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Health Insurance & Affordable Care Act

The Overlooked Obamacare Sales Force: Hospitals


Tenet Healthcare, another for-profit hospital chain that agreed in June to buy Vanguard, owns its own patient-enrollment and hospital-revenue consultancy, Conifer Health Solutions.  Working with Conifer, Tenet expects to have at least one insurance application counselor certified under ACA rules in each of its 49 hospitals, a company executive told stock analysts in early August.

Tenet declined to comment further. Vanguard did not respond to requests for interviews.

Mining patient records to get frequent customers covered is “clearly legal” for hospitals or their contractors under health privacy laws, said Mark Rothstein, director of the Institute for Bioethics, Health Policy and Law at the University of Louisville. “They are encouraging their patients who might well have financial problems to avail themselves of the health insurance exchanges so they can get access to government subsidized insurance.”

Health-law advocates welcome the effort. Given a short enrollment timetable, limited training dollars and active opposition from Republicans, they say, the more organizations involved in exchange signup, the better.

But with billions in revenue on the line, some worry hospitals could point consumers toward the insurance that’s best for the hospital, not necessarily the patient.

“It’s the tug between the concern that hospitals are going to steer people toward whichever plan might give them the best rates and getting all hands on deck to get people enrolled,” said Laurie Sobel, an attorney for Consumers Union. Among those promoting enrollment, she said, “it’s very hard for people to tell the difference between who has a conflict and who doesn’t.”

Insurance sold through health-law marketplaces cannot discriminate against those with preexisting illness and must cover certain procedures and have a minimum financial value. Nevertheless the plans are expected to vary widely in cost sharing for patients, reimbursement paid to hospitals and the size of caregiver networks.

With hospitals motivated to enroll the sickest and most expensive patients, insurers are eager to see healthier consumers sign up, too.   

“There is broad agreement that for the new marketplaces to work, there needs to be broad participation, particularly among young and healthy people,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, an industry group.

Some patient advocates are less than comfortable with hospitals hiring contractors to help exchange members enroll.

“This is a very big business. Some of them actually get paid for a percentage of the costs they recover on behalf of the hospital,” said David Roos, executive director of Covering Kids & Families of Indiana, a nonprofit that promotes enrollment in government programs. Sometimes for Indiana Medicaid signups, he said, “the for-profit vendors were more interested in their bottom line than in making sure everybody had equal access to enrollment services.”

Along with a few hospital systems and dozens of nonprofit groups, several for-profit hospital contractors won federal grants in August to enroll exchange members.

Fri, Sep 13 2013

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