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Health Insurance & Affordable Care Act

The Overlooked Obamacare Sales Force: Hospitals

WebMD News from Kaiser Health News

By Jay Hancock

Fri, Sep 13 2013

As community groups, brokers and insurers prepare to recruit members for medical plans that go on sale in October under the health law, nobody has a bigger financial stake in their success than hospitals.

And few may work harder to sign consumers up for the Obamacare insurance marketplaces than hospitals themselves.

“This is a major project for the next year,” said Craig Cooper, spokesman for Genesis Health System of Iowa, which hopes to enroll thousands of patients and substantially cut its $60 million annual bill for people who can’t afford to pay for care. “It’s important to [the CEO] and it’s important to our organization.”

Hospitals are setting up phone hotlines and planning visits to churches, child-care centers and soup kitchens to sign people up for coverage.  Like Genesis, some hospital systems received federal grants to train enrollment “navigators.”

Others are paying contractors to enroll consumers and identifying patients with high unpaid bills to make sure they’re covered for future care.

“Virtually everybody is asking for brochures and card tents that they can use in their various delivery sites — not just the hospital,” said Ellen Pryga, director of policy at the American Hospital Association. “Some of them are going to do a lot of community outreach. They’ll go to local community meetings. Some of them are likely to help out at health fairs.”

The Affordable Care Act creates online marketplaces known as exchanges where those lacking medical coverage can buy subsidized insurance.  Helping consumers buy health plans on the exchanges will differ substantially from the Medicaid enrollment hospitals and their contractors are used to.

Medicaid, the government program for the poor and disabled, allows enrollment and reimbursement for care even after it has been delivered. This will be true for people newly eligible for Medicaid, too, in the states that expand the program under the health law. But private plans sold through the exchanges won’t pay hospital bills unless patients are members upon admission.

“Hospitals are now starting to focus on outreach programs to individuals who are [frequently admitted] and try to get them signed up for insurance, so when they do present to the hospital, they are covered,” said Jeff Silverman, a vice president at  Emdeon Inc., whose business includes helping hundreds of hospitals and academic medical centers manage revenue.

Vanguard Health Systems, a for-profit hospital chain based in Nashville, hired Emdeon’s Chamberlin Edmonds division to help enroll probable Vanguard patients in the exchanges.

“We have data in our own systems to know who has come into our emergency rooms and what zip codes they live in that might be exchange eligible,” Keith Pitts, Vanguard’s vice chairman, told financial analysts in June.

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