Physicians

Could Med Students Help Win the Enrollment War?

State health exchanges are facing many challenges in the recent scramble to enroll their residents in the healthcare marketplace. Among the numerous obstacles, including online systemic glitches (Washington state botched the tax-credit calculation while Maryland’s appears to be having just general technical incompetence) and complete lack of knowledge (according to a recent Gallup poll, 71% of uninsured Americans have no clue what the exchanges are), a critical challenge is the quick generation of a new healthcare workforce, namely enrollment counselors and navigators.

According to the Center for Medicare and Medicaid Services, enrollment navigators are supposed to help people enroll, whether through online or paper applications, determine individual eligibility for various subsidies and assistance programs, and generally educate the public regarding the new health exchanges. Certified application counselors differ slightly from navigators, taking a less involved role in the process, but still serving as assistants to people who need help completing their application.

However, in many states, including Florida (1 navigator per 100,000 uninsured citizens as of October 1st), Georgia (only 4 people were certified to be counselors when the exchanges went live) and California (official numbers will be released on November 14th, but current estimates suggest less than 20% of future counselors are fully certified yet), there is a huge workforce shortage which is both reducing the rate of enrollment and contributing to people’s doubts about the Affordable Care Act in general.

Part of the problem is that many states, for several months now, have purposely made it more difficult for people to become certified enrollment employees; Ohio and Missouri are  widely cited as two of those. They have also instituted regulations on what information counselors can and cannot give patients and have tried to implement large fines, such as in Tennessee, which luckily ruled to temporarily restrain these penalties, for those who may unknowingly breach part of the contract.

As a medical student hoping to be more involved in influencing patient care, but unable to do so at a clinical level just yet, the opportunity to serve as an enrollment counselor or navigator is more than timely.

In my home state of California, training and certification to become a Certified Enrollment Counselor is not easy, but it’s doable. The process involves 20 hours of in-person courses, a number of online modules, and a background check. However, the cost of training is compensated—$58 per completed application, to be exact.


A recent study showed that many uninsured patients do not even have basic knowledge of insurance terminology, let alone a strategy of how to go about securing an insurance plan from the exchanges. As students, even helping to improve health literacy and teaching workshops at local clinics on basic insurance concepts would be a significant community service contribution. A group of medical and public health students at my school, UCLA, and USC are forming a collaborative to serve as certified enrollment counselors.

This experience will allow the next generation of medical leaders in our state to hear first-hand the challenges that patients face in terms of practical considerations that are often left out of medical school curricula, including financial limitations that restrict patient decision-making.  In today’s healthcare system, health professionals are not the only ones to have a direct impact on healthcare outcomes for millions of Americans—the opportunity for students awaits.

Abraar Karan is a Yale graduate and MD candidate at UCLA. He blogs at Swasthya Mundial.

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corporate gifts wholesale singaporedomainhttp://www.pcmlabo.com/AbraarDr. Rick Lippin Recent comment authors
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Guest

What’s up to every one, the contents present at this web page are in fact amazing for people knowledge, well, keep up the nice work fellows.

domain
Guest

Hello are using WordPress for your blog platform?
I’m new to the blog world but I’m trying to get started and create my own. Do you require any coding expertise to make your own blog?
Any help would be greatly appreciated!

http://www.pcmlabo.com/
Guest

you might actually will correct M ‘s. wi ‘m a normal FORMER RITTERNET customer left when a lmost all they offer men’s was di also – around us and went along to sudden l tattoo. discussion through ritternet website check out curious going up against determine if they offer education broadband if this happens. each phase parents primary nightmare is figuring out the little one is missing. the fact is a child is a good idea victim of fou d play or maybe but additionally the baby being voluntarily chosen to errant. my own detectives often work together with twos… Read more »

Dr. Rick Lippin
Guest
Dr. Rick Lippin

Why not dispatch hundreds of Government vehicles/vans-

– Call them “OBAMACAREMOBILES” –

-to US communities to sign up people who can’t use or navigate the broken website?

Neel Shah, MD, MPP
Guest

I applaud Abraar for wanting to take an active role in helping patients navigate the complexity of the healthcare system – at the end of the day, this is one of our most important jobs as physicians. The IOM, AAMC, and ACGME have all identified the importance of training “systems thinking” physicians and Abraar is on the leading edge. Sure, students have a lot on their plates, but understanding the mechanics of patient affordability is no less important than understanding genetics. Navigators, particularly those who are well informed, can play a critical role in addressing the gaps in public understanding… Read more »

Peter1
Guest
Peter1

“A recent study showed that many uninsured patients do not even have basic knowledge of insurance terminology, let alone a strategy of how to go about securing an insurance plan from the exchanges.”

Insurance and their for-free marketing government exchanges are not the solution.

Joel Hassman, MD
Guest
Joel Hassman, MD

Talking about taking advantage of “slave labor”! As if med students don’t have enough on their plates to learn how to diagnose and treat people, now the government is going to coerce them into selling this travesty?? Memo to any med students reading here, ask the apologists and defenders of this ilk legislation why, to my knowledge at least, less than 50% of practicing doctors in the US (and I am being charitable with that figure) support PPACA. So why should you help the government when the government is more than likely to NOT help you once you finish your… Read more »

Abraar
Guest

Joel, I understand your frustrations with the government. The fact is, the ACA is now law. As students, we are still focused on what is best for our patients today and tomorrow.

