How PURE Infusion Suites Reached More Patients and Reduced A/R by Moving Beyond Copay Cards

Background

Infusion therapy changes lives, but it carries a high price, and the assistance programs that exist to cover it often go unused. PURE had built real strength here. A full-time Patient Access Coordinator at every location reviewed benefits and enrolled commercially insured patients in manufacturer copay assistance, with nearly all eligible patients enrolled. The gap was everything copay cards do not cover.

Challenge

Copay cards only reach commercially insured patients. That left PURE's Medicare and other government-insured patients without a path to assistance, and at risk of leaving therapy they could not afford. Foundation funding could close the gap, but it works differently. It demands a deep understanding of insurance benefits and specific eligibility rules, and the funds open and close in minutes.

PURE's coordinators, already at full capacity, did not have the time or specialized training to work them. The result was mounting A/R and processes that varied from location to location as the organization grew.

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Solution

PURE put the TailorMed platform to work across all of its locations. TailorMed Core uses data and predictive analytics to proactively flag patients who need help and match them to relevant programs across more than 6,000 resources, then automates and speeds up enrollment. Real-time fund tracking alerts the team the moment a charitable fund opens, so patients are enrolled before it closes. The Pharmacy module manages free and replacement drugs, and Insights gives the team real-time reporting on the metrics that matter.

Technology was not the whole answer. Foundation work demands expert navigation, so PURE also brought on TailorMed Complete. Complete pairs the platform with TailorMed's in-house team of expert navigators, who carry a combined 75 years of healthcare experience.

That team took on PURE's Medicare patients, securing foundation funding and managing the copay claims that follow. Platform and people together let PURE reach more patients and act on more opportunities, without pulling coordinators away from the patient experience the organization is known for.

Results

• Government-insured patients, including Medicare beneficiaries, are now proactively identified and matched to foundation funding
• Enrollment and claims run on standardized workflows across every location
• A/R is down as a direct result of the foundation assistance secured
• Coordinators already at full capacity work more efficiently and face less burnout
• Leadership can track program success and show its value through analytics

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