Hello Health System: Meet the Newly Insured

In 2014, the health system will be introduced to the first of the 30 million newly insured under the Affordable Care Act (ACA). With less than a year to prepare for the uninsured, many states are still discussing whether or not to expand Medicaid eligibility and who they want to run their exchanges.

The rock band The Who once sang, “Meet the new boss, same as the old boss,” but that tune won’t work this time. The ACA’s first wave of newly insured is different than those who already have coverage, according to an analysis by PwC’s Health Research Institute. They are less educated, more ethnically diverse and less likely to speak English. In fact, 30 percent of them will speak a language other than English at home, compared to about 12 percent now. They are less likely to have a college degree—86 percent won’t compared to 63 percent of the currently insured. And they are less likely to have a full time job—42 percent versus 59 percent of the currently insured who are employed full time.

Those data points underscore a challenging reality that health system leaders may not be fully prepared to handle—namely, that a brand new population will soon navigate a complex system of copayments, appointment scheduling and health education and management afforded to them by having insurance. The education and management of this population will largely be left to the health system. If not done right, then it may result in disruptions in access and care.

Insurers providing coverage in the exchange will begin to enroll new members in October. But unlike past insurance models that relied on the employer group market, the majority of the newly insured will purchase individual coverage through the exchanges.  In states that choose to participate, the remaining uninsured will be covered by the Medicaid expansion. For insurers, understanding who their new customers are and how best to communicate with them will be a critical step in managing consumer expectations.

The doctors and hospitals that treat the newly insured should likewise focus on communication and population management. Assessing their health status is important for day one operations. For instance, some patients may have forgone routine medical care and as a result, now have more complex healthcare needs

Providers will need to leverage new technology as a way to manage the influx of patients. Mobile health applications, which allow patients to schedule appointments and even access their own health records, is one such tool providers should adapt. But if not used to its full potential, even the most elaborate electronic system will fail.

But there are ways to turn these challenges into an opportunity. After all, more coverage means less uncompensated care and more premium revenue. Yes, the first wave of the ACA’s newly insured may prove challenging to some providers. But the first step is to understand their needs so you can be ready to take care of them.

Go out there and say hello to the newly insured.

—Benjamin Isgur is a director in the PwC Health Research Institute.

Posted in Expert Opinions, Uncategorized.