Health Reform: Consumer Experience Considerations for Health Administrators

Written by Shannon Sakewski

Virtually all aspects of health care are being impacted by the Affordable Care Act (ACA)—and that’s the intention. To reform health care, all of the intricate moving parts of this mammoth industry must, in time, evolve. As decision-makers and influencers, health administrators must be aware of the policies and dynamics impacting their trade. This article will examine the post-ACA consumer experience, including health administrators’ relationship to the individual consumer, as well as the role the ACA plays in the lives and decisions of consumers.

Remember the Consumer during Mergers and Acquisitions

The ACA has introduced and amplified several health finance concepts, such as the Accountable Care Organization (ACO) model, a movement toward bundled payments, and value-based purchasing. As a result, there has been a trend toward consolidation among health systems and provider groups. ACOs are meant to facilitate cooperation between physicians, practices, and health systems. For both financial and operational reasons, unanticipated rates of merger and acquisition activities have been observed.

While provider systems often do a great deal of work to ensure a seamless patient experience during consolidation, confusion is likely—especially in scenarios where buildings are no longer in service, providers leave for a different practice, reimbursement contracts with payers are modified, and so on. Whenever possible, be aware of the consumer’s experience of consolidation. Collaborate with patient relations, marketing, and other communications staff to ensure that your messaging to consumers is consistent and complete.

Competition Requires a Consumer Orientation

As of July 2014, approximately 10.3 million people gained access to coverage via the ACA. This number includes individuals covered via Marketplace plans, as well as those newly covered by Medicaid in expansion states. For health systems, these newly-covered individuals represent opportunities for growth. As a result, provider systems are competing for consumer attention in creative ways which often point back to consumer comfort, access, and convenience.

However, the meaning and provision of comfort, access, and convenience mean different things depending on who a system is serving, and where that service happens. In order to react properly, it is important to know your system’s census as well as what challenges each segment of your population is facing. After gaining an understanding of your population, administrators will be better able to understand the costs and benefits associated with different potential competitive opportunities.

It’s Difficult to Navigate Health Insurance, Health Reform, and Health Systems

As professionals who have a deep understanding of our industry, it is sometimes easy to forget that most people do not have the same understanding of health finance and the provision of care. This applies not only to the 10.3 million newly-insured people mentioned above, but to many of us who have been insured for years. Health insurance in the US is usually tied to employment. It is often the employer who makes decisions about health insurance for employees. We, as consumers, are routinely non-participants in the health insurance decision-making process. Nevertheless, the employee/individual consumer must manage their health and health spending, especially in this era of high-deductible health plans and health savings accounts.

But how should one make responsible decisions if certain concepts (e.g., deductible, co-pay, co-insurance, etc.) may be almost indecipherable? That’s where you, your employer, and many community organizations come in. The people and projects in your organization who are public-facing play a crucial role in empowering and educating consumers regarding the best ways to navigate care and the financing of that care. For a list of organizations in your community who may also be able to assist consumers through these processes, visit the Marketplace’s list of Navigators and Certified Application Counselors.

If your organization has a team of advisors who work with consumers to understand their coverage and coverage options, that’s fantastic. They can help those who remain uninsured find coverage, which will help your organization’s bottom line. Remember that these counselors have important face-to-face interactions with consumers on a daily basis. If you want to know how to improve your services, operations, marketing, and so forth, talk to them regularly.

This is a very broad overview of some of the issues touching consumers in the era of the ACA. What’s missing? What concerns do you have? What experiences have you had with consolidation, competition, or service?

Author Bio: Shannon Saksewski
Shannon Saksewski has been practicing and studying health strategy in multiple contexts for more than five years. She earned a BA in psychology and studies in religion, a MSW focused on counseling practice, and a MBA focused on health strategy from the University of Michigan. Shannon can be reached via email (ssaksews@gmail.com), Twitter (@ssaksews), or LinkedIn.