Introducing Coverage Management

Redefining how we manage Medicaid Membership

We prefer to call a spade a spade. Redetermination has historically proven to be unreliable and has led to thousands of Americans dropping out of their Medicaid coverage due to avoidable procedural lapses. While reviewing enrollment data, PointCare noticed that the same patients were being re-enrolled multiple times each year.  When we asked enrollment teams nationally why this was the case, their responses were consistent: they did not know why their patients dropped from coverage. To further complicate matters, when patients showed up uninsured it necessitated re-enrolment. The by-product was delayed care and revenue. 

To be blunt, the healthcare system has flaws that are causing heartaches for Americans who are unknowingly losing Medicaid coverage and headaches for the clinics who are caught in a cycle of perpetual re-enrollment at point-of-care. PointCare CEO and Co-Founder Everett Lebherz knew the process as it stood was unsustainable and something had to change. 

A New Way of Managing Medicaid Members

Working closely with AltaMed, the nation's largest FQHC, PointCare spent three years developing and refining a method to identify exactly when Medicaid patients drop and engage these patients to get them recovered immediately. We call it Coverage Management - proactive identification and resolution of coverage issues to ensure continuity of care while improving the member's coverage experience. We developed our solution for scale and automation to ensure FQHCs of all sizes could benefit. 

We officially launched our Coverage Management solution in January 2023 and are now managing over 1M Medicaid members. Coverage Management works to keep patients covered and anchored to your clinic, ensuring timely revenue when they visit, reduced self-pay visits, and a perpetual coverage experience for the patient.

Ready to see how Coverage Management can help improve clinic operations and patient outcomes?

PointCare is here to ensure your Medicaid patients remain covered and your clinic thrives. Contact PointCare today to learn how we can help you maintain continuous coverage for your patients and secure your clinic's financial health.