Others are tired of talking, reading or hearing about it.
I apologize to those in the last group for yet another post on the ACA.
The Medical Group Management Association (MGMA) issued an early health exchange survey.
Its stated purpose was “…to better understand the impact of the Affordable Care Act’s (ACA) insurance exchange implementation issues.”
Thanks to a Group on LinkedIn, I became aware of the survey.
As I shared with the Group, in my humble opinion, it is way too early to be talking about utilization from individuals who enrolled through the insurance exchange (marketplace).
My reservation about this type of survey is determining if the responses are factual or anecdotal. I suspect the latter.
Health Exchange Survey
As the name implies, MGMA is an organization for professionals working in the management of medical group practices.
MGMA conducts periodic surveys on physician compensation, salaries, health care costs, revenue and other management services. In April 2014, the organization surveyed its members to evaluate the impact of health reform’s ACA.
More than 700 medical groups with more than 40,000 physicians responded. Let’s review some of the health exchange survey findings.
I’ll use the same three themes the MGMA report did.
- Obtaining coverage information
- Patient cost-sharing
- Network limitations
The infographic below illustrates key points.
Obtaining Coverage Information
As MGMA conducted the survey in April, it is not surprising medical groups had trouble obtaining coverage information.
Think back (as painful as it may be) to the first quarter of the year. The political pundits had a field day with the ongoing technical issues at Healthcare.gov.
- 36 states used the Healthcare.gov site for enrollment
- The enrollment deadline was March 31, 2014
- Due to technical problems, certain individuals received an extension
Too early to know if the infamous enrollment glitches are resolved.
Three-quarters of the responding MGMA members reported that health exchange patients were “very” or “extremely likely” to have a high-deductible plan.
The report quoted some respondents who indicated patients were confused about benefits and their portion of the cost. High deductibles and confusion are not exclusive to health exchange patients.
- Large companies − From an annual survey, 66 percent of companies with at least 1,000 employees offer high-deductible health plans. For 15 percent, those plans are the only option.
- Small companies − The 2013 Employer Health Benefits survey reports 22 percent of companies with fewer than 200 employees offer high-deductible health plans
- Familiarity with plan − 43 percent enrolled in a consumer-directed health plan stated they were “somewhat familiar” or “not too” or “not at all familiar” with the plan.
I wonder how many of the responding medical groups truly differentiated between patients from the health exchange and those with employer-sponsored benefits.
This category is one where I have more faith in the results.
- 20 percent of respondents were excluded from a narrow network they wanted to be a part of
- 10 percent chose not to participate in a narrow network
I’ve talked about narrow networks before. In some parts of the country that percentage may be much higher.
Insurers formed smaller (narrow) networks to coordinate care and lower costs. Narrow networks is the elephant in the room when it comes to health exchange plans.
Some individuals are in for a shock when they access health care from their family doctor or specialist. They may find their physician is not part of their health plan’s narrow network.
- Physicians who are not part of the narrow network are considered out-of-network
- Typically, that means much higher out-of-pocket costs to the patient
Previously, I offered my personal example. At the time of enrollment, half of the plans offered by Blue Cross of Idaho did not include my primary care physician.
We have two major health care systems here. Blue Cross (the largest local insurer) aligned with the one my doctor is not affiliated with.
Typically, my only visits are annual health screenings. If I did not understand narrow networks, I easily could have signed up for a plan in which my doctor is considered out-of-network.
Health Exchange Education
The impact of health reform is ongoing. It will take years before we have a better handle on the fallout − good or bad.
If you are someone who uses the federal or your state’s health insurance exchange (marketplace), education is critical. You do your homework before purchasing a car or other high-cost item. You need the same due diligence for health care.
Admittedly I am biased; however, I strongly recommend you partner with a knowledgeable health insurance agent or broker. And beware of early surveys about the impact of health reform.
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Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues.