The Access to Care Report (#25) / Incentives might improve 2014 access and attitudes for ACA

January 2, 2014

health-care-lawThis is installment #25 in a continuing series of Access to Care Reports.

One of the primary objectives of the Affordable Care Act (ACA) is to improve entry to care for those without past access, and to provide improved care coverage for others who have had only limited access.

Some successes are starting to be noted for both of these groups, as enrollment through the federal Exchange and state Exchanges begins to mount up—estimated to reach over 1 million by the end of 2013.

This is an appropriate time to look ahead at access issues for 2014. Once an individual has enrolled and obtained insurance coverage, there are still a variety of barriers to access to be overcome: these include out-of-pocket expenses and narrow provider networks for patients, and potential frustration and resistance by some providers over new administrative requirements that limit options and choices.

It would be helpful to begin to apply some additional techniques to “smooth out the bumps” as these—and other—access issues grow in importance.

One of the possibilities is to come up with innovative incentive strategies that can improve the reactions by both patients and providers, and help make them more ready to accept ACA requirements.

A recent report has surveyed incentive programs for health care in detail, and suggests some insights (“Workplace Wellness Programs Study”, by Soeren Mattke et. al., prepared by RAND Health, available at

According to this report, about “half of U.S. employers offer wellness promotion initiatives….”

And “more than two-thirds of employers (69 percent) with at least 50 employees and workplace wellness programs use financial incentives…and 10 percent use incentives that are tied to health-related standards….”

“Incentives are typically framed as rewards, with 84 percent of employers reportedly using rewards rather than penalties….”

“Incentives are offered in financial form…and…items such as gift cards….”

“Employers who use incentives…report significantly higher participation rates….”

For implementation of the ACA, incentives might be used to improve relations among insurance companies, providers, and patients.

An effort could be made to learn from businesses that excel in incentive efforts, such as “frequent flyer miles”, rebates, and gift cards.

Insurance companies and providers might award “points” for out-of-pocket payments by patients, to help them feel better about having to spend money personally toward copayments and deductibles.

Providers could award points to help offset narrow-network resistance and when patients conform to recommended treatment.

And insurance companies could award points to providers for doing a good job.

Perhaps everyone could benefit by reasonable efforts to encourage desired behavior, to help take the “sharp corners” off of mandates.

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.