Covered California grant money to educate health care professionals on new insurance exchange is a waste of money.
Covered California is in the final stages of awarding $3 million for outreach and education grants to educate providers such as doctors, nurses and allied professionals about the new health insurance exchange. This is truly a waste of money since these professionals are the folks that will be directly benefiting from the increased spending from expanded health insurance. There are numerous professional health care trade associations with the resources to educate their members about Covered California and how their patients can enroll for potentially subsidized health insurance plans.
Are the uninsured visiting their Primary Care Physicians?
With the exception of community clinics and emergency rooms, most people that are visiting a doctor’s office probably already have insurance. The primary focus of Covered California is to enroll individuals and families in health plans that currently don’t have insurance. While it is important that health care professionals understand what Covered California has to offer, they rarely have the time to engage in serious discussions about insurance. Most often patients with questions about insurance are referred to the people at the admissions desk that work with insurance issues all the time.
Administration should lead on doctor education
Doctors, nurses and clinicians are looked to as a source of reliable information and recommendations. Changes to Medicare, Medi-Cal or new state laws effecting private insurance are equally as important for these health care professionals to understand but we don’t pour money into education programs about these insurance changes. Education about new authorized tests, eligibility or covered benefits to existing health insurance is handled by the administration of the hospital or physician group.
Health care organizations already funded
Covered California has already awarded $43 million for public outreach and education. Seven of the recipients that received grant money are organizations that are already involved with the health care industry. UC Davis Health Systems received a $1,000,000 grant for public outreach. Yet we need more money spent just to talk to doctors, nurses and physical therapists? Is there no room for UC Davis to talk to their own physician group? UC Davis Health Systems has to reach over 100,000 people in 18 months about Covered California to meet the requirements of their grant funding. A primary source of contacts can be through health care professionals. It seems logical that the UC Davis grant would educate their health care professionals as outreach personal to help meet their goals.
Health care professionals are a pretty smart bunch
Health care professionals are highly trained and educated people with a vested interest in health care reform. Can’t they spend one hour reading a pamphlet on Covered California and what it offers so they can talk to patients about the benefits? Do they really need a personal visit by a Covered California cheerleader to educate them? It is not the job of health care providers to understand all the eligibility or income rules for enrolling in Covered California. This is all a doctor, nurse or clinician needs to say and do when asked about the health insurance marketplace:
- Covered California provides guarantee issue health insurance.
- You can’t be turned down for a pre-existing condition.
- There are subsidies to help families pay for the health insurance.
- There will be several plans to choose from which include covering services from this facility.
- Health plans from Covered California will provide insurance for 10 Essential Health Benefits including prescriptions, emergency room, preventive care, maternity and more.
- Some individuals and families will qualify for no cost Medi-Cal coverage.
They can then hand the patient a flyer with the list of certified enrollment counselors to help them enroll.
Their motivation for education is in future revenue
Hospitals, physician groups, pharmacies and other allied professional will be the direct recipient of expanded health insurance coverage. That alone should be enough motivation for their administration and trade groups to provide them education about Covered California. The California Medical Association already has a page devoted to the ACA and Covered California. There are a variety of resources on this page for doctors and their staff.
California Health Benefits Exchange Fact Sheet
Essential Health Benefits Fact Sheet
California’s Health Benfit Exchange: The positives and perils of contracting
California Health Benefit Exchange: How it will impact your practice and change commercial insurance
The American Nurses Association\California has a page dedicated to informing their members about the ACA in California.
Outreach and education has already started
It looks like these organizations have already taken a lead in educating their members. Professional trade organizations are usually the best at knowing how to reach and inform their membership on current issues. There is no reason for Covered California to grant money to organizations, possibly the same groups representing the health care professionals, to provide outreach and education.
Is the scope of the provider education grant program too large?
Covered California has a list of activities that they hope the grantees will implement in order to pierce the professional health care curtain and actually reach the providers.1
- Provide educational services to health care professional in-person (preferably).
- Direct outreach to health care professionals through mailings, email blasts, webinars and other low-touch methods
- Development and dissemination of collateral materials targeting health care professionals (subject to approval by Covered California)
These are all activities that could and should be coordinated by the administration of the office, clinic or hospital. I’m not sure health care facilities need another sales person knocking on their door asking for their valuable time. But the grant program also has a wish list of activities that seem to reach beyond just education and create long term programs.
- Develop and implement continuing education models for health care professionals and providers to deliver education about Covered California health insurance plans;
- Develop and implement models and systems for health care professionals and providers to deliver information about Covered California health insurance plans that touch the consumer at multiple points during doctor or hospital visits
- Deployment of a team of trained health care professional educators to local doctors and hospitals to provide education services to medical staff and other allied staff that have regular consumers contact
- Convening of learning communities to share best practices and promote peer learning
With all that the ACA is asking doctors and hospitals to do from reducing re-admissions to facilitating Accountable Care Organizations, does any one really believe health care organizations are going to create continuing education programs or “learning communities” just to chat about Covered California?
Copy a successful model
Instead of reinventing the wheel just copy the sales tactics of big pharmaceutical companies. No industry has been more successful at getting their products pushed through the doctor’s office than pharmaceutical representatives. Drug companies have been incredibly successful at getting doctors to prescribe more medications at higher prices than any other industrialized country.
Hire big pharma to represent Covered California
Since big pharma will be another recipient of expanded coverage for prescriptions under the ACA and they are so successful at marketing their products just hire the drug companies to provide education on Covered California. Drug manufacturers are very good at marketing. They can create lots of pens, totes and sticky notes to remind everyone in the doctor’s office to talk about Covered California. All the pharmaceutical companies can get together and throw a big educational seminar/golfing trip in Hawaii to get lots of doctors to attend.
Physician groups should lead education
Most physicians in California aren’t in private practice but belong to a physicians group such as Kaiser, Hill Physicians, or Mercy Medical Group. In addition, the California Association of Physician Groups (CAPG) represents 150 different groups that employ or contract with approximately 59,000 doctors. The physician groups in concert with CAPG seem like perfect organizations to spread the word about Covered California. If CAPG truly believes in its slogan “Improving Healthcare for Californians” they should be able to put together an outreach program to their physician groups at no cost.
Let the beneficiaries fund the education
The health care industry spent over $35 million in 2011 lobbying elected officials in California. That is ten times more money than Covered California wants to spend educating health care providers on the new health insurance exchange. If the health care industry can cough up ten times the amount of a Covered California provider education grant program, they can certainly rally the troops to contribute money to educating the health care professionals who will be the recipients Covered California subsidized health insurance plans.
1. Down load the final Covered California Provider Education Grant Proposal Review presentation. [wpdm_file id=80 title=”true” desc=”true” ]