From Coverage to Care

Strengthening and Facilitating Consumer Connections to the Health System

by Laurie T. Martin, Jill E. Luoto

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Research Question

  1. In the wake of the Affordable Care Act, millions of Americans have gained access to health insurance, some for the first time. Beyond gaining coverage, what else is important to help consumers connect to appropriate health care services and remain engaged with their care over time? What barriers are standing in the way of consumers achieving these latter goals, and what stymies stakeholder efforts to help consumers overcome those barriers?

To date, most Affordable Care Act implementation efforts have focused on getting individuals enrolled in health insurance coverage; indeed, millions of Americans, many of whom had never been insured, have since obtained health coverage, either through the health insurance marketplaces or through expanded Medicaid eligibility, if available in their state. Yet reducing the number of uninsured is only part of the law's goal. It also aims to improve population health and lower health care costs. Less attention has been paid to confirming that the newly insured obtain appropriate health care and maintain long-term relationships with their health care providers, which are critical steps to help achieve these latter goals. This perspective describes lessons learned from conversations with a variety of stakeholders in the health care industry. These conversations covered the gamut of steps consumers must undergo to become fully engaged with their health care, from applying for coverage and selecting a plan to finding a provider, accessing care, and engaging in care over time. In each phase of the process, consumers must take specific actions and overcome new challenges. Stakeholder efforts to help consumers often focus on just one of these phases, at the expense of the bigger picture, and often occur in isolation, with little coordination across stakeholder groups. Thinking more strategically and holistically can help provide the "connective tissue" that can help prevent consumers from becoming disengaged and falling through the system's cracks.

Key Findings

Consumer Engagement in Health Care Can Be Characterized as Phases Along a Continuum

  • The phases range from selecting a plan and applying for coverage, to finding a provider, and remaining engaged over time.
  • Stakeholder efforts to help consumers often focus on just one point along this continuum, at the expense of the bigger picture, and often occur in isolation, with little coordination across stakeholder groups.

Consumers Struggle with Low Health Literacy and Low Health Insurance Literacy

  • When consumers do not understand the terms, they cannot understand important details of their plans, such as covered benefits and out-of-pocket costs.
  • Despite significant efforts, ensuring consumer understanding warrants more attention.

Even After Gaining Coverage, Many Barriers Stand in the Way of Consumers Connecting to Appropriate Care

  • Provider shortages, consumer concern about out-of-pocket costs, and traditional social and structural barriers, such as transportation, hinder the ability of the newly insured to connect to care.
  • More-innovative thinking about ways to deliver health care services and incentivize providers to locate in underserved areas is needed.

In Addition to Strengthening Supports Within Each Phase, There Is a Critical Need to Consider Ways to Support Consumers' Transitions Between These Phases of Engagement

  • More and better coordination across payers, providers, consumer groups, and policymakers will be required to develop sufficient supports for consumers to help them navigate the complex health care system and progress along this continuum.

This research was sponsored by the Centers for Medicare & Medicaid Services, Office of Minority Health and conducted by RAND Health.

This publication is part of the RAND Corporation Perspective series. RAND Perspectives present expert insights on timely policy issues. All RAND Perspectives undergo peer review to ensure high standards for quality and objectivity.

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