How Are Insurance Exchanges Impacting Group Practices?

A Medical Group Management Association survey in April of more than 700 physician group practice members focuses on the affect that health insurance exchanges are having on practices. The responding practices represent more than 40,000 providers nationwide.

Heavy Participation Heavy Participation

Nearly 80 percent of responding practices are participating with new insurance plans sold on exchanges and more than 90 percent have seen patients with coverage through the exchanges. Eighty-five percent of the practices are contracting with one to five products and about 60 percent are participating to remain competitive in their market. Through April, however, 56 percent reported no change in their patient population size, while 24 percent saw a slight increase. Thirty percent don’t think the population will change much during the rest of the year and 44 percent think 2014 will end with a small increase. This shows, according to MGMA, that most practices are not being inundated by new exchange patients but expect to treat more of them as the year progresses.

Tough Luck Tough Luck

Exchanges aren’t making it easy for practices to serve their members. More than 60 percent of respondents say it is problematic to identify a patient with ACA coverage, verify eligibility, get cost-sharing or network information, and facilitate referrals. Says one respondent: “We thought we would be able to identify ACA insurance exchange products by their insurance card, but quickly found out this isn’t so.”

Money Worries Money Worries

Financial concerns hang over the exchanges. Three-quarter of responding practices say patients with ACA insurance are very or extremely likely to have high deductibles. Patients are confused about the substantial cost-sharing they face and practices have to educate them on the complexities of their coverage. “The at-risk piece of eligibility is tremendously hard to determine and explain to patients,” a responding practice says.

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Poor Network Designs Poor Network Designs

Providers also report limitations in how insurance networks are designed in many ACA exchange products. Nearly half of respondents have been unable to provide covered services to exchange patients because the practice is out of network. Twenty percent of practices were excluded from a narrow network they would have liked to participate in, and 10% declined to be in a narrow network. Patients don’t understand that their providers may not be in the network of their new insurer. Respondents report network provider directories that cannot be relied on, and consistently denied “out of network” approvals for patients who truly need to continue with providers they have had for years.

Low Expectations Low Expectations

Overall, only 13.8 percent of respondents believe the exchanges will favorably affect their practices. Nearly 27 percent are neutral and 59 percent think the change will be unfavorable. Complete survey results are available here.

A Medical Group Management Association survey in April of more than 700 physician group practice members focuses on the affect that health insurance exchanges are having on practices. The responding practices represent more than 40,000 providers nationwide.

 

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