Online Program

Adapting to patient coverage changes: Health care reform implementation lessons from a large healthcare system in Massachusetts

Monday, November 4, 2013 : 8:50 a.m. - 9:10 a.m.

Kim M. Simonian, MPH, Community Health, Partners HealthCare, Boston, MA
Denise McFadden, MPH, Community Health, Partners HealthCare, Boston, MA
When Massachusetts implemented its health reform law in 2006, health care providers needed to understand new coverage programs, including how to enroll patients in new coverage options and the benefits associated with each. Partners HealthCare undertook a series of internal educational efforts to respond to these changes. The system employs nearly 100 patient financial counselors who needed training on the new programs. Practices and physicians needed information about which new products were accepted and which benefits were included. Case managers and social workers needed to understand post acute benefit levels. Staff from Government Affairs, Public Affairs, and Community Health relied on a number of mechanisms to educate staff: trainings, presentations, email updates, materials development, and ad hoc workgroups were ways to reach different audiences across the system's hospitals and health centers. While health reform resulted in shifts in patient payer mix across provider sites, with greater numbers of insured patients, there were also unintended consequences. Despite better coverage options, the level of complexity in the new system necessitated a greater level of assistance in patient navigation. Gaps among the many programs emerged over time, causing disruptions in coverage and care for certain populations. The Affordable Care Act will undoubtedly create many of the same needs for health care systems across the county, and providers should be equipped to take advantage of new coverage options and raise their voices if and when disruptions in care arise.

Learning Areas:

Administer health education strategies, interventions and programs
Administration, management, leadership
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Describe steps undertaken by a large healthcare system in response to state health care reform. Discuss challenges that arose with health care reform implementation at the provider level.

Keyword(s): Health Care Reform, Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was responsible for implementing health care reform coverage changes for Partners HealthCare and led much of the work being presented here. I have been working in public health and health care for 20 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3035.0: Health care reform