Is Your Hospital Ready to Play the Game?

TUCSON, Ariz. — Like children picking soccer teams in the school yard, hospitals have been choosing their teammates for years now, and with key provisions of the Affordable Care Act about to kick off, it's about time to start playing the game.

That was one of the messages delivered by health care futurist and regular H&HN contributor Ian Morrison during the final day of the Siemens Health Executives Forum on Wednesday. Doctors have been flocking to hospitals and vice versa to "huddle for warmth" in the face of an uncertain future, and systems have been forming unique partnerships with everyone from payers to competitors.

"What I think the last two years have been about is picking teams," Morrison said. "It reminds me of when I was a kid in Scotland and we'd rush to school, get there early to play 10 minutes of soccer. We'd waste five minutes picking sides. All we've been doing is picking teams. Now we've got to play the game and the game is about clinical integration and making this work better for patients."

Part of making this work better will be appealing to the growing consumer side of patients, a megatrend that isn't going away, Morrison and his speaking mate, Debra Richman, a senior vice president with research firm Harris Interactive, told attendees. Consumers are set to start shopping the insurance exchanges in the fall. Both health care-rating websites and retail clinics are growing in numbers and popularity. Add yesterday's release of Medicare charge data and a picture of a more informed and more demanding consumer comes into focus.

Harris Interactive released a survey commissioned by Siemens this week, highlighting patients' thirst for openness and transparency from the health care system. Researchers found that about 92 percent of Americans value knowing what is wrong with their health just as much as having access to a doctor. Some 78 percent of those surveyed said they would want to have a test done to diagnose a disease, even if no treatment is available. And about 72 percent said they were more concerned about what they have to pay for their care than having access to care.

Morrison said transparency and clear communication from hospitals will be important as consumers, who may have little to no experience navigating the health system, start using plans off the exchanges. He expects there to be a lot of sticker shock as consumers figure out what is and isn't covered, followed by bad debt if patients don't understand why they're receiving these bills.

"The big sticker shock that's going to come with the Obamacare health insurance exchanges is that this isn't free care," Morrison said. "At 300 percent of federal poverty level for a family of four, you're going to write a check, after the subsidy, for $560 a month. After the subsidy. And that's for an actuarial value of 70 percent, meaning that 30 percent of the cost of care is not covered. So those people who bought this insurance for $500 a month are going to turn up in your hospital thinking that they've got coverage, and you're going to say, 'No, no, no, you have to satisfy your deductible and co-pay. You have to write us a check for $1,500,' and they're going to stiff you on that bill. I think the sticker shock here is significant."

In its recent survey, Harris found that consumers are becoming increasingly familiar with exchanges. About twice as many polled said they're "somewhat" familiar with the term "health exchange" in 2013 compared with the previous year. However, 42 percent were still "not at all familiar," and 22 percent said they're "not very familiar."

Public exchanges have a sizable budget for marketing and advertising, and Morrison said he expects a "blitz" of education efforts after Memorial Day, trying to grow public awareness. Still, employer-sponsored insurance remains the gold standard, according to Richman, and exchanges are expected to struggle avoiding the image of welfare care.

"Most consumers have no clue. They're only starting now to hear news stories about this," Morrison said. "The media blitz — Enroll America and all the other initiatives — are really going to hit in the fall. After Labor Day, there will be unbelievable amounts of ads, and when we go back to consumers early next year to do the time trend on this, we expect that number [of people familiar with exchanges] to go up to 60 or 70 percent."

What's your hospital doing to get ready for the exchange rollout later this year? Share your experiences in the comment section.