Oct. 29, 2014
By Laura Selby
With open enrollment for health insurance exchanges starting in mid-November, Matthew G. Heinz, MD, explained, it's a timely moment for physicians to help patients become more health literate. Dr. Heinz, director of provider outreach for the U.S. Department of Health and Human Services, is a practicing hospital physician as well as a former member of the Arizona House of Representatives. Patients who haven't been insured before, he stated, may be unfamiliar with insurance basics like how a deductible works, the need to bring insurance cards to an appointment, and how to determine which providers are within their network.
Physicians should also educate patients about primary care and the importance of regular checkups and follow-up appointments rather than going to the ER for any health issue that arises. Physicians can access videos, infographics and other health literacy resources to share with patients through the Centers for Medicare and Medicaid Services (CMS) Coverage to Care initiative.
This year marks the first "complete" open enrollment for the health insurance exchanges, meaning both new and existing enrollees will be purchasing or renewing their coverage. To ease the process, Dr. Heinz explained, the Healthcare.gov signup process has been streamlined for patients whose family situations are relatively uncomplicated. New functionality will also let patients check plans' provider networks and drug coinsurance information directly from the Plan Compare area.
By The Numbers
The Affordable Care Act has resulted in broad expansions of coverage, Dr. Heinz explained, citing these statistics:
7.3 million people are currently paying for coverage through the nation's health insurance exchanges
8.6 million people who are newly eligible for Medicaid thanks to state Medicaid expansions have enrolled in the program
3 million young adults have gained coverage
Over 5 million people who purchase insurance on their own through companies like Blue Cross Blue Shield have ACA-compliant plans
DOs Share Concerns
Several DOs addressed the group to share comments on health literacy and the consequences of the Affordable Care Act. These included:
Patients, particularly newly insured patients, don't always understand that there's a distinction between an annual wellness visit and a diagnostic exam. Especially in cases where the patient is unable to pay the copay for a follow-up visit, physicians may end up conducting a very long appointment but being unable to bill for more than a wellness visit. If this becomes a pattern, it can have a negative impact on the practice's bottom line.
Health literacy efforts that center around a website may not reach all patients, since not everyone has Internet access and extra time to spend perusing online resources. Grassroots outreach efforts that educate patients in their homes and communities should also be considered. Dr. Heinz suggested that installing a computer kiosk in your office waiting room could be another way to reach patients where they are.
Several DOs reported they have patients who receive poorer insurance coverage than they had before the Affordable Care Act went into effect. For example, some employers have stopped offering group health plans, leaving their employees to buy marketplace plans that don't always offer the same level of benefits. Dr. Heinz observed that cost-sharing reductions exist for patients with marketplace plans who qualify for assistance with copays and deductibles. He also noted that plans with very low premiums and copays may seem preferable to patients, but such plans can come with prohibitively high deductibles and limits on coverage.