take care of people—that’s why I went into nursing. I’m not taking care of one patient at a time; I’m taking care of important populations of patients for many hospitals at one time.”
Editor’s note: You can learn more about the Cardinal HealthTM Reimbursement Solution at cardinalhealth.com/rethinkrevenueprocess.