At the Margins

Don't count on your 24 million new customers just yet


David Lumbert

Since releasing our white paper on navigating health insurance exchanges, we've received dozens of follow-up questions and requests for further guidance—particularly this one:

    I know the federal government is spending millions of dollars to raise awareness about health insurance exchanges and fund navigators to help patients enroll in health plans. Do providers have a role in this effort?

The short answer: absolutely.



Low health insurance exchange awareness, for now

According to a recent poll sponsored by the Kaiser Family Foundation, 77% of respondents reported hearing "nothing at all" or "very little" about their state’s health insurance exchange.

From now until March 31, when open enrollment closes, patients will likely start getting more information from a variety of sources, including health plans, CMS- and state-sponsored multimedia campaigns, navigators, and media reports.

But is this who they want to hear from?



Providers: A trusted and needed information source

Providers have unique access to the uninsured patients currently using health care services, and we know from experience with Medicaid and CHIP that patients prefer to receive information from a doctor's office rather than from television advertisements or even schools. While the 9,000-employee call center will provide exchange guidance in over 100 languages, many patients may be reluctant to discuss personal information via telephone without a physician's approval.

Credibility and access aside, providers are also quickly becoming patients' primary go-to for information before open enrollment starts.

"There are so many moral and pragmatic reasons why hospitals should be engaged in outreach and [health insurance exchange] education… it’s a lot like political organizing." —Tina Weatherwax Grant, Director of State Advocacy, Trinity Health

Although CMS allotted $54 million to fund navigators in the 34 states with federally-facilitated exchanges, this investment may not be adequate to reach the uninsured residents of every community. To put this in perspective, California’s state-based exchange will spend over $50 million on navigators—just for 2014. 

recent GAO report also noted that the navigator program is behind schedule due to a two-month funding delay, meaning millions of exchange-eligible Americans may have one less credible resource to count on.

  • Uninsured mapWhich states will have the most uninsured residents in 2016?

    Using our Medicaid Map, recent Harvard projections, and 2012 Census data, we've estimated each state's rate of uninsured residents following the ACA's coverage expansion. Learn more.


Incorporating exchange information into current practices

Luckily, raising awareness and facilitating enrollment in exchanges is not as daunting as it seems. Chances are many of you are already actively enrolling patients in Medicaid, advertising services in the community, and developing affordable care plans for self-pay patients.

Rather than developing a new campaign, providers can incorporate health insurance exchange information into existing programs and tweak current practices to reach uninsured patients.

Take our recent profile on Trinity Health in Livonia, Mich. Trinity is tailoring its health insurance awareness and enrollment programs to reach newly eligible Medicaid and exchange patients.

While your strategy may depend on the demographics of your community, available resources, and state regulations governing enrollment procedures, providers certainly can—and should—play a role in raising awareness of exchanges and encouraging enrollment.

We're Here to Help You Through the Transition

Read our white paper and watch our on-demand webconference to get a full overview on the current status of the exchange rollout, how the exchanges, Medicaid, and employer-sponsored insurance interact, and implications for health system margins and operations.


On September 24-25, we're hosting a CFO Forum in Washington, D.C. This biannual event is an executive working retreat that features content designed exclusively for chief financial officers. Sessions will include:

  • Industry and government experts on preparing for state exchanges
  • Clinical executives sharing perspectives on improving physician engagement in documentation initiatives
  • Patient engagement practices to succeed under value-based systems

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