Firm finds niche helping uninsured find coverage.

02.14.05 ­ Even as the battle over health care for the uninsured gets more pitched, a Boston company is increasingly stepping in with a private-sector solution that some say makes at least a partial dent in the problem.

Hospitals hire Healthcare Financial, Inc. to help their uninsured patients find coverage, either through the state Medicaid program or other existing public insurance — an option targeted by everyone from Gov. Mitt Romney to the advocacy group Health Care for All in their own plans for the uninsured. Six year old HFI quietly grew more than 40 percent in 2004 and boosted its annual revenue to between $5 million and $10 million, up from $500,000 when the company first launched in 1999.

At the end of last year, HFI and its 53 employees represented 30 hospitals and health care facilities in Massachusetts, which the company says include Tufts-New England Medical Center, Cambridge Health Alliance and such Partners members as Newton-Wellesley Hospital. Six are new clients signed in the last three months of 2004 alone and worth up to $L5 million in new business for HFI, with a potential to save the client hospitals $15 million in uncompensated care costs.

"There’s clearly a growing need out there,” said Jerry Vitti, the company’s president.

A number of ideas are already competing for attention that would arguably insure more of the working poor and reduce the burden on the frees care pool, a money source funded by the state, hospitals and health insurers. Most plans also would find ways to shunt more of the working poor to Medicaid and other programs.

HFI makes its money based on a pay-for-performance model, earning money after it successfully places an uninsured hospital patient in an appropriate program. Vitti declined to discuss financials beyond initial revenue and the $5 million to $10 million expected for 2004. But the company is profitable, he said, and poised to add at least 25 percent more staff members in 2005.

HFI handled more than 25,000 referrals for uninsured patients in 2004, which included helping them navigate through a complicated Medicaid application process. Less than half that number — 12,620 — were successfully placed in Medicaid or some other public insurance program, Vitti said.

Vitti said one of his large teaching hospital clients has invested $1 million annually in his company’s services and has gotten back $20 million annually in state Medicaid revenue that the client wouldn’t have had otherwise.

Vitti said he has no real competition cause “there’s no one that does quite our model,” but he added that some attorneys in the past have competed for similar business.

Hospitals stand to gain from hiring companies like HFI, insiders say even though Medicaid reimbursement is of ten under 70 cents per dollar of care.

“Reimbursement tends to be better from Medicaid programs than the poo1 for almost all providers,” said Andrew Dreyfus, president of the Blue Cross Blue Shield of Massachusetts Foundation. Medicaid also covers more, he added, such as prescription drag costs.

More than 460,000 Massachusetts residents lack health insurance. Companies like HFI can help close the insurance gap by helping to navigate through a complicated, time-consuming application pmcess, Dreyfus said.

Alan Sager, a professor of health services at the Boston University School of Public Health, says companies like HFI only have limited effect, because they can’t help patients who don’t have health insurance and aren’t eligible for Medicaid or another public health program. He said such a company more likely helps hospitals respond to state auditors who want to make sure free-care money only goes to patients who have no other coverage option.

Vitti said he was simply intrigued about offering a service to help with Medicaid billing.

“My father was a social worker and he never made a lot of money,” he said. “He instilled in us to do something mission oriented,” he said. “This is".

(From the Boston Business Journal's January 2005 Issue)

Healthcare Financial, Inc. is a one of the top resources for information on healthcare changes in Massachusetts.

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