Paul
Guest
Paul

I would be concerned about advocating for ACA, thinking it in the best interest of your patients now or ever, when, there is some very serious doubt that it is a viable piece of legislation, and it could very well be repealed. Its flaws are so wide and deep because of flawed goals and unanticipated consequences. By being a medical professional navigator, you would have an aura of competence that no other navigator could possible have. Wouldn’t you feel just awful if you helped a citizen sign up for something that is truly harmful to them, the country and our… Read more »

Jardinero1
Guest
Jardinero1

There are several tens of thousands of LIfe/Health agents around the country who could facilitate enrollment. They happen to be fully versed in health insurance and had to pass licensing exams to prove it. Alas, they are specifically prohibited from acting as navigators. Too bad, so sad. All that talent, utterly wasted.

Tony Jewell
Guest

Which makes absolutely no sense at all. Why Congress and the Administration, in all their wisdom, believe a community group can help people “navigate” the insurance marketplace better than a broker is one of the biggest farces of this whole thing.

And it is a farce at its core.

Caleb Wilson
Guest
Caleb Wilson

Fee for service navigators are completely different from FFS physicians mainly because this service can only be preformed once per patient per insurance cycle (re-enrolling patients is also reimbursed at a much lower rate). There are many other reasons which I won’t go into but that comparison doesn’t make sense to me. Second, the ACA is no longer political. It is the law. Regardless if you agree with it or not it is law and the fact of the matter is connecting patients to care involves getting them insurance. SR it is sad that some facilitators are not well informed… Read more »

Paul
Guest
Paul

Medical school is a full-time endeavor and then some. No medical student I have known over 4 decades (I was a professor) has had time to work. If this student were to commit to help folks with ACA, he would have to sacrifice precious time needed to study and learn the craft of medicine, or not do a good job as a facilitator. Whatever you do, you should do with 100% effort.

Caleb Wilson
Guest
Caleb Wilson

Hello Paul, Thank you for your comments and insight. I am a little biased because I’m one of the medical students involved in organizing this effort. So far we have 145 student members between UCLA and USC medical and MPH students. While I think your concerns about not being able to work in medical school are valid I don’t think it’s as black and white as you describe. First, these medical students are largely first and second year students and the way our curriculum is set up we actually do have some time undertake this endeavors adequately particularly in the… Read more »

Tony Jewell
Guest

The answer would seem to me that navigators should know considerably more about the insurance system than the people they are trying to help.

Pouring millions into community groups with no expertise in health insurance seems like another way to waste money without actually help patients to, you know, enroll (even if they could get beyond the technical challenges).

Abraar
Guest

But the fact stands that we are having a shortage in the workforce…

userlogin
Editor

While I appreciate your desire to be more involved, I think you’re overreaching. First, having had several conversations with ‘facilitators’, I am shocked at their relative uselessness. True, I am both a physician, a business person, and someone fairly knowledgeable about this whole process, so maybe my bar is a little higher than the general public….but no, I’m not buying that argument. Any time I pressed for information, I got back a series of fairly rote, unsophisticated answers. This is the problem with the whole let’s give you 20hours of education and then you’re ready to be let loose upon… Read more »

Paul
Guest
Paul

As a medical student, you need to concentrate on your studies. That information learned, as you know, is cumulative, and it will likely benefit the patients you will treat in your residency and in practice. Although your concerns for the healthcare of the folks is admirable, you would be best served to avoid being embroiled in the politics of national health insurance at this point in your career. Later, when you have more experience in the real world, if you want to advocate for something, that would be fine. (from a physician)

Abraar
Guest

Hi Paul,
Your point is definitely valid– I do think, however, that we have a lot to learn about patient challenges with regards to healthcare access. Understanding these issues when we are young and relatively unbiased will be important when we are policy advocates in the future.

userlogin
Editor

Abraar –

You pose an interesting question.You’d think the administration would be encouraging healthcare providers to talk with patients – possibly even give them incentives to help enroll folks at the healthcare system’s main point of contact (you know, those doctor office front desk things with all the busy people filing out forms and answering phones). At the very least they should provide tools and information for doctors to help counsel patient …

joe
Guest
joe

Abraar- serious question:

I am going to assume you oppose fee-for-service medicine.

Why would you support fee-for-service navigator fees? Why not pay navigators for some value based metrics?

Also, why would medical students be more equipped than non-medical students to provide appropriate information and advice re: signing up for insurance?

Today, good brokers provide invaluable services to individuals (preACA) and small businesses on this issue… and big business outsources the extremely complex process to independent firms that can do analysis and give advice?

Abraar
Guest

Hi Joe,
We are working with public health students as well. This was really meant to advocate for all students, not just med students. As you probably know, authors don’t choose the post title.

As for the reimbursement method– we aren’t doing this for the money. I’m all for value-based payment, but our job is to connect people to navigators– hopefully there won’t be too much variation on how we do this (but who knows)

All in all, I think medical students would benefit a lot from engaging with people and understanding the difficulties they are facing with regard to healthcare access.