Hand with magnifying glass and diagram

Obamacare’s final burst has yielded what the administration had been coveting for a long time – more than 7 million enrollments with a healthy share of young, healthy individuals who will balance the risks and keep the premiums in check. However, with nearly 8 million enrollments coming through the Obamacare exchanges, a new challenge is shaping up – how does the administration plan to meet the care requirements of the newly enrolled. The number of enrollments has increased drastically, and naturally, there are a couple of problems cropping up around it.

1) Lack of information in post-ACA world – According to a report by Institutes of Medicine, 77 million Americans are not “health literate,” a term coined by the Institutes to describe an individual who is equipped to purchase, use, and claim basic health information and services available to him. A part of this health literacy is associated with using the health plan that has an individual covered. With such a huge gap existing between people with insurance and people who know how to use their insurance, there is desperate need for knowledge sharing.

2) Lack of guidance for elders and ethnic groups – For elders, people with less education, and certain ethnic groups, it is tougher to navigate the challenges of post reform world. Guided approach is acutely needed for individuals falling in this gap.

3) Lack of Doctors and Hospitals in Network – Another problem with the new surge of enrollments is that the network of doctors and hospitals available in a patient’s health plan has drastically reduced. People are unable to find the perfect combination of a covered hospital with a covered doctor operating out of it. For people with low health literacy and other compounding problems, this is another added overhead.

An approach that takes care of all the three challenges will deliver healthcare to the newly insured. Fortunately, the administration already has some aspects working the picture at the moment.

1) For the first two problems, there is a simple solution that comprises a couple of facets – community events, knowledge-sharing kiosks, and community health workers. Community events can help people from specific ethnic groups to gain leverage over the multitude of information on which health plan to buy and how to use insurance when required. Knowledge-sharing kiosks might not be of much use to everyone, but they can certainly serve as a backdrop for people who want to learn more. Community health workers, the most useful aspect of this strategy, will have a pivotal role to play. Community health workers are backed by years of experience and community service. With extensive knowledge of co-pays, deductibles, and premiums, community health workers can help people purchase health insurance without bias. These workers are also able to connect the dots between having insurance and using it fully. Health workers help make people with preexisting conditions make the best choice for themselves, and thus affect a better coverage and care factor.

2) The problem of shortened networks is fairly new, and a couple of suggestions have been worked out to tackle this. For ensuring that there is no gap between healthcare and enrollments, administration will push for a model where doctors and hospital compensation is streamlined to ensure uniformity in reimbursements. Since the whole industry is readjusting insurance premiums and other associated factors, normalization across the industry is going to be the theme.

Both these solutions require careful planning, and that’s what is in the works at the moment. Since community health workers are going to play such a big role in reducing the gap between enrollments and healthcare, state or federal funding might be poured into the program. As for the doctor and hospital reimbursements, the equation is a little more complex, and would require more time for streamlining. Anyway, once these solutions come to pass, there would be drastic reduction in the gap that currently exists between enrollments and actual healthcare, which is the actual aim of Obamacare.

Comments are closed.