The Access to Care Report (#23) / Possible incentive strategies for dealing with individual complaints about the ACA

December 12, 2013

health-care-lawThis is installment #23 in a continuing series of Access to Care Reports.

During 2014, implementation of the Affordable Care Act (ACA) is likely to encounter many types of complaints. Two complaints that are likely to be difficult to resolve—and have the potential for creating further public backlash—relate to provider networks and out-of-pocket expenses.

Narrower provider networks are being used by insurance companies to control costs. The loss of access to familiar and preferred providers may result in major resentment by some individuals, as they are affected.

And substantial out-of-pocket expenses may be incurred for those requiring extensive care: on the average, 40 percent of expenses for bronze plans, 30 percent for silver, 20 percent for gold, and 10 percent for platinum may fall to individuals with significant care costs. Loss of access may also develop if individuals refuse to seek care because of those costs that must be paid individually.

These aspects of insurance policy design are essential to viability of the ACA, but some way may need to be found to “soften” the impact of such potential complaints.

It is interesting to consider how companies in general have long dealt with the problem of making individuals feel better about spending money.

A common strategy—which has been successful—is to provide “rebates” in the form of “points”, “credits”, “coupons”, or “gift cards” that may be applied toward attractive rewards.

These incentives encourage individuals to feel better about the money that they are spending.

Following this concept further, insurance companies and providers could team up to provide point awards whenever network services are used, to encourage positive feelings toward the network. Providers could also award extra points for desired patient compliance with preferred treatment strategies.

Each visit to the network for services could result in a reward that makes the network seem more attractive, reduces resistance to the network, and improves service delivery.

Insurance companies could also provide redeemable “points” whenever insureds have to pay out-of-pocket for care.

Individuals could then feel somewhat rewarded for “paying their share”.

Such arrangements could build on highly-successful incentive strategies that are commonly used by most companies today to encourage “brand loyalty” and ease the resistance to paying for goods and services.

Such well-defined incentive programs could improve individual reactions to ACA constraints and help ease ACA implementation.

The result could be to improve access to care while also improving reactions by individuals to the ACA.

It would also not hurt attorneys to consider how similar incentive programs might be used by their practices.

Perhaps the use of incentives would more than pay for itself through positive client reactions (and referrals), and fewer client complaints about charges.

More on these and related ACA topics, with an in-depth discussion of organizational reactions to implementation issues, may be found in a recent book by the authors that describes evolution of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.