IOM Helping Providers Help Patients Understand ACA, Insurance

Date Posted: June 19, 2013

June 19, 2013 - The Patient Protection and Affordable Care Act (ACA) will change many aspects of the healthcare system, yet many Americans do not understand the law or how it will affect them. Recognizing that, the Institute of Medicine’s (IOM’s) Collaborative on Health Literacy, Health Care Coverage, and Care has issued a paper presenting basic information that can be used to help people understand their health insurance options and guide them through enrollment.

Kavita Patel suggested providers use the IOM guide with patients.
Kavita K. Patel, MD, MS, suggested healthcare providers download the paper, use it as a reference and give it to patients.

“This is a guide for navigators and healthcare workers,” said Kavita K. Patel, MD, MS, lead author on the paper, Helping Consumers Understand and Use Health Insurance in 2014, and a fellow at The Brookings Institution. “They can hand it out or use it as a guide for themselves.”

The paper aims to serve as a resource for people such as healthcare professionals, patient navigators and others who will be helping consumers understand the options for health insurance and make more informed decisions. Providers can copy the document and pass it out to patients.

“The goal was to be basic and take healthcare, as complicated as it is, and dissect it into chunks,” Patel said. “People need a frame of reference for different programs and ways to get health insurance, along with knowing what to ask.”

Patel and colleagues emphasized that it’s not enough to just tell people what’s in the IOM guide. For education to occur, she suggested using teach-back techniques to ensure that the person has comprehended the information.

“We combined the principles of health literacy with the Affordable Care Act, and that’s where the value is,” Patel said.

Becky Ditmer: providers and payers can work together to educate people about ACA.
Becky Ditmer said providers and payers can collaboratively work together to educate people about ACA and insurance options.

Healthcare providers are already receiving questions about the act and choosing among different health insurers, reported Becky Ditmer, a principal in the health care advisory practice at Ernst & Young in Ohio.

“The provider community has to be part of the solution, and they play a critical role in structuring that conversation with their patients,” Ditmer said. 

Kristen Vennum, principal in advisory performance improvement-customer practice at Ernst & Young in Washington, D.C., attributed many of the queries to patients not knowing whom to trust and reaching out to someone they have entrusted with their health. However, providers may not be prepared to answer the questions. Vennum thought the IOM summary, while 16 pages, could prove helpful. 

Enroll America, a nonpartisan, nonprofit organization committed to maximizing the number of uninsured Americans who enroll in health coverage made available by the Affordable Care Act, has launched an enrollment campaign directed at consumers. It reported having already partnered with insurers, hospitals, pharmaceutical companies and community health centers to help people with coverage concerns and enrollment questions.

Kristen Vennum expects patients will ask providers about ACA and health insurance.
Kristen Vennum expects more patients will ask providers about the ACA and health insurance, because they trust them.

“Enrollment is one of many areas where these consumers will need support navigating a complicated environment,” Vennum said. People will also need to learn how to most appropriately access the healthcare system.

The ACA requires Americans to have health coverage and will impose a penalty, payable at income tax time, for those who do not obtain a qualifying health insurance plan.

Yet about half of adults do not understand how the law will affect them, according to the Henry J. Kaiser Family Foundation’s April 2013 Health Tracking Poll, which found that 42 percent of Americans are unaware that the ACA remains the law of the land, including 12 percent who believe the law has been repealed by Congress, 7 percent who believe it has been overturned by the Supreme Court, and 23 percent who don’t know whether or not the ACA remains law.

For people who will likely benefit the most from the law, those currently uninsured and in low-income households, the numbers are even worse, with 60 percent not knowing the ACA is still law and 56 percent of low-income individuals and 58 percent of the uninsured stating they do not understand how the law will affect them.

Many consumers will be obtaining health insurance for the first time and will unlikely know how it works. Teaching people about that and the ACA could demonstrate nonprofit hospitals’ service to the community, Patel said.

“It’s objective information about health insurance and different routes for that access,” Patel said. “For hospital administrators, it can be a great resource to meet the needs of their community-benefit requirements.”

Additionally, as more people have coverage, the numbers of patients receiving uncompensated care should decline.

Formally or informally, providers will be discussing the ACA and insurance coverage with patients, because people remain unclear about it and will want to know more as the country moves closer to full implementation.

“That trusted relationship is so important,” Vennum said. “In the healthcare ecosystem, the most trust is between the physician and patient.”

The IOM Collaborative roundtable plans to issue a second paper that will focus on choices for healthcare, how to get it and use it, and what the costs will be.



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