CHA News Article

CHCF Releases Brief on Patient and Provider Care Experience Under ACA
Findings suggest opportunities for improved transparency and greater consumer education

The California HealthCare Foundation (CHCF) has released a report titled Patients and Providers Speak: Early Care Experience Under the ACA. The study provides early insight into the Affordable Care Act’s (ACA) successes and challenges from the perspectives of consumers and providers in California clinical organizations. According to the study, consumers enrolled in qualified health plans through Covered California described challenges associated with understanding their coverage and obtaining care, yet were generally happy with the care they received since January 2014.

Other highlights from the research include:

Consumers’ Experiences Under the ACA

Experiences of Care

  • Consumers are generally happy with the care they have received.
  • Spanish-speaking consumers have been able to receive care in the language they prefer.

Cost and Coverage

  • Consumers were thankful to finally have health insurance coverage.
  • Most consumers were pleased with premiums and copays.
  • Consumers struggled to understand what services were covered under their health plans, and their cost-sharing responsibilities.
  • Consumers found it challenging to obtain costs and coverage information that was accurate, consistent and easy to understand.
  • Consumers want dental and vision services covered through their medical insurance.
  • Many consumers had to change medications because of restrictive prescription drug formularies.
  • Consumers who were able to keep their trusted doctors or to find an in-network doctor easily were satisfied with their health plan networks.
  • Consumers transitioning from Medi-Cal or no health insurance may be the most satisfied with their health plan networks.
  • Consumers who encountered inaccurate or ambiguous information about health plan networks were not satisfied with their health plan networks.
  • Finding in-network specialists was more difficult than finding in-network primary care physicians.

Access to Care

  • Appointments for specific conditions and routine care were easy to get quickly, while specialty care appointments took longer.
  • High deductibles led to delays in care.
  • Consumers delayed care while sorting out network scope and information challenges.
  • Inaccurate provider network information meant that consumers received care from providers who were not their first choices.
  • Consumers, particularly in nonurban areas, may be traveling long distances to see in-network specialists.

Clinical Organizations’ Experiences Under the ACA

Systems Changes Made to Accommodate ACA Implementation

  • Some providers attempted to increase capacity and infrastructure to manage changes under the ACA.
  • Some primary care providers have to refer their patients to new specialists.

Health Plan Contracting and Payment

  • Claims processing occurred more smoothly than expected, and administrators are optimistic for further improvements.
  • Administrative staff found the pre-authorization process for medications labor-intensive.
  • Provider representatives found the process for contracting with qualified health plans offered through the marketplace confusing and lacking in transparency.
  • Satisfaction with reimbursement rates varied by type of clinical organization.
  • Provider organizations experienced increases in patient volume.
  • Provider representatives noticed more patients with chronic conditions accessing care.
  • There has been an increased demand for preventive services.
  • A few provider representatives reported slight changes in race/ethnicity and primary language of patients being seen.

The full report is available on the CHCF website.