Marketplace Insurance Coverage won the Presidential Award for Innovation at Harris Health's Fifth Annual Innovation Summit.
Five years ago, Michael Norby, executive vice president and chief financial officer, Harris Health System, had an idea to help Harris County residents attain health insurance. Since 2015, his idea has helped more than 16,000 people and generated an estimated $30 million in revenue—funds redirected into the system to care for additional county residents.
The program allows patients to receive care wherever their coverage is accepted and includes Harris Health facilities. In the first year, Harris Health enrolled 1,000 patients in coverage. Today, there are more than 16,000 patients enrolled. On average, the net benefit of every 1,000 patients generates $1 million a year for Harris Health. This past year, that amounted to $16 million.
Initially, Harris Health hosted annual Health Insurance Marketplace enrollment fairs to help patients apply for healthcare coverage because they no longer qualified for Harris Health's financial assistance program. In most cases these patients could not afford government-subsidized or third-party health insurance. In the process, some patients were identified as needing further financial assistance to meet plan premium payments.
After the first two years, the program evolved from enrollment fairs to subsidizing patients' insurance premiums not entirely covered by federal funds—usually 15 percent of the premium. Patients who qualify for premium subsidies have incomes that fall between 0-150 percent of the federal poverty level.
"Initially, the goal was to help new self-pay patients understand the (Health Insurance) Marketplace and what it could offer them," says Adrienne Mendoza, administrative director, Patient Services and Professional Billing Service, and lead program coordinator. "But now, we're able to provide this our qualified patient population with Marketplace coverage they could otherwise not afford while generating revenue to fund healthcare for other low-income residents of Harris County."
After the past five years, patients have expressed their gratitude to Harris Health for the role it plays in their medical insurance coverage.