Patients come with ACA questions: They view you as 'the experts'
Patient access is moving outside hospital walls
Executive Summary
Patient access is fielding many patient inquiries regarding how to obtain health insurance under the Affordable Care Act (ACA). The patient access role is expanding to include assisting patients in obtaining coverage within the hospital and also outside in the surrounding community. Departments are doing the following:
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becoming health navigators and helping people in the community enroll;
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becoming certified application counselors and helping people enroll at the point of registration;
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implementing a pre-registration process to help self-pay patients become enrolled pre-service.
At Genesis Health System in Davenport, IA, patient access employees have long assisted patients in obtaining coverage once they present for services. Now some also do so in the surrounding community.
"It is not uncommon now that our financial counselors or health navigators provide assistance in completing an insurance application for a potential insured, or get a member started on having coverage for whatever care needs they may have," says Pam Scott, revenue cycle administrator.
Three health insurance navigators, who are trained and licensed in Iowa and Illinois, have been very active helping people in the region enroll. Michele Cullen, who manages the health insurance navigators at Genesis, says, "This defined and specialized group has done dozens of events to help people sign up."
The navigators have been active in a five-county region targeted in a federal grant. "We have been part of a community coalition called Enroll Quad-City," says Cullen. "We meet monthly to discuss outreach events and help one another with areas of concern."
In 2013, the navigators reached 1,088 consumers with events, handouts, emails, phone calls, and one-on-one appointments. More than 150 people were enrolled through the marketplace and Medicaid expansion that year. Other patient access employees have become certified application counselors and assist with completing applications at the time of registration. "This allows us to assist in getting the patient insured, both for this visit and for future healthcare needs," says Scott.
Educating patients on new coverage options available under the Affordable Care Act is "critical," notes Jeff Goldman, vice president of payment policy for the American Hospital Association.
"Many hospitals are becoming certified application counselors," Goldman says. "Others are providing space to federally funded navigators."
Access is on front lines
Patient access employees are "on the front lines" of educating individuals and helping them gain access to coverage, says Christopher Ricaurte, senior vice president of revenue cycle operations at Accretive Health, a Chicago-based company that helps hospitals manage revenue.
"One great example of commitment to community outreach includes one of our hospital clients in the Midwest, which established nine 'assistance stations' in their main facility and in facilities in surrounding counties," says Ricaurte.
The self-service kiosks enable users to access certified application counselors who have undergone federal training to help people apply and enroll for healthcare coverage through their state exchange. The hospital completed a physical redesign of the facilities to accommodate these kiosks and the influx of users.
"They are not required to be current patients but may need assistance in navigating complex benefits options or the exchange's application process," says Ricaurte.
Patients turning to access
"How do I enroll?" and "How will I know if I qualify for coverage and/or tax subsidies?" These are the two most common questions patients are asking access employees at Rex Healthcare and UNC Healthcare in Raleigh, NC.
"Our health system has made a concerted effort to enlist the help of staff from patient access, patient financial services, and volunteer services," reports Joe Palumbo, director of patient access.
Patient access worked with the hospital's marketing department to create informational material to distribute to patients at registration areas.
"Our marketing director knew how much the ACA would impact the front-line staff," says Palumbo. A website was created to provide patients with information. (To acces this website, go to http://getcoveredunchealth.org.)
Due to the complexity of the enrollment process, patient access employees should expect to receive an increased volume of patient inquiries regarding how to obtain health insurance, says Ricaurte.
Not surprisingly, patients are asking patient access employees for answers to complex questions on coverage options under the ACA. Michael Hester, vice president of revenue cycle at Nationwide Children's Hospital, Columbus, OH, says, "They do look at us as the experts. We are, unfortunately, very limited in what information we can provide."
At times, patients ask Hester directly which plan he would choose. "Obviously I have payers I prefer, both operationally and in my personal life, but I can't tell them," he says. The hospital staff could "get in trouble" if they make negative comments about a payer, Hester says. He also doesn't want to be perceived as trying to influence the patient because of a financial benefit to the facility. For this reason, patient access doesn't go beyond providing the federal websites to patients.
Ricuarte recommends that patient access leaders take these steps:
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Train all patient access employees on the basics of how a patient can enroll in the marketplaces or exchanges.
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Create a brochure and update websites to communicate how and where patients can receive assistance.
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For scheduled services, implement a process in scheduling and pre-registration in which self-pay patients are immediately connected with a navigator or certified application counselor to become enrolled pre-service.
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Institute robust patient outreach to assist uninsured and underinsured patients with identifying a funding source that can assist with their medical care.
Many options to help
At Rex Healthcare and UNC Medical Center, some patient access employees have volunteered as certified application counselors, and others are navigators. Both groups are helping people in the community to enroll.
Enrollment is a new expansion of the role of patient access and patient financial services staff, eports Palumbo.
"There is no doubt that the skills that our co-workers are getting will help them both personally and professionally," he says. "It will also gain some notoriety for the patient access industry overall."
Patient access staff can apply this knowledge toward the department's career path program. "This new training should boost the outlook on what is involved as a patient access employee, when it comes to future recruitment," says Palumbo. (See related stories on other ways that patient access is helping patients obtain coverage, this page, and how the ACA is expected to affect bad debt, p. 28.)
SOURCES
- Tricia Brooks, Research Associate Professor and Senior Fellow, Georgetown University Center for Children and Families, Washington, DC. Phone: (202) 365-9148. Email: [email protected].
- Michael Hester, Vice President, Revenue Cycle, Nationwide Children's Hospital, Columbus, OH. Phone: (614) 722-2085. Email: [email protected].
- Joe Palumbo, Director, Patient Access, Rex Healthcare/UNC Healthcare, Raleigh, NC. Phone: (919) 784-3096. Fax: (919) 784-6248. Email: [email protected].
