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Will Providers Lose Big in Move Towards Health Care Consumerism?

unhappy physicianThis year, the Affordable Care Act (ACA) ushered in the largest insurance coverage expansion since 1965, making historic changes that will affect how physicians provide care and the type of reimbursement available for these services. While many doctors initially embraced Health Care Reform, an increasing number of health care providers are now concerned about the ACA’s rollout — and how the influx of new, previously uninsured patients will affect overall coverage reimbursement.

Are providers going to lose big in the move towards health care consumerism?

How Will ACA Affect Providers?

Last November the medical firm Jackson & Coker surveyed more than 3,000 physicians about the Affordable Care Act, and a 61 percent majority of those surveyed said that their view of health care reform had changed for the worse.

Initially, many providers had embraced the ACA, envisioning that the reforms would lead to better health outcomes for previously uninsured patients. Even now, many providers continue to support the legislation, at least in partial measure — particularly those provisions that bar insurance companies from discriminating against patients with pre-existing conditions.

However, providers are concerned about who will end up footing the bill for this expanded coverage. Many enrollees in the new health insurance exchanges will be low-income people who will get subsidies to buy coverage and pay out-of-pocket charges. Some doctors are worried that they'll be left holding the bag for increased administrative costs associated with providing care for newly insured. And many practices are wary of accepting recently insured patients who have purchased their coverage through the exchanges.

It’s not all bad news, however.

Coverage through the exchanges and the Medicaid expansion could be a plus, to some extent, for family physicians — many of whom currently see an average of 8 patients a week on a discounted or free basis. The coverage provided by these plans, as minimal as it may be, will serve to alleviate at least some of that particular cost burden.

Patient Education Key to Supporting Providers

Millions of newly insured Americans are now looking for a primary care physician and specialists. While reimbursement concerns are understandable, it’s an opportunity to focus on a new patient education strategy that can improve market share and offset the cost of subsidized patients.

For example, newly insured patients are likely not familiar with the basics of insurance coverage, including insurance ID cards, paying deductibles and coverage limits. More importantly, these individuals may have put off preventative exams for years because they did not have adequate coverage. Consequently, doctor-patient communication becomes essential in educating the newly insured about their benefits and the importance of preventative care — a step that can help lessen the strain on limited emergency care resources.

Traditionally, many uninsured patients tended to wait until their health problems became serious until seeking treatment, all too often ending up in the ER receiving care that they would likely be unable to pay for — leaving providers to foot the bill.

But the exchanges offer can offer relief from this cycle, if your organization takes steps to educate the recently insured on the new care options available to them. Granted, this is easier said than done for many patients (see Jan 6, 2014 article “Healthcare Market Research Predicts Increased ER Visits with ACA”)

Ideally, an education campaign that “redirects” behavior and helps to move individuals away from the ER and towards early intervention with primary care providers will not only increase physician billables, but also reduce unnecessary health care expenditures. By letting patients know that there are viable, affordable coverage alternatives to the ER — such as nearby pediatrician practices or OB/GYN practices — providers are helping to redirect these behaviors.

Moreover, taking a consumer-centric approach, engaging patients in the manner they prefer and activating behavior change based on individual motivations will lead to higher satisfaction and better outcomes.

The Bottom Line

Health care providers don’t have to lose big in the move towards health care consumerism. While concerns over the rising cost of health care and the reduced opportunities for service reimbursement are not unfounded, a proactive health care marketing strategy can help improve market share and offset the cost of subsidized patients. Health care providers will also benefit when they target their marketing efforts at correcting expensive behaviors, such as relying on emergency rooms rather than primary care physicians.

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