Health Insurance Exchanges - Working Through the Kinks

Dr. Jitesh Chawla feels that health insurance exchanges are a honest attempt to fix all the on-going problems with trying to provide the proper access and coverage to Americans that were created by insurance companies. But, like any new initiative, there are kinks that need to be worked out as this article explains.

The Health Insurance Exchanges, central pieces of the Patient Protection and Affordable Care Act (PPACA), opened as scheduled on October 1 amid debate in Congress and a government shutdown over the future of the law. The launch of the Exchanges along with open enrollment for Americans came just after the government released premium rates for 33 federal Exchanges.

Technical Problems in Accessing Exchanges

Consumers seeking online access to federally-facilitated Exchanges (FFE) faced intermittent outages and error messages throughout the first day of enrollment. Some state-based Exchanges, including those in California, New York, Maryland and Colorado had similar issues with their websites. Traffic to these sites was very high, leading many of the sites to slow down considerably. Similarly, those seeking assistance by phone also encountered long wait times.

Many proponents of the law, including those who are helping to develop the Exchange systems, have warned of glitches as the Exchanges roll out over the next several months. Many of these predictions proved accurate as large numbers of Americans logged on to the Exchange websites to browse coverage options. As initial curiosity over the Exchanges subsides in the coming weeks, it will be easier to more accurately assess the functionality of the websites.

Rates Announced

On September 24, the U.S. Department of Health and Human Services (HHS) released an issue brief outlining the premium rates in the 36 states with either an FFE or a partnership Exchange. Since data concerning premium rates is complex and ambiguous, supporters of PPACA hail the rates as a success for the health reform law, while opponents view them as a major failure.

The issue brief outlines the number of Qualified Health Plans (QHPs) offered in each state and the average premium rates that enrollees would pay for different plan tiers. Average premium rates are detailed for a 27-year-old (before and after tax credits are assessed), and a family of four with a specified income of $50,000 per year. Rates for the lowest bronze, silver, gold and catastrophic plans as well as the second lowest silver plans are described. The average number of QHPs offered in the 36 states is 53 with as many as 106 plans offered in Arizona and as few as seven in Alabama.

Update: On October 1, the U.S. Department of Health and Human Services posted premiums for over 17,000 plans being offered in the 36 states where the federal government is operating an Exchange. The premiums are listed for different geographic regions, age groups and different family sizes. Metal levels and plan type information is also provided.  This list provides people the ability to compare plans within and between states. Click here to access this resource.

To see the full article, please click this link.

Please join Jitesh Chawla, MD. in the discussion by posting your comments on this blog post.

Patient Portals: What are they and how can they be important?

A Patient Portal is a software functional feature that enables patients to view or to send their own health data without the need of medical provider or staff. Screens are available where patients can see their medication list, allergy list, labs and schedule appointments. It can be described as a "window looking into their electronic patient chart" Some portals allow patients to also see their visit bill, fill out of their initial intake form, email their providers and send data from medical devices (ie. glucose, BP values, etc).

Patient portals can be part of an EMR or be used standalone or be linked to an EMR, PM system, etc. This a tool that has been important in getting patients engaged in their own care. Also, it helps organizations cut costs. For example, lab results don't need to be mailed, staff time is not wasted to help patients schedule appointments or answer simple questions about their bill.

Patient benefits include cutting down time filling paperwork on a new patient visit, more freedom in accessing certain health data (ie. labs, med list) on demand and an ability to contact their medical provider directly without having to depend on the practice staff.

One study revealed that 75% of patients wanted to email their physicians, 2/3 rds wanted to lab results online and at least were very to upload data from their home monitoring device into the EHR. These days it is easy for a practice to get a patient portal. In fact, Meaningful Use certified EMRs come with patient portals. Some have basic features only (results viewing), while others allow you to schedule appointments, refill meds and send messages.

Screenshot of a patient portal

(reference: omedix blog)

However, there are a few important points to what features to make available.

1. Consider the implication that the patient portal feature will have on practice workflow. For example, you may want to include lab results as a feature as most are normal and don't take away time from the provider to explain (as an abnormal result would do).

2. Getting reimbursed for the work it creates. For example, in some organizations providers don't get paid for responding to emails from patients or the pay may not be worth the time it takes. Therefore, you may not want to offer a secured messaging feature to your patients.

3. IT issues may take time or expense. Being software, patient portals are amenable to technical problems. You must decided if your practice or organization has the resources to deal with that. Once you introduce a new service to your patients, it's too late to back out. Especially, if people like using it and patient portals are becoming more and more popular.

If you want Jitesh Chawla's advice, set up a trial period with your patients in which you ask them all to utilize the patient portal for certain funcationalities such as booking appointments, requesting med refills.

I hope this has given you some basic information about patient portals and how they can be used.
Patient portals have a tremendous potential from improving practice efficiency to exchanging data with health information exchanges.Will patient portals stay or suffer the fate of some of the PHRs (like Google Health)? I am not sure and only time will tell. But, one thing is for sure - healthcare consumers want more charge of their health and health information. Patient portals serve as one of these tools.