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Registro crescente do cuidado de saúde sob o ACA

February 02, 2015
Everett Lebherz
From the January/February issue of HealthCare Business News magazine
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.

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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.

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