Open enrollment doesn’t start for a couple more days, but if you’re shopping around the health insurance marketplace, you know that the “window shopping” phase of enrollment has already begun. If you remember the marketplace 1.0 fiasco from last year, and are hesitant to give the new and improved page a go, here’s a rundown of what you can expect when you head over to sign up.
Many people who talk about managed care don’t realize that it has actually been undergoing a bit of a renaissance since the late 1980s - and has existed conceptually since the ‘30s. Since the late ‘80s, MCOs have progressed through several phases: Phase 1: Using utilization review and pre-admission certification to manage access to care. Phase 2: The addition of fee-for-service networks and managing benefits. Phase 3: Shift from utilization review to utilization management with an emphasis on the ‘appropriateness’ of care as well as the care setting. Phase 4: The current phase of MCO development, which has only started in the last couple of years, looks at establishing a continuum of services, lessening the tendency for providers to operate in ‘silos’ which has been the dominant structure of healthcare in the U.S. for years.
When we talk about Accountable Care Organizations (ACOs) , a lot of people think that they are nothing more than a second try at the ol’ Health Maintenance Organizations (HMOs) of the late 80s. ACOs may have some things in common with HMOs, but when you look a little bit closer you’ll see that there are a few very distinct elements that differentiate them.
Accountable Care Organizations are cropping up nationwide. With over 10 million patients covered by Obamacare, the pressure is on for hospitals to acquire ACO status. Accountable Care Organizations were a hot topic of conversation at the beginning of the year, 15 million patients had coverage under an ACO in the U.S. Now, midyear, a new report shows that the number has jumped up to over 20.5 million.
Imagine if your doctor could see your credit card transactions. They’d know when you were going out to eat, skipping out on your gym membership, going out for a night on the town - you name it, they’d know it.
Yet another provision of the ACA, this one concerning ACA subsidies, is under scrutiny, this one could change health insurance as we know […]
A study done by Harvard Medical School, published this week, looked at a private, South African hospital that has been experimenting with incentive programs to improve patient health outcomes. Could something like this ever work in a U.S. Hospital?
With so many ACA delays thus far, is the ACA really what we bargained for? Should the President have the authority to delay ACA provisions at his discretion or is it his duty to uphold the law as written? The Affordable Care Act was enacted in 2010 with provisions becoming effective over several years, many of which have been delayed. Why the ACA delays? •Limited resources for implementing the law •The need to prioritize limited resources •Technological limitations, such as the “glitches” in the computer systems as they related to the healthcare exchanges •Complaints from various quite vocal groups, both political and non •Undue hardships placed on employers and / or employees •Additional time and / or funding required to comply •Tax and reporting requirements •Political reasons
Americans were a little wary of the healthcare marketplace when it debuted this past year, but now, some are beginning to see the benefits - of the benefits. New data released this week from the Department of Health and Human Services reports that new Obamacare customers are paying, on average, about $82 in monthly premiums for their coverage. For many, that’s less than many of their utility bills, such as internet, cable and smartphones.
What will you decide for your organization beginning 2015? Will you “play or pay”? The “play or “pay” principle basically says that if employers with 50 or more full time employees don’t meet the minimum requirements of offering insurance coverage, they will pay very steep penalties. The provision will be phased in beginning in 2015. The “play or pay” principle is part of the PPACA, specifically under the provision of “shared responsibility”.