Texas doctors, uninsured patients, and the ACA: What’s next?

Tags: affordable care act, health care reform, health insurance, health insurance marketplace, marketplace

Texas doctors, uninsured patients, and the ACA: What’s next?

By Ankeny Minoux

Wonder just what the Affordable Care Act will mean in practical terms for your office and your patients? Join the club; thousands of Texas physicians are beginning to realize that within the next few months, it will no longer be practice as usual.

While there is much to consider in the coming months, one growing area of realization is that physician offices will be one of the first places patients turn to for information and advice. Eventually, patients will be directed on how to access additional state, federal, and private resources, but in reality, it’s you—the trusted physician—who is going to get a lot of questions. Patients will ask: What do you think about all of this? What does the ACA mean for my family? Will my health care be free? What options do I qualify to receive? What am I supposed to do?

Becoming an insurance resource is a tall order for physician practices that are already burdened with new regulations and concerns over how to care for an ever-increasing patient base and the ongoing challenges of EMR integration. Just how exactly are MDs supposed to add insurance advisor to their list of responsibilities?

While Texas is not creating its own health insurance marketplace, the state is actively seeking ways to reach out to patients and ensure those that need health care can access it. One program is even becoming a model for others nationwide. In March, Blue Cross Blue Shield of Texas launched Be Covered Texas, a grassroots campaign designed to work with community-based organizations, such as schools, religious institutions, and doctors to introduce uninsured Texans to the new health insurance options available under the ACA.

While valuable, efforts like this will take time to roll out. Some industry analysts are predicting that because initial penalties for non-enrollment are so low during the first year, it may be another three to five years before most patients are screened, enrolled, and have coverage in place. This means you and your staff will continue to be viewed as a resource by patients while you continue to struggle with securing payments.

The good news is that solutions and strategies are entering the marketplace for you and your patients that can provide assistance today – not in October when open enrollment begins and not on Jan. 1, 2014 when ACA will formally launch.

Look beyond Medicaid

Solutions begin with knowing about coverage options and getting that information to patients–this includes options that go well beyond Medicaid and private coverage. In Texas, public programs, such as the Texas Health Insurance Pool that provides access to health insurance for HIPAA-eligible patients who have pre-existing conditions, CHIP, Indian Health Services, and the Breast and Cervical Cancer Services Program, are often overlooked when screening patients for coverage.

The challenge is that hospital and office staff may not be aware of these other programs without having the appropriate resources and training. Fortunately, there are organizations that are using experience and technology to resolve this issue—creating manageable screening software and trainings that do not take time away from other staff duties and provide information about all coverage options.

Develop an outreach and enrollment strategy

To help their busy practice prepare for the ACA, a California-based community clinic, ChapCare, began using a cloud-based, health coverage screening tool that enabled staff to screen patients in minutes and more easily assist with enrollment. The developers of the tool also educated all staff members on available coverage options in their community and explained what to expect with ACA implementation. Clinic workers take the tool into the community using tablets and laptops to screen and begin enrolling people on the street, at health fairs, and at other community events.

The clinic’s strategy is simple: the more patients that can be screened and enrolled before presenting into the clinic, the more time staff can spend focusing on the patient’s immediate health care needs. The clinic is successfully screening patients; enrolling about 100 to 200 people each month. Plus their staff now is confident that they are well prepared to handle the ACA provisions and coverage options as they come into play.

Realize that enrollment is a three-step process

Unfortunately, there is no magic button that will simplify the enrollment process under ACA, but breaking down the different parts of the process can assist with developing strategies to help your office and your patients:

  • Screening: Patients are going to have questions and need assistance with identifying their coverage options, and they will look to you for answers. Develop a consistent screening procedure—utilizing available technology and resources—to help your staff identify coverage options.
  • Verifications and applications: Train your staff to be knowledgeable about health insurance—giving them the ability to confidently help patients gather eligibility verifications (i.e. proof of residency, income, citizenship) and to complete applications. Consider working with local licensed brokers in your area for additional help.
  • Enrollment: Following the first two steps should lead to successful enrollment—however, snags happen. It’s important to have a process in place for follow-up to ensure patients are getting covered and claims are being compensated by the liable third-party payer.

What you can do now

Texas physicians have a great opportunity to lead and develop working strategies and solutions, as the ACA marketplace in the state is still being hammered out. Start preparing now by reviewing successful enrollment strategies, such as ChapCare’s, asking important questions about your current setup, and taking the appropriate steps to put an enrollment process in place.

Talk to your staff about the issue of uninsured and private pay patients. What impact do they have on your practice? Are you already getting questions from patients? Are they turning to you for information and advice?

What is your local community, including hospitals, health plans, and businesses, doing to get the word out? Look for ways to participate in and support community-based enrollment events, such as health fairs, booths at local events, coordination with local employers, etc.

Implement technologies and available programs that will give your staff the ability to screen patients for coverage quickly. The screening tool and educational trainings used by ChapCare were both provided by software developer, PointCare. The tool’s database contains every U.S. private and public option and will have ACA health insurance marketplace options available as more information comes out.

Train staff and develop a consistent process to assist patients with gathering verifications, completing applications, and following up on enrollment.

Be a pioneer

Whether you are a large facility in an urban area, a small group of physicians in the suburbs, or are part of a rural-based community clinic, your patients will depend on you and your staff as ACA implementation moves forward. It’s up to you how prepared your facility will be.

You don’t need to wait for others to step in and help patients. Start today by asking yourself the questions above and reaching out to appropriate resources and technology providers. If you haven’t already, begin the conversation about your outreach and enrollment efforts with hospitals and other health care leaders in your community. If you work together to create coordinated and focused efforts, private pay and uninsured patients in your community will not only receive quality health care services, but will also receive information and coverage that will benefit their health and financial future.


Ankeny Minoux is COO of PointCare, developer of the cloud-based health coverage screening software, PointCarePA, and educational trainings for hospitals, community clinics, providers, and third-party vendors. More information is at www.pointcare.com or call for a free demo at (650) 762-1928.