An Avenue for Cost Savings through Nonprofit Charitable Assistance Programs
Nathan Thomson, State Government Affairs, Patients Services, Inc. (PSI)
We are living in an era of where safety net systems are increasingly strained and state health budgets are saddled with competing priorities. No one entity or sector can keep up with the demands to increase patient access to care and make health care more affordable. A coordinated approach between state health agencies and nonprofit organizations can serve as a model to achieve both goals successfully. The importance of state fiscal responsibility runs parallel with increased patient access. State governments must explore every avenue to balance cost-savings priorities and improve health outcomes. In its partnership with Title V entities for more than 20 years, Patients Services, Inc. (PSI), a national 501 (c)(3) nonprofit, has bridged that gap.
Since 1996, PSI partnerships in three states have led to a cost savings of $127 million. PSI wants to help your state save money while providing increased access to medical care for the uninsured and underinsured.
Founded in 1989, PSI serves patients with rare and chronic diseases by providing financial assistance in several key areas:
- Health insurance premiums
- Pharmacy and treatment co-payment/co-insurance
- Nursing and infusion service-related costs
- Travel and ancillary expenses.
During the COVID-19 pandemic, PSI expanded assistance to include grants for families grappling with the virus by helping with expenses such as rents and mortgages, utilities, groceries, and childcare. PSI also provides free legal services to individuals seeking disability benefits through our ACCESS Program (Advocating for Chronic Conditions, Entitlements and Social Services).
In addition to assisting more than 16,000 patients annually in all 50 states through our disease fund programs, PSI also contracts with state partners in Kentucky, South Carolina, and Virginia.
Partnership with Title V Helps PSI Focus on Health Care Premium Coverage for Uninsured/Underinsured Individuals with Specific Chronic and Rare Diseases
PSI’s partnership with Title V Children with Special Health Care Needs programs allows PSI to administer health insurance premium assistance programs for uninsured or underinsured individuals in specific disease areas, including hemophilia, sickle cell disease, and cystic fibrosis. Through these partnerships, PSI works with patients to obtain health insurance coverage, subsidizing the high cost of premiums as well as the out-of-pocket costs associated with their treatments. This side-by-side approach in Kentucky, South Carolina, and Virginia allows affected individuals to receive comprehensive care while also delivering significant cost-savings to state health budgets.
Both the State and the Patients Benefit from the Partnership
The idea is simple but effective: utilize Title V grant dollars to transition individuals in the children with special health care needs program into private health insurance coverage. The patients with rare and chronic illnesses benefit by receiving comprehensive care through the coverage. The state also benefits by reducing the cost burden for these programs and avoiding the need to expand their use of safety net programs.
Types of Patient Assistance
Set out below are brief descriptions of the various types of patient assistance PSI can offer the state Title V Program:
Insurance Case Management
PSI’s Patient Access Professionals specialize in health insurance education and help patients apply for health insurance through multiple avenues.
PSI helps the patient with the cost of the health insurance premium, whether the patient is already insured or has recently obtained an insurance plan. Assistance can take the form of patient reimbursement or direct payment to the health insurance company. As a result, patients are able to obtain comprehensive care and can avoid issues like needing to “spend down” their resources.
PSI helps with the costs of the copayment/coinsurance for Food and Drug Administration-approved and indicated medication/treatments associated with a covered illness. Assistance is provided through a payment assistance card, which is given to patients. Approved patients simply present their primary insurance card along with their PSI payment assistance card, before they access services covered by their approved PSI assistance. When patients pick up a prescription, the PSI payment assistance card works like a secondary pharmacy payer. The remaining copayment due will be immediately approved (deducted from the payment card) at the time of purchase.
Ancillary assistance subsidizes the cost of the other copayment costs for health care needs associated with the condition. Examples include copayment for office visits, laboratory testing, vaccines, vitamins (e.g., iron and folic acid), hospitalization copayments, and the like. The patient receives a prepaid assistance card with purchasing options preloaded on the card.
Infusion and Nursing Services
Infusion and nursing services are an approved type of assistance when the cost of infusion and nursing is related to the treatment associated with the specific chronic illness.
Travel assistance covers the cost associated with travel to and from a treatment center for the condition.
State health programs should utilize health insurance premium and cost-sharing assistance to ensure access to care for patients with rare and chronic illnesses in a fiscally responsible manner. PSI is the only national nonprofit assistance charity equipped to serve as a partner in your Title V program. We welcome opportunities to discuss ways to partner with every state in the U.S. If you are interested in learning more about the possibilities, please contact Nathan Thomson, State Government Affairs at firstname.lastname@example.org. Feel free to also visit our website to learn more about all the services offered.