Payers Drive Patient Navigation, Education to Cut Uninsurance
Payers’ patient navigation and education efforts may help underserved and uninsured communities understand their health insurance options and obtain coverage, alleviating the uninsurance rate.
Source: Thinkstock
- Health Care Service Corporation (HCSC) seeks to address uninsurance in the US by developing an education and patient navigation campaign, known as Be Covered, to inform the uninsured of their health insurance options.
“Through Be Covered, we aim to decrease the number of uninsured by expanding access to the necessary information for people to make informed decisions about their health care,” said Monica Berner, clinical officer at HCSC. “We look forward to working together with the communities where we live and work to help improve the health and wellbeing of our friends, families and neighbors.”
Last year, uninsurance rose significantly for the first time in nearly a decade. In 2018, 8.5 percent of the nation lacked health insurance. A portion of that percentage includes children, over two percent of whom dropped out of Medicaid and CHIP but it is unclear whether this is because they obtained employer-sponsored insurance.
“Our goal with Be Covered is to improve the health of the communities we serve by helping the uninsured and underinsured understand their options and gain access to coverage,” said Maurice Smith, president at HCSC. “We have many decades of living and working in the communities we serve, and we see it as our responsibility to support our neighbors as they navigate the complexities of the health care system and barriers that may prevent them from getting covered.”
The Be Covered campaign collaborates with community organizations, leaders, and centers of community life to make sure that local populations know about their healthcare options. HCSC hosts events that offer health insurance guidance. However, these events also serve the community’s immediate, physical needs. HCSC provides preventive and wellness care counseling as well as family entertainment and offers attendees healthy food.
Apart from in-person guidance, HCSC also launched a website, BeCovered.org, where it houses tools to help an individual learn on their own and navigate through the enrollment process. Their online resources include a glossary that touches on healthcare terms ranging from the “Affordable Care Act” to “qualifying event” or “participating provider option.”
The site includes single-page fact sheets in four categories. These categories cover basic health insurance and Medicare information, preventive care including chronic disease management information, how to prepare for unexpected changes in healthcare like when an individual loses her job, and other general subjects like renewing coverage.
The campaign serves five states in which there are 7 million uninsured persons. Over four million, however—or around 60 percent—are eligible for Medicaid or federal subsidies.
According to a December 2018 fact sheet published by the Kaiser Family Foundation (KFF), one of the reasons Americans are staying uninsured may be due to the fact they do not realize they can be covered under the Affordable Care Act (ACA).
Under the ACA, states were allowed to expand their Medicaid programs as they chose, which led to increased overall coverage and quality of care. However, with every state’s Medicaid program looking a little different, members may assume they are still ineligible for coverage based on their previous eligibility status. In this case, increased education could go a long way to decreasing the uninsurance rate.
Furthermore, not only does eligibility change with the state’s decision to expand, but it also changes with various life events such as marriage, academic changes, or income fluctuations.
“Some uninsured who are eligible for help may not be aware of coverage options or may face barriers to enrollment,” the KFF researchers explained. “Outreach and enrollment assistance was key to facilitating both initial and ongoing enrollment in ACA coverage, but these programs face challenges due to funding cuts and high demand.”
As CMS keeps the funding at $10 million for outreach and patient navigation efforts, payers and organizations can step up to fill in the gaps for underserved and uninsured communities.
