With health insurance exchange opening for enrollment tomorrow, hospitals and health systems should devote sufficient time and energy to this latest healthcare reform change, the Philadelphia Business Journal reported. However, many hospitals are not ready for reform to kick in and have yet to create strategies to identify, educate and help people enroll in coverage through the new online marketplaces, according to a September report from PwC's Health Research Institute.
PwC attributes hospitals' lack of preparedness to healthcare reform "fatigue" as they have busy advocating for Medicaid expansion while fighting national and state budget cuts, FierceHealthFinance previously reported.
Hospitals must start thinking differently in the new insurance marketplace, according to PwC, and take several steps including:
1. Run the numbers. Hospitals should review their charity-care levels and compare them to the potential new revenue from patients gaining some level of coverage. To calculate potential payments versus unpaid care, include reduced Medicare and Medicaid disproportion share hospital (DSH) payments and federal payment rates, as well as federal quality reporting program dollars, PwC noted.
2. Use frontline staff as counselors. Train financial counselors and hospital volunteers on exchange information. Hospitals also are hiring contractors to enroll consumers or receiving federal grants to train enrollment "navigators." Moreover, outreach groups such as Enroll American are turning to physicians to help spread accurate healthcare reform information. And physician organizations, including the American College of Physicians and American Academy of Family Physicians, offer resources to help doctors inform patients about new coverage options.
3. Team up to reach new customers. To spread the word about healthcare reform to the public, PwC recommends healthcare leaders join forces with advocacy groups and the business community. For on-the-spot-enrollment, hospitals can reach the public at health fairs, community events, football games, laundromats and pharmacies. Some hospitals also are conducting community outreach at churches, child-care centers and soup kitchens, as FierceHealthPayer previously reported.
4. Target outreach. Local, tailored outreach efforts have a better chance of success, according to PwC. The report points to Ascension Health, a St. Louis-based system with more than 113 hospitals, which plans to send an informational flyer to patients who previously qualified for charity care. Targeted ad buys, such as radio, television, Internet and newspaper ads also can reach a large share of patients who will qualify for Medicaid and exchange subsidies under healthcare reform.
To learn more:
- read the Philadelphia Business Journal article
- check out the PwC report