Providing Assistance with Cost-Sharing: The Health Exchange Financial Assistance Initiative
The implementation of the Health Insurance Exchange Marketplace in 2014 offered an exciting opportunity to enroll previously uninsured individuals and families in the Greater Richmond area in marketplace plans and increase their access to care. However, many people were unable to afford the premiums, deductibles, and copays that were part of these health plans. This compromised their ability to fully benefit from this opportunity for insurance coverage.
To address this challenge, the members of this collaboration hoped that their efforts would:
- Increase the likelihood that their patients would enroll in a marketplace plan;
- Ensure that those who enrolled in a plan are able to remain covered; and
- Improve access to care among newly covered patients.
Resources and Support from the National Partnership
To support the development of the HXFA, the National Partnership for the Health Care Safety Net conducted a series of interviews with similar financial assistance programs around the country to gain insight about the processes, challenges, and important considerations related to implementing such a program. The information collected from these interviews helped the Richmond partners make important decisions about how to design and structure the HXFA.
Increasing Coverage and Access Among New Enrollees: The Power of Collaboration
The leadership team for the HXFA initiative comprised three local health care providers that target their care to vulnerable populations in the Greater Richmond area, as well as a local medical society. Members of the leadership team quickly recognized that they would be able to accomplish more collaboratively than individually, so they chose to align their efforts in addressing this issue. Together, they hoped to leverage their resources to help local low-income individuals and families fully benefit from the opportunities emerging from the implementation of the Health Insurance Exchange Marketplace.
The leadership team also hired a project manager to support their efforts and convened a group of local stakeholders to provide guidance during the development of the HXFA initiative. The stakeholder group included representatives from:
- Other health systems
- Free and charitable clinics
- Research organizations
Each of the organizations in the leadership team and stakeholder group offered a unique and valuable perspective on how to implement the initiative in a way that was most beneficial for both patients and providers.
Eliminating the Costs of Copays and Deductibles
Although the Affordable Care Act increased access to health care among many people who were previously uninsured, the cost-sharing requirements for the Health Insurance Exchange Marketplaces plans was too much of a financial burden for many low-income Americans. This resulted in the following negative consequences:
- Preventing many low-income individuals and families from becoming and remaining enrolled in a health plan
- Reducing access to necessary health care services among newly eligible individuals and families who have either a) remained uninsured or b) enrolled in a plan but were unable to afford the copays and deductibles
- Restricting revenue among safety net health care organizations because of continued reliance on their charity care programs, which limits their ability to provide comprehensive care to all of their patients, including those who are not eligible for any coverage
Numerous efforts took place to address these challenges in other parts of the country, including HealthConnect, HealthWell Foundation, and Project Access Northwest, but before the development of the HXFA initiative, there had not been any efforts like it in the Greater Richmond area. As in other parts of the country, enrollment in marketplace plans among patients served by safety net health care providers in the Greater Richmond area was low. Therefore, the HXFA initiative filled a crucial gap by helping cover the cost of copays and deductibles for patients, which allowed more patients to become enrolled, remain enrolled, and access the care that they need.
The Partnership for Richmond’s Safety Net
The Richmond Partnership consists of the following organizations:
- Virginia Commonwealth University Health System: an academic medical center and the largest safety net health system in
- VirginiaCapital Area Health Network: a Federally Qualified Health Center that operates six sites in the Greater Richmond Metro area
- The Daily Planet: a Federally Qualified Health Center that operates three health center sites in the Richmond area serving a medically vulnerable population, which includes a sub-population of homeless individuals
- Richmond Academy of Medicine: a local medical society that supports over 2,300 healthcare professionals in the Greater Richmond Metro area
In the News
Health Systems Team Up on Project to Help the Newly Insured, Richmond Times-Dispatch
The Daily Planet and Capital Area Health Network are Key Part of Health Care Safety Net, Richmond Times-Dispatch