Hospitals emerge as health care sales force

KAISER HEALTH NEWSSeptember 14, 2013 

As community groups, brokers and insurers prepare to recruit people for enrollment in medical plans that go on sale in October under the health law, nobody has a bigger financial stake in their success than hospitals.

And few may work harder to sign up consumers for the marketplaces than hospitals themselves.

“This is a major project for the next year,” said Craig Cooper, spokesman for Genesis Health System of Iowa, which hopes to enroll thousands of patients and substantially cut its $60 million annual bill for people who can’t afford to pay for care.

Hospitals are setting up phone lines and planning visits to churches, child-care centers and soup kitchens to sign people up. Like Genesis, some hospital systems received federal grants to train enrollment “navigators.”

Others are paying contractors to enroll consumers.

“Virtually everybody is asking for brochures and card tents that they can use in their various delivery sites — not just the hospital,” said Ellen Pryga, director of policy at the American Hospital Association. “Some of them are going to do a lot of community outreach.”

The Affordable Care Act creates online marketplaces where those lacking medical coverage can buy insurance. Helping consumers buy health plans on the exchanges will differ substantially from the Medicaid enrollment hospitals and their contractors are used to.

Vanguard Health Systems, a for-profit hospital chain based in Nashville, Tenn., hired Chamberlin Edmonds division to help enroll patients in the exchanges. “We have data in our own systems to know who has come into our emergency rooms that might be exchange eligible,” said Keith Pitts, Vanguard’s vice chairman.

Tenet Healthcare, another for-profit hospital chain that agreed in June to buy Vanguard, owns its own patient-enrollment and hospital-revenue consultancy, Conifer Health Solutions. Working with Conifer, Tenet expects to have at least one insurance application counselor certified under ACA rules in each of its 49 hospitals.

Mining patient records to get frequent customers covered is “clearly legal” for hospitals or their contractors under health privacy laws, said Mark Rothstein, director of the Institute for Bioethics, Health Policy and Law at the University of Louisville.

But with billions in revenue on the line, some worry hospitals could point consumers toward the insurance that’s best for the hospital, not the patient.

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