What the new Pointcare patient experience says about who we are, what we believe, and why it matters to every health center we serve.
Everett Lebherz
CO-FOUNDER & CEO, POINTCARE
Brands are not logos. They are not fonts or color palettes or taglines. A brand is a declaration of what you fundamentally believe - about the problem you're solving, the people you serve, and whether you've had the conviction to build everything around that belief even when it was inconvenient.
The upgraded Pointcare patient experience we just launched is that kind of declaration. I want to tell you what it says - and why it took us 13 years to be ready to say it this clearly.
THE UNCOMFORTABLE TRUTH
Our industry exists because of a system designed to fail the people it's supposed to help.
I'll say what most people in this space won't: the revenue cycle industry - all of it, including the early version of us - largely exists because of dysfunction at the public level. If Medicaid and Medicare worked the way they were intended to work, there would be no industry built around helping health centers navigate what they're owed, who is covered, and how to bill. The broken system upstream is what creates the market downstream.
Here is the part that genuinely made my blood boil when I finally saw it clearly: states have a perverse financial incentive to remove eligible people from Medicaid. At roughly $10,000 per member per year in premium payments, simply kicking someone off saves the state money - even when that person is still eligible. The procedural barriers aren't accidents. The onus gets placed on the member to navigate a system deliberately designed to be opaque. And the people we're supposed to be helping lose coverage over and over again, not because they're ineligible, but because the paperwork didn't work out.
"I know how much we all pay into the system to have this work. When I see the lack of empathy, the lack of effectiveness - that's contrary to everything you hear these states say about wanting to help people."
THE MOMENT THAT CHANGED EVERYTHING
Three Medicaid applications. Twelve months. The same person.
I was in our office in Walnut Creek, logged into a customer instance to help with a member question. I pulled up one record and saw something I couldn't unsee: a single member had three separate Medicaid applications in the past 12 months - all with different start dates, different approval dates.
I called the user who had worked with this member. She told me, almost casually: they show up thinking they're covered, but they're not - so we enroll them again. Three times in 12 months. And she said, that's why we're here. That's just what happens.
I run an employee benefits firm alongside Pointcare. If one employee shows up without coverage, the broker representing them is going to answer for it - maybe lose the account. And yet the people in our society who need the most help were being terminated without notice, repeatedly, and the system had just... normalized it. That moment is what kicked off our coverage management journey. Not a market analysis. Not a pitch deck. A single member record and the quiet resignation of a navigator who had stopped asking why.
WHAT WE BELIEVE
The answer isn't better enrollment. It's ongoing representation.
For twenty years, this industry has solved an acute problem acutely. A patient walks in uninsured - get them covered at the point of care. Charge contingency. Repeat. The revenue model rewards the problem continuing. The incentive to actually solve it doesn't exist.
We looked at that and said: what if you just made it so that people show up covered? Stop chasing encounters. Stop re-enrolling the same person three times a year. Build the infrastructure that makes coverage continuous - so the acute problem goes away because you solved it upstream.
We also believe something unpopular in our space: scaled enrollment departments at health centers are not the answer.They never were. When ACA launched and commissions got cut so low that brokers exited the individual market entirely, health centers stepped into that vacuum without the tools, expertise, or scalability to fill it. They've been doing it for 13 years. They've done the best they could. But I've never seen a health system with enough navigators to service their patient volume. Not one. The right answer is to let health centers do what they're brilliant at - delivering care - and let coverage management experts handle the insurance. That's not a criticism of health centers. It's a respect for what they actually do well.
"People appreciate having support. They appreciate having someone look out for them, an advisor in their corner. That exists in every industry. For the people we serve, it almost completely disappeared when ACA passed - and we're bringing it back."
WHAT THE UPGRADE ACTUALLY IS
Coverage management, made visible to the people it was always for.
For most of our history, Pointcare has been operationally excellent and almost entirely invisible to patients. We were wired into health center workflows, managing coverage events in the background, and patients had no direct relationship with us at all. The clinics trust us. The members didn't know we existed.
Until we engaged with AltaMed. It's a blessing when vision is shared, and Dr. Robert Young not only grasped it, expanded it. His insight as VP of Patient Financial Services has led to product improvements and value reporting that has impacted health centers and their members across the country.
Real-time coverage visibility so no one arrives for an appointment guessing whether they're covered. Household-level management - one survey, one process, every person in the family checked - because a mother's lapse almost always means her children's coverage needs attention, too. A single session to apply across Medicaid, Medicare, and Marketplace without bouncing between state portals and answering the same questions five times. Coverage Management reports for health centers to validate success. And when Medicaid isn't an option, a direct path to marketplace plans for as little as $10 to $20 a month.
It adapts to where each patient actually is. Someone scanning a clinic QR code for the first time gets a very different experience than someone re-enrolling after a lapse, or a patient preparing to document work requirements hours before a 2027 deadline. Every moment in the coverage journey now has a designed experience behind it.
WHAT THIS MEANS FOR HEALTH CENTERS
Your patients will start asking whether you manage their coverage.
I want to be direct with health center partners about the competitive implication of what we're building. In the not-too-distant future, when a member is seeking providers, they are going to ask: do you help manage my coverage, or do I have to do that on my own? That question is going to shape decisions about which health center they choose. Coverage management is becoming a patient retention differentiator - and health centers that offer it will have an advantage that is very difficult to replicate with in-house enrollment efforts.
The upgrade connects seamlessly to the organizational coverage management infrastructure already running in your clinic. No new implementation. No additional integration work. It extends what you already have - proactive termination detection, automated outreach, payer-level monitoring - to a patient-facing experience that keeps members informed and ready to act when coverage events arise.
For your staff: fewer patients arriving uncovered. Fewer phone calls chasing paperwork. Fewer navigators doing the same enrollment a third time for the same person. The system absorbs the complexity so your clinical teams can do what they came here to do, and operational excellence follows.
LOOKING AHEAD
We've been here 13 years. We built this for exactly what's coming.
For most of our history, Pointcare has been operationally excellent and almost entirely invisible to patients. We were wired into health center workflows, managing coverage events in the background, and patients had no direct relationship with us at all. The clinics trust us. The members didn't know we existed.
H.R. 1 is not abstract. Semi-annual redeterminations for the expansion population begin in 2027. Work requirement verification means members document 80 hours a month of qualifying activity, on an ongoing basis. Every new requirement is a new place for a member to fall through the cracks - and a new reason why ongoing representation matters more than any point-of-care enrollment ever could.
The Covid Public Health Emergency delayed our coverage management launch for 3 years, but it didn't stop us from building, working with CHCs honing our workflows and developing for scale. We knew it would unwind at some point and had no patients under management until January of 2023, outside of our pilot population. We now manage coverage for 2,000,000 patients every month. When the unwinding began, we were ready. We saw the wave forming, paddled in and are still riding it. This new launch is Pointcare settling into the barrel of the wave where the momentum surges forward, powerful in its simplicity.
The vision I keep coming back to is a family sitting around a dinner table and saying: thank God for Pointcare. All our coverage - Medicaid, Marketplace, Medicare, all of it - managed in one place, enabled by the providers we already trust. No paperwork maze. No phone trees. No showing up and finding out you're not covered.
We solved a national problem by refusing to solve it at the national level. We went local. We built trust with every health center, one at a time. And every health center that signs up today stands on the shoulders of the ones that worked with us when we were still figuring it out.
The upgrade is our way of saying: we see the people we're serving. And we built this for them. That's why we are representing the unrepresented.
Everett Lebherz
CO-FOUNDER & CEO, POINTCARE