ACA a catalyst of change in health industry

Since the Affordable Care Act (ACA) was passed in 2010, more than 800,000 Ohioans have signed up for Medicaid or new private health insurance coverage under President Barack Obama’s signature health reform law.

As a result, hospitals and health insurers have attracted throngs of new paying customers, resulting in increased patient volumes and demand for care as well as lower costs for caring for the uninsured.

But while expanded health coverage has been a boon for many of the area’s largest hospital networks and insurers, it has also introduced major changes to the health care delivery system and and the way providers are reimbursed for their services.

We questioned local hospital officials and insurance executives on the front lines of health reform about the ways in which the ACA has been a catalyst for change in their industries.

Todd Anderson, senior vice president, market strategies for Dayton-based Kettering Health Network:

Q. The ACA has had a greater impact in Ohio than many other states because of Gov. John Kasich’s decision to expand Medicaid eligibility requirements under the law. Have you seen an increase in Medicaid revenue as a result and a corresponding decrease in the cost of care for the poor?

A. We have seen a slight decrease in the uninsured component of care, and an increase in the number of patients who are covered through Medicaid. But at the same time, we’ve also seen a slight decrease to the traditionally commercially insured component of care.

Q. What does that mean?

A. In our community, we see the continued pressure on employers to look at their health insurance costs, and those employers that we’ve seen are also making their patient portions more (passing on more of the cost of insurance to their employees). As we’ve looked at our market on the commercial insurance side, we’ve seen an increase in the amount of patient liability, such as higher deductibles, higher co-insurance amounts and co-pay amounts. And some employers are unable to cover their members with insurance like they have in the past.

Q. Does that mean you’ve seen an overall decrease in the demand for care and services?

A. No. Within the Kettering Health Network, we’ve seen our market share increase and our services increase, but the type of mix in terms of the patients we serve is where we’ve seen some shift.

Q. Some employers who have dropped insurance coverage have offered stipends and other incentives to help their employees sign up for coverage on Ohio’s health insurance marketplace, where their premiums and out-of-pocket costs are often subsidized. While you’ve seen a decrease in employer-sponsored coverage, have you seen more people with marketplace plans?

A. We are seeing more folks coming through the hospitals through these exchange plans, and it is something that we’ve been conscious of in partnering with the health plans around delivering access to care for folks enrolled in those products. (Note: Kettering recently announced it will become a preferred provider for Anthem Blue Cross and Blue Shield’s new Ohio HMO plans, which will be sold on the state’s health insurance marketplace next year). Some of these folks traditionally have not had coverage, so we think it’s important to provide that access to care, and we’ve taken the kind of a strategy in which we are partnering with a health plan to deliver those services to those members.

Steve Ringel, president of the Ohio market for Dayton-based nonprofit CareSource, the state’s largest Medicaid managed care provider and also one of 16 health insurers on Ohio’s health insurance marketplace, created by the ACA:

Q. Since you launched your CareSource Just4Me marketplace health plans in Ohio in 2013, you’ve expanded into several other states, including West Virginia, Kentucky and Indiana. How does your success in selling commercial health plans fit with your strong tradition of caring for under-served populations on Medicaid?

A. Our whole mission is to be in the marketplace to provide insurance to cover that gap when people go through life situations. Everybody goes through life situations, some people just happen to go through tougher life situations. For folks on Medicaid, they’re obviously the folks who have had a tougher time in life for the most part, and the expansion helped them tremendously. That has expanded coverage to hundreds of thousands of people who didin’t have coverage before. That’s preventing bankruptcies. That’s helping families stay together. That’s truly making a difference in the health outcomes of Ohioans. For those people who are in that middle ground and have the ability to buy a marketplace product, we feel it’s very important to provide those services and those types of products at a very low price point. (Note: Most CareSource Just4Me plans have monthly premiums of $100 or less for those who qualify for federal tax credit subsidies). This is not “skinnied” down coverage. This is a very good health insurance.

Q. CareSource has had the highest penetration of any of the 16 marketplace health insurers with more than 42,000 members. But thousands of eligible Ohioans remain uninsured, largely because of the cost. How are you addressing this dilemma?

A. It’s a real dynamic. People are going to say the $100 a month I’m spending on health insurance could be taking away from my rent, from my car payment, from food. But if they have to go for a hospital stay, and they don’t have insurance, it could easily force them to go bankrupt or worse. It’s not uncommon for anybody going into the hospital to ring up instantly a $10,000 or $15,000 tab. There’s no way most individuals can afford that. Insurance provides that safety net so you’re not spending nearly as much. You have to look at the lifetime cost of not having health insurance.

Premier Health, southwest Ohio’s largest hospital network:

Q. Have you seen an increase in Medicaid revenue, and decreased cost of care for the poor?

A. Our Medicaid volume has increased and we have experienced a lower volume of self-pay patients. Because Medicaid reimburses at a rate less than what it costs to deliver care, it is challenging for health systems to absorb the difference in payment. While some payment is better than no payment at all, challenges remain and put economic pressure on health systems and physician practices.

Q. We know the ACA has expanded health insurance coverage to thousands of local residents, but expansion of coverage does not necessarily mean an expansion of care. How has Premier handled the flood of newly insured patients, who are putting pressure on a delivery system that was already strained?

A. Our newly insured patients from the exchange, who utilize either our health plan or other plans we contract with, have not been experiencing issues of access. We continue to work with our physician companies, independent practitioners, the Boonshoft School of Medicine, and the recruitment of new physicians to Premier Health, to address the needs of the community.

Q. Premier is unique among hospital networks in the area in the respect that in addition to being a health services provider you also sell insurance coverage on the health insurance marketplace. Has your insurance product worked to provide more efficient, seamless care? And how important is it for your network to capture insurance premiums at the source, rather than depending solely on fee-for-service reimbursements from other insurers?

A. Through our provider network, Premier Health Group, our Premier Health Plan products offer a path to population health and work as tools to allow us to focus more on proactive patient care and wellness — all designed to provide better outcomes for individuals and the community as a whole.

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