Open enrollment for health insurance under the ACA may have ended February 15, but an extra enrollment period (Special Enrollment Period) will take effect March 15 to April 15. So if you missed the deadline, you might have a few options to get coverage.
Managed care has been around for almost one hundred years, at least in theory. When placed up against fee-for-service payment models, however, it was a hard sell. Traditionally, the way that physicians were compensated for their services was a fairly straight-forward invoicing process: they would bill the patient (or later, the payer) for everything they did in terms of diagnosing or treating the patient. Everything.
Five years into the Affordable Care Act, the healthcare climate of the United States has continued to evolve and improve. While there are some long term changes required that have just begun to take shape, many changes brought about by the ACA are immediate gratification. Changes to Medicare and Medicaid have helped many Americans gain coverage that they previously wouldn’t have had access to. While the system is imperfect, there’s plenty of positivity to consider since it launched in 2010.
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?