Hospitals lag in HIX enrollment preparation

Few hospitals have developed comprehensive strategies to identify, educate and assist individuals with enrolling in health plans offered through the health insurance exchanges (HIXs). With the Oct. 1 start date for enrollment fast approaching, hospitals and providers should heighten preparations in order to benefit from the financial boost of a new customer base, according to a study from PwC’s Health Research Institute (HRI).

In the report, “Health Exchanges: Open for Business,” (the first in a two-part series), HRI surveyed executives from more than 150 hospitals across 25 states, national hospital associations and patient advocacy groups on their HIX preparations.

HRI found:

• Many providers are inadequately promoting the expanded coverage options due to “reform fatigue”, the need to finalize contracts with insurers, the slow trickle of information from regulators and the desire for additional regulatory guidance.
• The newly eligible pose an enrollment challenge, as many do not understand which plan best fits their needs, which could impact the health of the patient and the hospital’s revenue and reputation.
• Some health plans include only select hospitals and physician groups in their exchange offerings in an effort to hold down costs. This enables health plans to offer lower premiums, but may result in higher out-of-pocket expenses.

The HRI also offered an array of recommendations as providers gear up for enrollment. These include:

• Review the amount of charity care the provider offers and then compare it to the potential new revenue it would receive as patients gain some level of coverage
• Develop exchange training for financial counselors and hospital volunteers
• Promote the exchange through local, community networks and invest in advertising
• Partner with advocacy groups and the business community to help publicize the new mandate and plan options
• Rethink the hospitals’ long-term goals in terms of its potential growth opportunities

“Outreach and education should be top-of-mind for hospitals and health systems, but many are still coping with operational issues to ensure readiness for open enrollment. These companies will have to shift into gear quickly to focus on their consumer strategies and how to attract and retain a diverse mix of exchange customers,” Ceci Connolly, managing director, PwC HRI, said in a statement.

To view the full report, go here.