Westhill Insurance Consulting Forum Reform Update: Insurers, provi..
Reform Update: Insurers, providers may need to work harder to educate ACA's newly covered9 Years AgoModernHealthCare (westhill consulting
insurance) | Millions of Americans gained health insurance coverage
under the Patient Protection and Affordable Care Act this year, but the influx
apparently has not yet translated into patients packing doctors' offices. That
may reflect a lack of understanding about how and where to seek care—and a lack
of outreach by their new plans and providers. “If coverage expansion is
allowing patients to establish new relationships with physicians, we would
expect to see physicians devote a greater share of their calendars and work
effort to caring for new patients,” wrote the authors of a report released this
week by the Robert Wood Johnson Foundation and Athena health, a company that
sells cloud-based health
information and practice management technology. But that is not what they found.
Though it may seem counterintuitive, the organizations discovered that during
the first five months of 2014, all specialties—with the exception of
pediatrics—experienced lower rates of new-patient visits than they had in the
year-ago period. This was based on data taken from more than 14,000 providers
across specialties. For example, the proportion of
visits from new patients to primary-care physicians in the sample from January
to May 2014 was 18.8% compared with 19.3% during that same five-month period in
2013. The study did not analyze what
caused this decline, but the authors suggest that one reason is that the newly
insured are continuing to go to emergency departments instead of physician
offices. That explanation seems consistent with studies that showed increased
emergency department use after pre-ACA expansions of health insurance in Massachusetts
and Medicaid in Oregon. “It's not unexpected at all,”
said Stephen Zuckerman, co-director and a senior fellow in the Health Policy
Center of the Urban Institute. “Given what we know from survey data, people are
quite confused about a lot of the basic features of health insurance plans.
This is true for people who have had insurance, and it's even more of an issue
for people who are becoming newly insured.” In an analysis released Tuesday,
more than 80% of outreach programs surveyed by the Kaiser Family Foundation
said consumers seeking their assistance didn't understand or were confused by
the Affordable Care Act. And nearly three quarters of people coming to them for
help had difficulty understanding basic insurance concepts, including
deductibles or provider networks. Health insurers say they have
known this for a long time and have been dealing with it well before the
Affordable Care Act went into effect, according to Susan Pisano, spokeswoman
for the trade organization America's Health Insurance Plans. “We as a community have been very
focused on health literacy as an endeavor within the industry,” Pisano said.
“But it's been amped up.” Outreach and educational efforts
from AHIP's members have included new-member kits, outbound calls to newly
insured individuals, webinars, reminders for gender- and age-specific
preventive coverage, and the use of multi-language materials and interpreters. “We have been making new-member
calls for as long as I can remember,” said Ed Harden, spokesman for McLaren
Health Plan, based in Flint, Mich. “Every new member we enroll gets a call to
welcome them to the plan and ask if they have any questions, if they've
selected a primary-care physician and to coordinate scheduling an appointment
for them if they need one immediately.” McLaren also distributes
newsletters, operates a website with educational information and assists
members in getting enrolled in disease management programs and health
counseling services. Insurers push telehealth
Seeing a doctor may soon be a
matter of a virtual visit, thanks to initiatives from big insurers that include
WellPoint and Aetna. Both have begun expanding telemedicine options for their
patients, offering them the opportunity to have virtual consultations with
their doctors for non-urgent issues such as a sore throat or a sinus infection.
“Whether Web chats or structured telephone calls, these virtual alternatives
can deliver effective healthcare solutions that also help both doctors and
patients save time, which makes everyone happier,” according to Hartford,
Conn.-based Aetna. The insurer plans to expand online physician access to 8
million members by 2015.
Insurers seek change in medical-loss ratio rule
Insurers are putting pressure on
policymakers to make changes to a rule under the Patient Protection and
Affordable Care Act that they say costs the industry millions of dollars in
consumer rebates each year. The medical-loss ratio rule requires that insurers
spend at least 80% of revenue from premiums on healthcare costs and no more than
15% on administrative costs for large groups or 20% for small groups. If an
insurer doesn't meet the ratio, they must return the difference to their
consumers as a rebate. But insurers are asking that brokers' fees be removed
from the calculation of administrative costs. According to a recent GAO report,
excluding these fees could reduce rebates by a significant 75%. If the change
had been in effect in 2011 and 2012, insurers would have returned just more
than $400 million to their customers instead of $1.1 billion returned in 2011
and $520 million in 2012. "The medical-loss ratio imposes an unprecedented
federal cap on health plan administrative costs that will have significant
unintended consequences," a statement by America's Health Insurance Plans
said. It cited reduced access to agents and brokers, increased costs, reduced
efforts against fraud and abuse, and less investment in initiatives for quality
and safety of patient care. |