Enhancing Patient Outcomes: Leveraging Medicaid Redetermination as an Opportunity for Holistic Care Delivery

With every challenge comes opportunity. Such is the case with Medicaid redetermination. With an estimated eight million or more Medicaid recipients losing coverage, hospitals face many challenges. It is possible that many patients will not know that they’ve lost coverage until they show up for a service. This can lead to surprise bills for the patient and increased collection challenges for hospitals.

Instead of seeing the redetermination initiative as a burden, more forward-looking hospitals consider it an opportunity to improve care in their communities.

Then there are patients who know they must find other coverage but don’t know how to navigate the often complex medical insurance system, which can cause them to put off much-needed care. And when patients put off care, their conditions can worsen and send them to the emergency department, driving up costs for both the hospital and the patient, and impacting value-based care reimbursements.

Another challenge hospitals face is the potential for increased denials due to difficulty determining coverage and eligibility, which can lead to growing write-offs and higher collection costs. A report by Kaufman Hall indicates that hospitals are already dealing with an increase in bad debt and charity care, “signaling a material impact Medicaid disenrollment has had on hospital financial performance.”

Instead of seeing the redetermination initiative as a burden, more forward-looking hospitals consider it an opportunity to improve care in their communities. They are taking a patient-centered approach throughout the redetermination process, focusing on better health outcomes and patient satisfaction. The following are opportunities to do just that.

Automate Coverage Determination

Patient satisfaction and outcomes can be influenced from the very first encounter and every touchpoint after that. Automating eligibility and coverage verification can improve the patient experience by removing manual, error-prone processes that inhibit a patient’s ability to receive timely care—especially those impacted by Medicaid redetermination.

Nearly a third of hospitals and health systems surveyed don’t use revenue cycle automation.

The best automation solutions use artificial intelligence (AI) and robotic process automation (RPA) to identify and capture coverage, eligibility, and demographic data faster and more accurately than humans alone. This reduces gaps in care, care delays, and surprise bills. Providers benefit from getting a more complete view of not only existing insurance but also new coverage options.

Enhance the Patient Financial Experience

Patients impacted by the redetermination initiative will need all the help they can get in paying for their medical care, and it’s in a hospital’s best interest to make it as easy as possible. This means using tools like propensity-to-pay analytics to determine a patient’s eligibility for financial assistance or charity care. After all, sending numerous statements and late notices to a patient who genuinely cannot pay makes no sense and is a waste of time, money, and scarce resources. Understanding a patient’s unique financial situation enables hospitals to become advocates for patients by helping them find the help they need.

It is important that hospitals take the extra step, especially now, to help impacted patients navigate the steps of applying for assistance and to find the most appropriate, affordable coverage. Think of the impact going this extra mile could for a hospital’s brand reputation and patient satisfaction scores, not to mention that it helps ensure patients are able to get the care they need to live better, healthier lives.

Elevate Patient Education

These are challenging times for patients going through the redetermination process. Helping them understand their financial responsibility and options can help alleviate their stress and remove barriers to care. For example, 40% of patients surveyed who had inquired about what they would owe said the information was “inaccurate or difficult to locate.” Offering patient financial estimations allows hospitals to educate patients about their coverage, co-pays, remaining deductibles, and other coverage details at or before the time of service. This allows patients to make more informed decisions about how to pay for their care.

Provide Patient-Centric Payment Options

Nearly half of Americans say they have outstanding medical debt and 70% say they are not on a payment plan to pay their medical bills. This is a missed opportunity for both the hospital and the patient. It is at no fault of their own that patients are losing their coverage and hospitals should do everything they can to alleviate the burden by making it easier for patients to pay. The most effective payment plan programs include the following elements:

  • Are customizable to the patient’s financial situation
  • Enable consolidation of all medical bills into one affordable monthly payment
  • Allow other family members’ medical bills to be added to the payment plan
  • Are flexible enough to be updated as a patient’s financial situation changes

Patient-centric payment options should also include multiple payment methods, including mobile payments, online through a payment portal, via voice-activated phone systems, through the mail, and using customer service reps. Making payments more convenient allows patients to pay when and how it’s most convenient for them.

Consider Outsourcing

For many hospitals, labor shortages have made it difficult to keep up with existing revenue cycle processes, let alone redetermination workflows. Outsourcing with revenue cycle experts is a great opportunity for these hospitals, and Conifer Health is an excellent choice. Conifer’s Eligibility and Enrollment Services provide streamlined access to care for patients impacted by Medicaid redetermination. Leveraging its omnichannel patient engagement technology, analytics and automation solutions, and patient-facing revenue cycle experts can empower hospitals to help patients not just survive redetermination, but to thrive.

Conifer Health gives hospitals the tools they need to help improve their patients’ health journeys in a more holistic way. Conifer offers:

  • On-site and centralized certified application counselors
  • Financial assistance and personalized payment consultation
  • Digital self-service application process
  • Proprietary AI and predictive analytics

A hospital partnering with Conifer Health has achieved the following:


increase in certification volume


eligibility and enrollment conversion rate


decrease in bad debt expense

Opportunities, Not Burdens

What can seem to many as a great burden can appear to others as a great opportunity. Hospitals should embrace the latter by taking a more proactive approach to Medicaid redetermination and using it to increase timely access to care, improve outcomes, and enhance the patient experience.

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