Early Implementation of the ACA: Lessons Learned
Friday, September 20, 2013
Posted by: Joy Ingram
by Rachel Krause, Marketing Manager, Erie Family Health Center
Erie Family Health Center was one of 13 Chicago-area organizations that began enrolling patients in 2013 into “CountyCare”, an early implementation of the Affordable Care Act (ACA) in Cook County, IL. Through organization-wide engagement and robust patient and community outreach, Erie has already enrolled over 2,200 participants.
We shared our work with CountyCare at the August ‘13 NACHC meeting in Chicago. Our hope is that some of what we experienced may prove helpful to other health centers as we all anticipate implementing the full ACA provisions in January ‘14.
Following is a summary of lessons learned:
1. Plan, plan and plan. ACA implementation will impact every part of the organization. Consequently, it’s essential to engage a multi-disciplinary, cross-agency team, including HR, marketing, patient access, finance, billing and many others. Meet with this team early (now) and often (weekly or bi-weekly) to develop a plan and monitor ongoing progress.
2. Make data-driven enrollment projections. In order to set and determine whether you are meeting your enrollment goals and to guide your budget planning, you will need to project how many people you plan to enroll. You can use your electronic health record system to identify how many people are potentially eligible and then consider other factors such as changes in income status, residency and immigration status to revise your goals and projections.
3. Hospitals are critical – engage them early. Hospitals are key to assuring access to comprehensive care for your patients. Do not assume that all of your hospital partners will sign up or that they will cover every service and procedure that your patients will need. Do not even assume they will use common terminology in describing their services. To make sure that patents can access all of the diagnostic and specialty services they may need, you will need to continuously negotiate with your hospital partners and possibly engage new partners.
4. Know your target audience. We initially thought that our eligible patients would be so excited about the idea of getting health insurance that they would all sign up immediately. We were wrong. Many factors affect the decision about whether and when to enroll. Assessyour patients and others you’d like to enroll to determine their unique barriers against and motivators for enrollment as well as what outreach messages and means are the most effective.
5. Evaluate early, often and on multiple levels. Your plan may make sense on paper, but will work very differently in real life. By evaluating key measures such as enrollment numbers (by service site), effectiveness of your marketing communications, and reasons for patient denial, you can identify what is working well and make changes as needed.
6. Keep staff and providers engaged and informed. While providers are often the most effective at encouraging patients to enroll, everyoneon your staff plays a role in ACA implementation. All of them will need different types of ACA information, however, based on whether they are a provider, administrative staff, front desk staff or fill other positions within your organization. Staff in different roles also have different preferred ways of receiving information. For example, we had the best luck communicating with providers through Grand Round presentations and our electronic health record system, while other staff preferred to receive information via email or our employee intranet.
7. Keep patients informed. Clear, accurate patient communication is critical. In order to expedite the enrollment process and manage patient expectations, share as much as you can with them about what the enrollment process involves, how long it takes to be accepted, what services will be covered, the referral process and other key aspects of their new coverage.
8. ACA implementation is a lot of work. You probably already knew this. We did, too, but it was still more than we expected. In addition to the full-time efforts of our enrollment agents, it also involved substantial effort for our patient access staff to follow up on every referral, our Quality Improvement team to keep the EHRS updated, our senior leadership to negotiate with hospital partners and CountyCare administrators, our marketing team to implement and evaluate multiple outreach efforts and many other staff. This does not include the time spent developing evaluation instruments, evaluating efforts and discussing progress in regular meetings. Be ready to commit significant staff time to ACA implementation!
While our experience with CountyCare has positioned us well to fully implement the Affordable Care Act, we know that we still have much to learn as the landscape continues to change. We look forward to further sharing lessons learned with our health center partners as the ACA provisions unfold over the upcoming year.
If you would like a copy of our presentation which contains more detailed information and examples, please contact Rachel Krause, Project Marketing Manager, at email@example.com.
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