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.
One, DECO Recovery Management, got a $1.2 million navigator award to recruit South Carolinians into the exchanges. Concerned that its hospital business could conflict with the navigator job, DECO decided not to seek South Carolina hospitals as exchange-enrollment clients, said vice president Andy Foland.
“Putting us in a situation where we’re also getting paid by the hospital for that creates a huge mess,” he said. DECO plans to recruit exchange members for hospitals in states where it didn’t get federal navigator dollars.
Other potential concerns are enrolling patients who aren’t eligible for coverage or the kind of aggressive approach allegedly taken by Accretive Health, another hospital contractor.
Last year Accretive paid a $2.5 million settlement and agreed to cease business in Minnesota after Lori Swanson, the attorney general there, alleged that company employees approached sick patients in the emergency room to collect hospital debts. Accretive declined to comment on its plans, if any, to enroll exchange patients.
Industry officials said they would abide by strict rules in advising consumers on plan enrollment.
Fri, Sep 13 2013