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Access to Health Insurance is NOT Access to Health Care

access healthcareExpectations have been high after millions of Americans successfully signed up for health insurance on federal and state exchanges. But there are still a few troubles to be routed out before the system can be called an undeniable success.

In California, high enrollment numbers are coupled with a shortage of primary care physicians, leading Dr. Kevin Grumbach at University of California-San Francisco to describe the situation as “medical homelessness.”  Elsewhere in the country, a combination of miscommunication and inexperience has left many of the newly insured patients feeling like second-class citizens, unable to find the care they expected. 

Patient Experiences Vary Across the Country

While California is experiencing a serious shortage of primary care physicians, not all regions of the U.S. are equally challenged. A recent Commonwealth Fund survey had some positive results to report. The poll of newly enrolled adults revealed:

  • 60 percent had already used their new coverage to go to a doctor, hospital or fill a prescription
  • 54 percent found all or some of the doctors they wanted on their plans

Among the 20 percent of newly enrolled adults who needed to find a new primary care doctor, the results varied more widely:

  • 41 percent got an appointment within a week
  • 37 percent got an appointment in less than a month
  • 15 percent waited longer than one month to get an appointment

The Commonwealth Fund survey did identify a trend that has led to some of the patient frustrations. 

Of the 41 percent of new enrollees who were given a choice between a traditional network and higher premiums or narrow network and lower premiums, many opted for the more inexpensive plans, not realizing that the lower cost correlated to narrower provider networks and higher co-pays. 

Finding Specialists Is a Challenge in Narrow Networks

One Houston physician shared her recent experiences in a July Kaiser Health News story. 

Dr. Charu Sawhney, an internist at the Hope Clinic in southwest Houston, admits, “I was so consumed with just getting people to sign up. I didn’t take the next step to say ‘Oh by the way, when you sign up, make sure you sign up for the right plan.’” Now Dr. Sawhney is finding that the low-premium plans that many of her previously uninsured patients have selected have such restrictive provider networks that she is struggling to find specialists and hospitals for referrals. 

In one case, Dr. Sawhney was able to find an oncologist for a newly-diagnosed stomach cancer patient, only to have the oncologist, Dr. Paul Zhang, run into similar problems scheduling radiation treatments and finding a surgeon with the right specialization as local hospitals are not in the patient’s plan network — though, in an ironic twist, the local hospital would have taken on the patient if he had been still uninsured. 

The narrow networks lead to other problems for physicians — higher administrative costs. Dr. Elizabeth Torres, president of the Harris County Medical Society, tells KHN that inaccurate or out-of-date provider directories are a problem, saying, “There’s no guarantee because you see their name on the website that they’re actually participating, and that’s an issue.”

The discrepancies mean care providers must call to verify information. If physicians find that making referrals takes too much time, they may opt out of already narrow networks. 

Overcoming Obstacles to Improving Patient Outcomes

Primary care physicians, hospitals and insurers all have a stake in overcoming these obstacles. One key to ensuring that consumers pick the right plan is education.

One consumer advocate notes that previously uninsured consumers “might not actually understand when they’re signing up for an HMO that it’s a very narrow network.” While it might be less of a problem for the healthy, young adults who are a primary target of the insurance exchanges, network must be a top concern for enrollees with chronic health problems. 

So how can hospitals and insurers get the right messages out to the right people — before the next enrollment period begins? Consumer segmentation can provide much needed insights to help health care organizations to communicate more effectively and ensure that next year’s insurance exchange enrollees choose plans that lead to improving patient outcomes rather than increasing patient frustrations. 

To find out how c2b solutions can guide your patient communications, contact us today.

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change

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