tion, "MGMA ACA Exchange Implementation Survey Report

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MGMA ACA Exchange Implementation Survey Report May 2014

Overview Medical Group Management Association (MGMA) conducted member research in April 2014 to better understand the impact of the Affordable Care Act’s (ACA) insurance exchange implementation on medical group practices. This research follows up our September 2013 study, which helped shed light on a number of ACA exchange implementation issues. The survey includes responses from more than 700 medical groups in which more than 40,000 physicians practice nationwide. Almost 80% of survey respondents reported their practice is participating with new health insurance products sold on the ACA exchanges (ACA exchange products) and more than 90% of these practices have already seen patients with this coverage. Of practices participating with ACA exchange products, 85% are contracting with one to five products and almost 60% reported they are participating in order to remain competitive in their local market. While more than 8 million consumers have enrolled in health insurance coverage through the ACA exchanges, 56% of respondents reported no change in their practice’s patient population size through April and 24% reported a slight increase. Practices expect a small shift in this trend through the end of the year. Thirty percent of respondents projected no change to their practice population size by the end of 2014 and 44% predicted a slight increase. These figures illustrate that most practices are not being inundated by new ACA exchange patients but do expect to treat somewhat more of these patients as the year progresses. This research also revealed key issues practices are experiencing with ACA exchange implementation.


MGMA ACA Exchange Implementation Survey Report, ©2014. Medical Group Management Association. All rights reserved.

Summary of Findings MGMA noted three main themes within the findings. Obtaining coverage information Practices have experienced difficulty identifying patients with ACA exchange coverage and obtaining essential information related to that coverage. • 62% of respondents reported moderate to extreme difficulty with identifying a patient that has ACA exchange coverage as opposed to traditional commercial health insurance. • Compared to patients with traditional commercial coverage, nearly 60% of respondents indicated that for patients with ACA exchange coverage it is somewhat or much more difficult to: • Verify patient eligibility • Obtain cost-sharing or network information • Obtain information about the plan’s provider network in order to facilitate referrals “We are going to have to hire additional staff just to manage the insurance verification processs.” “Identification of ACA plans has been an administrative nightmare.” “We thought we would be able to identify ACA insurance exchange products by their insurance card, but quickly found out this isn’t so. “ Patient cost-sharing Practices are facing a number of challenges related to patient cost-sharing for ACA exchange coverage. • 75% of respondents reported that patients with ACA exchange coverage are very or extremely likely to have high deductibles compared to patients with traditional commercial coverage. • Practices reported significant patient confusion about the substantial cost-sharing related to many ACA exchange products, and practices are working to help patients understand the complexities of their coverage. • Practices cited some of the main reasons for not participating with ACA exchange products were related to concerns about financial burdens from patient collections (such as burdens related to collecting high deductibles from patients and concerns about financial liability from the 90-day grace period). “Patients have been very confused about benefits and their portion of the cost. Once the patients find out their deductible, they’ve cancelled appointments and procedures.” “The at-risk piece of eligibility is tremendously hard to determine and explain to patients.” “Patients don’t always understand how health insurance