Ryan Brebner: Connecting Uninsured Patients with Affordable Coverage

What he did

With his sister, Laura Robbins, Ryan Brebner founded Advocatia, a company that uses data technology to sift through available aid programs to match uninsured and under-insured patients with the programs that can reduce their healthcare costs.

Their story

Advocatia’s story starts with a tragedy.

“My co-founder Ryan Brebner … was helping a family enroll their mother, Avila, into Medicaid,” COO Laura Robbins told Matter. Avila worried about the cost of insurance, so she lived without regular medical care – and without the knowledge that she was eligible for Medicaid. Instead of seeing a doctor, she tolerated stomach pain for months. “By the time she arrived in the emergency room, she had stage four stomach cancer, and unfortunately passed away within a few short days.”

Brebner, who has worked in healthcare for 18 years, told Avila’s story to Robbins, an operations professional at a start-up. “There had to be a better way to help patients understand what programs they’re eligible for,” said Robbins. They founded Advocatia in 2016 to do just that.

Advocatia uses data technology to sift through available aid programs to match uninsured and under-insured patients with the programs that can best reduce their healthcare costs. In doing so, it helps hospitals recover costs for care that would otherwise go unpaid.

“Initially, we had actually thought about doing a not-for-profit,” says Brebner. “The reality of the situation is to get technology to scale, it made more sense for it to be a business.”

The company sells hospitals and other healthcare stakeholders access to the software that matches patients with aid programs. A patient answers seven to ten quick questions through an internet browser, email, or SMS. How much money do you make per year? How many people live in your household? Are you pregnant? Financial counselors can help patients with this process during or after their hospital stay.

“On the backend, our tool is auto-filling multiple applications that [counselors or other patient advocates are] able to complete for the individual and then submit straight from our platform,” Robbins explained in a presentation at the 2020 Change Healthcare pitch competition. By the end of the process, that patient could be insured through Medicaid or getting help with food through the Supplemental Nutrition Assistance Program (SNAP). Advocatia’s basic package covers these well-known, national programs; its most comprehensive offering covers local charities, as well.

When Advocatia registers an uninsured patient for Medicaid, it’s a win-win for both the patient and the provider. Uninsured patients, faced with high medical bills, now get financial support to cover their costs. And by matching patients to aid programs, hospitals ensure that they will be reimbursed for providing the necessary care. Hospitals normally rely on financial counselors to connect patients to aid; Advocatia helps them do their job more efficiently and effectively.

In 2019, 29 million Americans were uninsured. Of those Americans, nearly 16 million — 57% — were eligible for free or subsidized coverage. Many had no idea. A 2020 study found that 41% of Americans were not aware the Affordable Care Act provides financial aid for lower- and middle-income Americans to purchase insurance.

Lack of insurance can have life and death consequences. An uninsured patient is more likely to delay care than an insured patient, risking tragic outcomes like Avila’s.

Uninsured patients can also cost more to treat. Hospitals provided $41 billion in uncompensated care in 2019; much of that went to patients who were eligible for financial assistance.

Advocatia estimates that hospitals that use its service help 30% more patients find coverage per year.

But the platform connects patients to more than insurance. Advocatia’s most comprehensive package checks patients’ eligibility for up to 40 programs. In addition to insurance, that includes SNAP, the Low Income Home Energy Assistance Program (LIHEAP), and local charities.

“[Insurers] want to see … their members in different programs like SNAP and LIHEAP, because it … generates a cost savings for them,” Brebner explains. “It’s important for [insurers] to get their members healthier, and getting people access to food and things of that nature is immensely important.”

Based in Chicago and Tennessee, Advocatia now works with over 200 providers in 21 states. By early last year, they had helped over 150,000 patients; today, that number is much higher. “We’re assisting tens of thousands of people every month,” Brebner says.

What’s next? In addition to expanding to more states, Brebner is “looking at where we can partner with organizations that are touching any aspect of the uninsured population.” The pitch to hospitals is relatively simple: get patients covered and save money on uncompensated care. But insurers also profit from healthier, more food-secure members; social determinants of health start-ups could use a ready-made eligibility assessment tool.

That path forward was made possible in part by the pandemic. “Healthcare has been historically very competitive, even between not-for-profits,” says Brebner. “But I think COVID made a lot of that go away. We’re in much more of a spirit of collaboration — getting things done, moving forward.”

Another silver lining of the pandemic? “Everybody is much more aware now that, you know, job security isn’t what you thought it was. And health is something that everybody, myself included, can’t take for granted,” says Brebner. “A lot of people’s view of how important it is to assist people who are less fortunate has changed dramatically.”

Sources

Ryan Brebner, interview with Ciara McLaren, Apr 20, 2021

“A better future for the uninsured”, Matter, May 30, 2019, https://www.youtube.com/watch?v=t8WIWH9z2dY, accessed Apr 20, 2021

Kourtney Cunningham, “ISU alumna determined to provide affordable healthcare to the uninsured”, Vidette Online, Sep 11, 2019, http://www.videtteonline.com/features/isu-alumna-determined-to-provide-affordable-healthcare-to-the-uninsured/article_2ac1738c-d4d1-11e9-b557-eb40ef69a82d.html, accessed Apr 23, 2021

Cynthia Cox and Daniel McDermott, “Millions of uninsured Americans are eligible for free ACA health insurance”, Nov 24, 2020, KFF, https://www.kff.org/policy-watch/millions-of-uninsured-americans-are-eligible-for-free-aca-health-insurance, accessed Apr 23, 2021

Mollyann Brodie, Elizabeth C. Hamel, Ashley Kirzinger, and Drew E. Altman, “The past, present, and future of public opinion on the ACA”, Health Affairs, Feb 19, 2020, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2019.01420?journalCode=hlthaff, accessed Apr 23, 2021

Rachel Garfield, Kendal Orgera, and Anthony Damico, “The uninsured and the ACA: A primer”, KFF, Jan 25, 2019, https://www.kff.org/report-section/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act-how-does-lack-of-insurance-affect-access-to-care/, accessed Apr 23, 2021

Heather Landi, “How a new wave of technology startups is tackling social determinants of health challenges”, Fierce Healthcare, Feb 10, 2020, https://www.fiercehealthcare.com/tech/new-wave-technology-startups-tackling-social-determinants-health-challenges, accessed Apr 23, 2021