Everett Lebherz

Increasing health care enrollment under the ACA

February 02, 2015
By Everett Lebherz

The low-hanging fruit from the 2013 Affordable Care Act (ACA) enrollment is gone. More than seven to eight million people enrolled in an available health plan, but that means there are millions of people still to enroll.

And while enrollment in 2013 was far from easy, the difficulties are far from over. The nation’s hospitals and medical clinics must ensure that other populations, including non-English speakers and the economically disadvantaged, as well as young people who see no need for insurance, are targeted, educated and supported through the enrollment process.

That’s a tall order for providers, ranging from busy hospital emergency rooms to federally qualified health centers (FQHC) and community clinics. Yet there is still more to achieve. Policymakers and payers are adding further challenges to the process. Many state exchanges are ratcheting down on enrollment rules for providers and cutting back on reimbursement.

In addition, providers are being pushed to better connect “the front end” of enrollment with “the back end” whereby the intake follows through to a seamless post-enrollment tracking of important patient data such as:

  • Did the prospective enrollee complete the process?

  • Can he/she prove residency?

  • Is all the demographic data correct? (An especially troublesome issue for the past enrollment.)

  • Did the consumer make the initial insurance payment?

  • Finding answers
    Part of the solution lies in the technology marketplace that is rising to meet the increased demand for greater enrollment connectivity by offering new cloud-based portable eligibility software. The capability to streamline the enrollment process is crucial. In our experience, an application that asks five simple and quick questions, including information about patient demographics, employment and immigration status, and uses that data to quickly pull up available coverage options in a community, can meet the need.

    Adding further value to patients, payers and clinics, especially those medical facilities in states that don’t yet have local exchanges, it’s important that the software doesn’t just provide exchange information, but that it also provides a full listing of all available coverage options. For example, some patients may qualify for certain county programs, or be eligible for a hospital’s charity program— that is information not available on an exchange, but which is of critical importance to patients and providers.

    Important lessons from a facility that has had success in implementing an enrollment program, which are useful to other organizations seeking to maximize enrollment include:

    Exploring new screening and data capture technology. Busy clinic and hospital staff need access to simple, easy to learn and use technology that provides guidance and support tailored for their organization. Also, exploring technology that allows enrollment staff to enter patient data into one cloud-based system, rather than a spreadsheet, will reduce human error and enable instant data analysis and reporting (important for providers seeking grants) when it’s needed.

    Reaching out to the community. Because we are now targeting the harder to reach populations, it will be imperative that providers go where their prospective patients and enrollees may be. This may mean sending staff into the community to knock on doors, go to health fairs and visit locations where the homeless or uninsured may congregate. Utilize laptops and smart phones with access to your enrollment system to help with the enrollment process, ensuring you have “feet on the street.”

    Don’t limit your offerings to exchange information. As many providers are discovering, there are coverage options beyond those listed on an exchange that can help patients gain access to health services and providers secure much needed reimbursement. Ensure that your programs provide information on all available coverage options in your community. No doubt, the process is challenging. But with committed staff, knowledge from past experience, and technology, organizations will be better able to help patients and ensure their own success.

    About the author: Everett Lebherz is vice president of PointCare,LLC developer of the cloud-based health coverage screening software, PointCare-PA, and educational training sessions for hospitals, community clinics, providers, and third party vendors.