Overview

PFA helps hospitals enroll eligible Medicaid patients into Health Insurance Premium Payment programs to gain access to employer-sponsored or COBRA commercial insurance, with Medicaid as a secondary payer. It uses a national web-based platform with algorithms to identify eligible patients and Patient Advocate Specialists to guide enrollment and provide ongoing support. They differentiate themselves by partnering with hospitals nationwide (including academic medical centers and children's hospitals) and delivering incremental revenue to partners by converting Medicaid patients to higher-reimbursement commercial plans, backed by private equity. Their goal is to expand access to broader insurance networks and care management for patients while improving hospital payer mix and health equity.