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Health Care Reform:

Health Insurance & Affordable Care Act

The Overlooked Obamacare Sales Force: Hospitals

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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.

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.

Fri, Sep 13 2013

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