Turning ACA Headaches into Practice Opportunities

The first round of the Affordable Care Act has impacted medical practices in at least two significant ways: an influx of newly insured patients and a barrage of previously insured who changed health plans via the ACA due to policy cancellations. Those two factors could cause increasing headaches for medical practices in the form of lack of physician availability and insurance eligibility, just to name two.

But some practices, such as southern California-based MemorialCare Medical Group, see less of a problem and more of an opportunity. For the medical group, the glass is truly half full.

“We’ve spent a lot of time understanding how we can improve our access,” explains Mark Schafer, MD, chief executive officer of the medical group. “So that when there is an influx of patients, we’ll be ready for them; we’ll be ready to provide them with the same level of care we provide to all our other patients.”

Planning ahead

For starters, the medical group has opened several new offices, including one in Long Beach called Los Altos—a 30,000-square-foot office with 19 physicians and full-service urgent care. The medical group also “staffed up” its urgent care clinics, and added retail clinics called Health Express—some of which are located in supermarkets and are staffed by nurse practitioners and physician assistants.

“We’ve kind of spread throughout the community so that patients have that extra access, so that if they need care and don’t want to try to get in to see the physician, they can go to a Health Express clinic and be seen by a nurse practitioner for minor things,” Schafer says.

The medical group also trained staff—receptionists, customer service, and front-line staff—to handle patients who signed up for health care and may not have received their insurance packets. They’re trained to work with insurance plans to ensure new patients understand their plans. And clinical staff has been trained to deal with patients who may have waited for needed care because of a lack of access to primary care services.

“The training has been really important, because patients are really confused; the whole system was very complicated even before the ACA, and it’s even more complicated now,” Schafer explains. “Patients don’t necessarily know how they’re going to get access to care. Some of them are coming in confused, not knowing whether they’ve really signed up or not. So it has been really helpful to train our staff to not turn those patients away and to be patient. Let’s treat their medical problems first and then we can research their insurance on the back end if we’re not really clear what plan they have.”

Positive impact

Despite the monetary outlay required to expand facilities and train staff, Schafer believes that the manner in which the medical group has approached the ACA will have a positive impact to the group’s bottom line.

“[The] hope is to gain greater market share and see more patients; patients who are insured,” Schafer says. “That’s a benefit to the medical group. And those benefits will flow down to the physicians as well.”

David Kim, MD, medical director for MemorialCare Medical Group, agrees with Schafer’s assessment, and points to the group’s three-decades-old business plan as the reason it sees so much opportunity.

“We don’t have to change our business model to make this work for us,” Kim explains. “We’ve been value-driven: do what’s best for the patient. We’ve been set up for this; we’re in a position to succeed. And as Dr. Schafer referred to, it’s a chance for us to grow our patient base and grow the people we get to take care of and how many people are coming into our system. We’re just being asked to do more of what we know we have done and proven to do very well over the past 3 to 4 decades.”

Starting point

Schafer says that, unfortunately, the ACA has been so heavily politicized that many physicians are viewing the transition with a negative outlook from the start. He encourages physicians to have a positive attitude in the sense that there are opportunities resulting from being able to get more patients in for coordinated care.

“That’s got to help physicians down the road, it’s got to help our patients down the road, and hopefully it will help our society,” Schafer says.

Kim echoes those thoughts.

“There’s a lot of talk of patients and medical homes, and designing medical homes and medical care institutions that put the patient at the center,” he says. “I can’t begin that process if the patient doesn’t come into my office—if patients are scared away because they don’t have insurance. For me as an everyday physician, this really is the first step to being able to create a system where the patient truly is at the center of what we’re doing.”