How to Talk Shop with Patients in the New Health Insurance Marketplace

While the grand unveiling of the new health insurance marketplaces has since come and gone, the confusion and skepticism surrounding the coverage kiosks and the mandate they were built for remains firmly intact. But it doesn’t have to be all doom and misunderstanding forever — according to the American College of Physicians (ACP), employing information tools like its novel virtual resource center in doctor-patient discussions can make all the difference.

Aptly named the “Help Your Patients Enroll in Health Insurance Marketplaces” resource center, the informative web collective relays helpful tips for providers to employ when talking insurance enrollment — a discussion industry experts anticipate happening more often between patients and their doctors now that the Affordable Care Act legislation has taken a realistic hold.

“With the imminent expansion of health insurance coverage and the cascade of new rules and deadlines affecting our practices and our patients, physicians are undergoing changes unlike any in memory, ACP can provide physicians with a trusted source of information to help their patients,” said ACP President Molly Cooke, MD, FACP, in a prepared statement.

“It’s very, very important that the doctor speaks to his or her patient about the new opportunity with the health insurance exchanges,” Charles Cutler, MD, FACP, chair of the ACP’s Board of Regents and Pennsylvania practitioner (pictured above), elaborated in an interview with Medical Practice Insider.

Both Cutler and the ACP resource center posit that a physician source is viewed as a trusted compatriot of health services who aims to do “best for [their] patients,” and thus should be informed not only about what the changes ahead mean for their practice, but what those changes mean for their patients as well. (Find the top ten questions and answers concerning physicians about ACA implementation here within the ACP resource)

So how does a physician best broach the subject of the insurance marketplaces and the opportunities they pose? It starts with dismantling fear, according to Cutler.

“The conversation is on the tip of everybody’s tongue right now given the establishment of health insurance exchanges and there’s a lot of choices out there — there’s some change going on and I think a lot of the change is for the better,” Cutler said. “But patients need help understanding all of it. I think there’s unnecessary alarm created among the American population because people don’t like the Affordable Care Act and rather than really address the weaknesses in the program, the whole program has been labeled as harmful to Americans, which it’s not. We just need to look at what the changes are and work through them, and pick out the right plans, and make sure that everyone has coverage and access to care.”

And it’s not just the fear in patients that needs undoing, but the dread within doctors themselves too. To this point, Cutler relayed his following top tips for physicians to follow when preparing to discuss insurance exchanges:

1. Don’t panic — “The greatest thing to fear is fear itself, and maybe that needs to be said. I think that’s the first tip for doctors — they themselves shouldn’t be frightened by the changes for their practices and they shouldn’t be frightened for their patients either,” Cutler said. “Because the deeper you delve into this, the more you see the incredible benefit that lies not even on the horizon, but right in front of us within the next few months and the early part of 2014.”
2. Get Educated — “When you have some free time, go to the ACP website and read through it — it’s not that long, it’s not that complicated and it’s easy to navigate. You can get a sense of how to approach the conversations with patients.”
3. Reach Out — “I think once you’ve sort of conquered the anxiety about this and done a little bit of education, it’s worth reaching out to patients [who potentially haven’t spoken up] and reassure them that their access is going to improve, their opportunities for health insurance will be expanded, and certainly patients can go to the ACP website too and see all the resources that are available to them, to learn more and approach this in a very logical and organized fashion.”

The depth of these conversations is subject to vary, Cutler continued, and while it may be difficult to squeeze such talking points into an already strapped office visit, it’s imperative that physicians respond to questions and even inquire first as a means to alleviate stigma and unawareness. Cutler projected the following conversation outlines for your discussions, broken down by patient demographic:

• Employed Patients: “Depending on the situation, they can get very much in-depth. A lot of folks have employer-based health insurance right now and, by and large, that’s not changing, so the conversation can be very simple to assure a patient that unless your employer tells you otherwise, your insurance is going to be the same in 2014 as it was in 2013 and 2012 and 2011 and so forth. So that alone satisfies a certain segment of the population.”
• Older/Senior Patients: “By and large, what’s happening with Medicare — which most older patients have, and I take care of a lot of older patients —  is all positive in my view. There are some changes in reimbursement that will affect hospitals and doctors, but it won’t really affect patients. And patient coverage if you have Medicare is going to be the same or broader and so again, that simple conversation needs to take place and that may satisfy a large number of older folks.”
• Previously Uninsured/Under-insured Patients: “The conversation can be very simple and straightforward but for people who haven’t had insurance or have been under-insured, for people who have lost their job, for folks who have had pre-existing conditions and now have access to coverage, there are a number of different choices that they can make, and so more detail is required in that setting.”

Overall, now is a time to get excited and raring for an evolving landscape of care — not a time to scare the dickens out of you, although some Dickens is absolutely permissible, Cutler concluded.

“I think Charles Dickens was wrong — these are not the best of times and the worst of times, they are the best of times and we have to educate ourselves, all of us, all Americans have to learn what’s out there. As a result, we all have an opportunity to live healthier and more productive lives,” he said.

Madelyn Kearns is Associate Editor at Medical Practice Insider, a publication of MedTech Media that provides business and technology intelligence to forward-thinking medical practices.