Approx. $87 million converted from uninsured to ACA insured.

Overview
A large community-based health system in the lower Midwest is committed to advancing population health management. The Affordable Care Act (ACA) highlighted a critical challenge for them: patients whose incomes exceeded Medicaid eligibility but couldn’t afford ACA premiums. Many of these individuals, unable to navigate the complexities of affordable insurance, resorted to emergency department visits instead of primary care due to cost barriers.
The Health System also identified a growing demographic transitioning from commercial insurance to Medicare as they turned 65. In addition to Medicare Parts A-D, many of these patients were unaware of additional coverage options available to them to mitigate underinsurance and coverage gaps, such as Medigap, Medicare Savings Programs, and Dual Eligibility.
Solution
The Health System adopted RevOne’s WellFund solution to bridge these gaps. The program provided comprehensive education, application assistance, and support to help uninsured and underinsured patients find affordable health coverage options.
  • For patients without Medicaid or Medicare eligibility, WellFund assisted in enrolling them in ACA Marketplace plans, often securing $0 monthly premiums.
  • For Medicare-eligible patients, WellFund offered personalized guidance to find in-network programs that closed care gaps and reduced out-of-pocket expenses. This included exploring Medicare Advantage, Medigap, Supplement Plans, Dual Eligibility, QMB, QDWI, SLMB, QI, and Special Needs Plans for chronic conditions.
The WellFund’s holistic approach ensured patients had access to affordable insurance options tailored to their needs, enabling them to maintain consistent healthcare access.
Results
Since its launch in 2015, WellFund has delivered transformative outcomes for this Health System and its patients:
  • Assisted 5,000 families in enrolling in ACA Marketplace plans, converting approximately $87 million in unreimbursed healthcare costs into insured claims.
  • Supported 81,000 patients with Medicaid enrollment.
    Helped over 4,000 patients transition to Medicare, including 3,000 Dual Eligible enrollees, saving these individuals an estimated $7,000 annually.
Beyond the numbers, WellFund’s efforts have empowered patients with better insurance coverage and lower out-of-pocket expenses, enabling them to prioritize regular primary care visits. This proactive access to healthcare has improved patient health outcomes, aligning with the Health System’s mission to enhance community well-being.