Steering clear?

Hospitals and medical groups are the organizations that most commonly see uninsured patients and have a powerful incentive to find a payment source. You might think they would play a major role in signing up uninsured Americans for subsidized private coverage through the state insurance exchanges and for expanded Medicaid coverage under the healthcare reform law.

But fewer than 10 hospital systems nationwide are participating as “navigator” organizations and receiving federal grants to help consumers enroll in exchange plan coverage. Some hospital systems and medical groups have received federal designation as certified application counselors, but no data are available on how many. This is seen by healthcare reform supporters as particularly a problem in the 36 states—many led by Republican officials opposed to the healthcare reform law—where the federal government is facilitating the exchanges. States running their own exchanges generally are engaged in more aggressive, better-funded education and enrollment activities.

Observers say the surprising lack of participation by hospitals and physician groups in helping Americans sign up for exchange coverage and the expanded Medicaid program is due to a number of factors. These include lack of information among provider systems about these consumer assistance programs and political pressure not to participate from Republican leaders in many states who are opposed to the Affordable Care Act.

One hospital system that is participating in the navigator program is the University of Mississippi Medical Center. It's one of more than 100 organizations that received navigator funding from the CMS in August. UM's $831,986 grant will be used for a statewide educational campaign. The UM Medical Center draws patients from nearly all 82 of the state's counties—which makes it uniquely positioned to help guide residents through the open enrollment period that begins Oct. 1.

UM financial counselors will meet one-on-one with uninsured patients. In addition, the hospital has used its electronic health-record database to identify another 3,000 patients who would benefit from the insurance exchanges—and will target them with direct mailings and educational events.

The hospital estimates that it sees more than 200 patients a day who would qualify to receive federally subsidized private coverage through the state exchange, which is being run by the federal government.

Navigators across the country include universities, health departments, clinics, advocacy groups and religious organizations. In addition to the navigator program, the CMS also has designated some organizations as certified application counselors—a term for entities that are trained to help in the enrollment effort but do not receive federal funds. Like navigators, certified application counseling staff have to go through training and take an exam.

The Wayne State University Physician Group in Detroit has received CAC designation and will deploy a team of financial counselors to guide people through the enrollment process, said Cathy Barrett, who oversees the group's revenue-cycle management. It is also fielding questions from other organizations, such as public libraries, that are receiving ACA inquiries from confused consumers. The multispecialty physician group is the only CAC in the Detroit area, which Barrett attributed to a lack of information among provider groups.

In other Republican-led states, some providers have been discouraged from participating in the navigator or CAC programs. In Ohio, Cincinnati Children's Hospital Medical Center was awarded a $124,419 navigator grant. But the hospital returned the funds because of a new state law that prohibits groups that receive insurance payments from serving as navigators.

Ohio is not alone in its restrictions. Other states such as Texas, Georgia and Florida have established rules limiting federal and private efforts to help consumers enroll in exchange plans. They have cited various reasons such as conflict of interest, lack of training, and the risk of fraud and privacy violations.

But Sabrina Corlette, a senior research fellow at the Georgetown Health Policy Institute, said such state efforts are intended to suppress enrollment. “Some of that seems so egregious,” she said, noting that the navigator program has clear provisions to protect against conflict of interest. The state restrictions could be having a chilling effect on provider participation. “Hospitals don't want to make political enemies,” Corlette said.

Still, some systems are engaging in their own exchange outreach efforts. At CHE Trinity Health, more than 87,000 employees in 21 states are helping to educate their friends and relatives. The system also has information available on its website, and is funding a multimedia campaign in some of its markets.

At 291-bed Mercy Hospital and Medical Center in Chicago, which received a CMS navigator grant, the hospital has hired eight people who will host educational events at its satellite campuses starting Oct. 1. About 38% of Mercy's patients currently are on Medicaid, and another 3% to 4% are self-pay, said Connie Murphy, vice president of marketing and development.

“It's very important for us to grow our volume—and it's just good for our community,” Murphy said.

Follow Beth Kutscher on Twitter: @MHbkutscher