by Mitch Morris, MD, Vice Chairman, National Health Care Providers Lead, Deloitte LLP
They say that old habits die hard. Who are “they”? They are the retired executives who still wake up at 5 a.m. to read the paper front to back while enjoying a cup of coffee. They are the parents who continue to remind their fully grown, adult children to eat their vegetables. They are also many of the previously uninsured who, once they’ve gained insurance coverage, continue to visit emergency departments for their regular care.
This resistance to change was the subject of a recent op-ed that appeared in The New York Times. In it, Ezekiel Emanuel referenced a new study by the American College of Emergency Physicians. The study found that three-quarters of emergency physicians have seen increases in patient visits since the Affordable Care Act (ACA) passed.1
Emergency physicians aren’t the only ones feeling the pressure. The Deloitte Center for Health Solutions 2014 Survey of US Physicians shows that 44 percent of physicians are treating more newly insured patients. The effects are felt differently depending on physician specialty: primary care physicians (PCPs) are more likely to report seeing increases in newly insured patients (56 percent) than are surgical specialists (40 percent), non-surgical specialists (38 percent) and other physicians (33 percent).2
As outlined in the recent Expanding coverage: How primary care physicians are accommodating the newly insured report, among the PCPs who are seeing an increase in newly insured patients, many report the patient influx is straining resources.
While opponents of the ACA may view this as a failure of its policies, I’m in the same camp as Dr. Emanuel. I believe that people will continue acting on old habits, seeking care where it is familiar to them, until something or someone educates them on alternative options that exist.
That is why it’s not enough to stop at the coverage expansion; health insurance coverage does not equal health literacy. Dr. Emanuel references some of the programs that have attempted to curb this trend. The collaborative between Group Health Cooperative of Puget Sound and SEIU Healthcare NW Health Benefits Trust is just one example of the larger issue at hand: patient engagement and education should go hand-in-hand with increased access to health insurance coverage and health care services.
Moreover, Deloitte’s findings from the forthcoming 2015 Survey of US Health Care Consumers suggest that consumers may be more ready to do this than many previously thought. Many consumers are interested in comparing health plans, providers and services based on cost and quality. And, one in five is interested in using a website, mobile app or personal medical device to learn more about or choose between different treatment options.
In order to advance patient engagement, where can organizations begin? Health plans and health systems are looking at how to use technology and social media to reach out to patients to help them navigate their health services. Not everyone is technologically enabled, and sometimes marketing and outreach campaigns can raise awareness. It is a process of ongoing education that needs to be easy to access and culturally sensitive. Those providing hands-on primary care also have an important role in helping the newly insured better understand how to maintain good health and, when they are not well, how to best access services appropriately. Together, these efforts should not only reduce inappropriate utilization of emergency services, but they should also enable healthier populations.
Allowing mid-level providers to practice to the top of their license may also help. We’ve already seen what can happen when these initiatives are enacted. In Kentucky, shortly after the state expanded Medicaid, the expansion population was using PCP services 55 percent more than the traditional Medicaid population.3 To alleviate the pressure on PCPs, the state legislature expanded nurse practitioners’ scope of practice, allowing them to assist with care coordination and chronic disease management.
As a physician, I know that arming PCPs with care coordination tools and chronic care management capabilities could also help move the needle on patient engagement. Ultimately, once patients become fully aware of the myriad options they have to receive care, I believe they will begin to make wiser choices around when and where they seek that care. At that point, maybe they’ll be able to finally say they kicked their old health care habits.
Mitch Morris is the National Leader for the Health Care Provider sector at Deloitte including Consulting, Audit, Tax, and Financial Advisory Services. Dr. Morris has more than 30 years of health care experience in consulting, health care administration, research, technology, education, and clinical care.
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PS. In observance of the Memorial Day holiday, the Deloitte Center for Health Solutions will not publish a Health Care Current on Tuesday, May 26, 2015.
1 Emanuel, Ezekiel, “How to solve the ER problem,” New York Times, May 6, 2015; American College of Emergency Physicians, “ER visits continue to rise since implementation of Affordable Care Act,” May 4, 2015
2 Other physician type is comprised of Anatomic/Clinical Pathology, Occupational Medicine, Public Health and General Preventive Medicine, and Other (i.e., some other specialty not listed).
3 Deloitte, Commonwealth of Kentucky Medicaid Expansion Report, February 2015