Solutions

Daily, patients around the country rely on clinicians to protect their health and maximize their time with loved ones. But, as a result of confusing insurance coverage policies, patients delay – or even forgo – medically necessary preventive care or other treatments, even when recommended by their clinician.

Patients are not the only ones turning away from medicine. We've heard directly from our clinicians working directly with patients - burnout has reached an unprecedented level due to the administrative requirements. When policies force healthcare’s greatest experts to take a step back, solutions must be identified now to drive clinicians back to the bedside.

Removing barriers to annual wellness care

After listening to all the people impacted by government mandates - our frontline clinicians, patients, and support teams - the Center is taking action on the most readily identified issue: The significant challenges created by annual checkup coverage and documentation policies.

The problem

Under the Affordable Care Act (ACA), preventive care – including annual checkups – is supposed to be fully covered by public and private insurers at no cost to the patient. However, the ACA and resulting health insurance coverage policies fall short of realities. Today, insurer approaches to preventive care coverage vary widely, making what is and is not covered confusing for both patients and clinicians. What nearly all of these policies have in common, however, is that discussion of any chronic condition or acute health concern is not covered as part of an annual checkup. If a patient wants their clinician to address such issues, it triggers a separate evaluation and management visit in addition to the annual checkup, often requiring out-of-pocket patient cost-sharing and the need for clinicians to document two distinct office visits.   

For patients, this means unexpected bills and growing frustration with a healthcare system driven by coverage decisions. For clinicians, this means more time spent on documentation and less time spent with patients. The mental and financial burden that result are driving clinicians away from practice and patients away from care.