Local hospital gears up for ACA

-A A +A

Health Care > Staff is assisting community members with information

By Arin McKenna

Los Alamos Medical Center is ready and willing to help county residents maneuver through healthcare changes triggered by the Affordable Care Act.

“A very good friend of mine said, ‘Feliciano, I look at it like this. Either we’re going to be a part of the process or the process will supersede us,’” said LAMC’s Chief Executive Officer Feliciano Jiron.

“Hence, all of our efforts to educate the public, partner with different organizations and associations, partner with our county government, and work with our state agencies; because the process is going forward. How we become a part of that process and how we steer people in the right direction is a role that we have to play as a hospital and as a community organization.”

LAMC is taking a multi-pronged approach toward providing the public with information about the ACA and assistance with signing up for insurance.

“We thought it was important to go out and create an opportunity to educate the public, because of the fact that as a hospital and at LifePoint (LAMC’s parent company) we’ve recognized that there were some shortcomings with some of the implementation and education of the public,” Jiron said.

“So what we wanted to do was to create an opportunity, a portal for people to gather information and really disseminate what was going to be relevant to them.”

“Whoo…Who’s covered?” is the center’s outreach program, available to both English and Spanish speakers.

The webpage on LAMC’s website explains simply and concisely the key elements of the ACA and what documents consumers will need to sign up for ACA coverage. The one downfall with the page is that it does not contain links to either bewellnm.com, the state’s ACA website, or to healthcare.gov, the website for those who wish to register online.

Those seeking information or help signing up can call 1-888-982-9144 or email LosAlamosCAC@lpnt.net. Assistance is available 24/7. In person appointments may be scheduled Monday through Friday during normal business hours, and by appointment after hours and on Saturdays.

The hospital has trained “navigators” available, personnel who are qualified to help individuals sign up for insurance through ACA exchanges. LAMC initially trained staff as CACs, or Certified Application Councilors, but when the State of New Mexico informed them that only those trained as navigators (an updated version of CACs) would be allowed to sign people up, LAMC sent all their CACs for 20 hours of additional training.

Although the state has yet to send the navigator’s certificates, they are already assisting people.

LAMC has also been working with various entities to not only expedite the rollout of the ACA but to provide educational workshops to the public.

This education blitz is geared toward walking people through the new options.

“If you say to somebody, the plan is going to be bronze; the man on the street doesn’t understand what bronze is. He just wants to know, am I covered if I go to see my family practitioner, if I need a cardiologist? Can I go to the hospital? What’s my co-pay? What’s my deductible? That’s pretty much the extent most of us understand our healthcare,” Jiron said.

“But now, suddenly, you’re expecting the public to become as educated as those people who are inside the healthcare system, who have a better understanding of what each of these components is going to mean.”

Navigators can also help consumers determine which of the four insurance companies participating in the New Mexico exchange have the particular providers someone wants.

The hospital itself has already signed agreements with three of the four insurance companies in New Mexico’s exchange (Blue Cross/Blue Shield, Lovelace and Presbyterian) and is in discussions with New Mexico Health Connections, the state’s new nonprofit agency.

Jiron does not yet know how Blue Cross/Blue Shield’s recent purchase of Lovelace will affect the exchange plans.

The ACA implementation has had one surprising outcome. Many of those seeking enrollment in ACA insurance plans are discovering they are eligible for Medicaid, and not simply because of the expanded Medicaid program. That includes seniors whom healthcare providers identify as Medi-Medis: those eligible for both Medicare and Medicaid.

“We’re seeing that across the state, realizing that a lot of people are eligible for Medicaid who didn’t realize that they were. We were just not aware that so many people would qualify. So we’re discovering all these flaws in our system, all these people eligible for benefits we were unaware of,” Jiron said.

“And with the Medicaid expansion extending the qualification points, now we have the opportunity to go out and assist those people and get them enrolled much quicker.”

Those eligible for Medicaid are directed to Alberta Lopez of First Source (661-9162), who will be handling Medicaid signups once the state sends her certificate. Lopez is trained and ready to go as soon as the certificate arrives.

Despite all the preparation, the impact the ACA will have on LAMC is unclear at this point.

“I won’t say we’re on top of it,” Jiron said.” We’re just trying to keep from being put underneath it. It’s a steamroller and it’s heading our way. We won’t know what it’s going to mean for us until next year.

“It’s just a different time for us in healthcare in that so many things are changing. And what I will have to say is that the one constant that we’re seeing right now is change.

“And at the same time, this is an exciting time for us in healthcare. I think it’s going to really be neat to come out the other side and have that experience, to be that much wiser organizationally and professionally, having gone through this much change in an industry; to be part of such amazing change, and to be able to look back in five years and say, I remember that. I remember that change.”