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Apr 07 2013

Obamacare Seeks Navigators – Is There a Role for You?

navigationIt seems that word is getting out about one of the aspects of the Affordable Care Act that hasn’t been highlighted much before now.  That is, the role of “navigators” and “in-person assisters” as they are called by the government.  Many of the folks who read this blog are interested in whether there is a role for them (especially whether they can make any money from such a role!)

The answer is – maybe – but probably not.  Because these “navigators” may not be what you think (or hope!) they are.

Here’s why:

Reason #1:  Obamacare navigators will be tasked with helping insurance customers – both individuals and small businesses – choose the right insurance plan for them to help them fulfill the individual mandate.  This form of navigation will have nothing whatsoever to do with shepherding someone through their healthcare journey. It will have everything to do with helping them review and choose health insurance. If you are a patient advocate who works in the insurance realm, you may find something here, but….

Reason #2:  ACA Insurance Navigators will be organizations, not individuals.  They will be groups like Chambers of Commerce or senior groups or church groups or small business organizations.  Now, it is possible that a for-profit business might be selected to be an ACA Navigator, but since none of this choosing has happened yet, we just don’t know. If a for-profit entity is chosen to be a navigator, there will be a list of proficiencies it will have to showcase ranging from cultural and literacy knowledge to knowledge of health insurance plans in general.

Reason #3: Navigators will function only in those states that establish Insurance Exchanges (also called Marketplaces).  As of early April 2013, only 18 states have decided to host their own exchanges.  It is thought that “in-person assisters” will be used in the states that do not develop exchanges but again, since none of this has been implemented yet, there are still questions.

There is much still to be decided, and an entire system to be implemented before ACA navigators begin serving consumers to help them choose the right insurance program for them.  The target date for the opening of the exchanges / marketplaces is October 1, 2013.

Learn more about the development, training and funding for Obamacare Navigators.

APHA Members:  If you have questions about these new navigators, please post them in our Forum so we can share answers with others (You’ll find the question has been added to our Forum.)

If you are not an APHA member, you can sign up to be notified with updates here.

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Update April 9, 2013:  new information was forwarded from CMS this afternoon and has been posted in the APHA forum for those who are interested.

 

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4 comments

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  1. Sue Radcliff

    I was planning to post the following from the Health Affairs blog, for those who are interested in even more information:

    Tim Jost explains new federal regulations establishing standards to govern exchange ‘navigators.’
    http://healthaffairs.org/blog/2013/04/04/implementing-health-reform-proposed-regulations-for-exchange-navigators/

    He also writes about the final rule on increased Federal Medicaid Matching Funds and the FAQ on Medicaid Premium Assistance Programs.
    http://healthaffairs.org/blog/2013/03/31/implementing-health-reform-final-rule-on-increased-federal-medicaid-matching-funds-and-faq-on-medicaid-premium-assistance-programs/

    Colorado’s Health Benefits Exchange is contracting with a number of existing organizations (as Trisha notes) to fulfill the ACA Patient Navigator role.

    In general, Health Affairs provides some of the most respected health policy research and commentary. Both their monthly electronic table of contents (free) for the journal and their weekly Health Policy Update (also free) are one way to keep up with current topics. http://www.healthaffairs.org

  2. Trisha Torrey

    Sue – good information – thanks so much for posting.

    You and I will have to agree to disagree on the general benefit of Health Affairs. In general, I am not a fan of theirs. Their work is focused on providers’ points of view and rarely (if ever? I’ve never seen it) accounts for patients and their ability to share in decisions, participate in their care, etc. They treat patients as if we are invisible.

    I have publicly posted my opinion about Health Affairs: http://patients.about.com/b/2011/04/07/health-affairs-briefing-patients-becoming-less-invisible.htm

    Two years later, still nothing has changed.

    So while I do agree with you that they offer good resources on some topics (and this one happens to be one of them), I find them too often to be anti-patient and therefore not balanced in their presentations. I believe that’s a major disservice to their readers.

    1. Sue Radcliff

      Trisha,

      It’s certainly also my experience that many (probably most) medical journals don’t focus on patient experience or engagement. But perhaps Health Affairs recently redeemed itself, at least in the February 2013 issue (vol 32, number 2) that was entirely dedicated to the “New Era of Patient Engagement.” The trick will be how this topic is integrated in future issues.

      I do think it’s a (finally) emerging emphasis, although I agree that the culture probably will be more receptive in some environments (and publications) than others. In fact, there was an article on today’s Health Leaders Media news post titled “Patient Advocates Are Not the Enemy:”

      http://www.healthleadersmedia.com/content/LED-290839/Patient-Advocates-are-Not-the-Enemy

      In addition, last year I completed a project with the American Geriatrics Society, updating guidelines on “Potentially Inappropriate Medication Use in Older Adults” that included public/patient participation in the development process. There are also a number of specific public education resources related to the guideline on the AGS website.

      http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2012

      Since my advocacy/navigation experience is limited to family members, I also recognize that my perspective is limited at this point. I’m still taking coursework and building “infrastructure” for my practice. So, I appreciate the wisdom of your extensive experience and frame of reference.

      Sue

  3. Teri Dreher RN CCRN iRNPA

    My information from Illinois is that “Navigators” will not be allowed to advise in any way, or the hospital they work for (or Medicaid office) will be penalized for non-insurance industry trained personnel offering professional advice. The president of the Illinois Hospital Association told a group of insurance industry underwriters last month that navigators will basically just point incoming patients to a computer in the lobby to sign up for insurance on the Marketplace. Any advice or counsel of any kind is absolutely not allowed. To get federal funding for the salaries of navigators, the state must call them “in person assisters”. The whole thing is very political here and likely elsewhere. I am advising clients to get make careful, well thought out decisions with trusted advisors who know their personal situations. Federal subsidies for insurance will be available privately as well as on the web based marketplaces. Most of the hhs and various government websites give a decidedly positive spin on the ACA and ignore the pitfalls. Advocates need to get educated and be able to discern propaganda and hype from reality for our clients. It’s a whole new world we are entering…….buyer beware!

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