Insurers Fill Gaps in Health-Law Plans

The Wall Street Journal article noted “Health insurers in several states are adding to the choices of doctors and hospitals in their health-law plans amid concerns among some consumers and state officials about access to care.”

“The insurers that are expanding their networks said they aren’t responding to complaints. Instead, they said, the tweaks reflect more willingness by some health-care providers to join the new networks, which often pay them less than traditional employer plans, as well as adjustments to serve the specific populations who enrolled.” Read more

The Foreign Language of Health Insurance

The Kaiser Health News article noted “As soon as Deb Emerson, a former high school teacher from Oroville, Calif., bought a health plan in January through the state’s insurance exchange, she felt overwhelmed.”

“She couldn’t figure out what was covered and what wasn’t. Why weren’t her anti-depressant medications included? Why did she have to pay $60 to see a doctor? The insurance jargon – deductible, co-pay, premium, co-insurance – was like a foreign language. What did it mean?”

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Shift from Fee-for-Service Medical Care to Fee-for-Quality

The Forbes article noted “If you didn’t know it, the key intent of Affordable Care Act is to shift medical care from fee-for-service to fee-for-quality.”

“For too long, hospitals have gorged on referrals into their systems and walk-ins to their emergency rooms. But besides electronic medical records—a low hanging fruit–hospitals are hailed widely as being inefficient and sloppy. But the game changes when hospitals start getting paid for how many people they heal, not how many people they process. Think: outcomes not transactions.”

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Link between Internet Use and How Often You End Up in the Emergency Room

The New York Times article noted “At least that’s one of the curious connections to emerge from a health care analysis project at the insurance division of the University of Pittsburgh Medical Center.”

“It is at the forefront of an emerging field called predictive health analytics, intended to improve patients’ health care outcomes and contain costs. But patients themselves are often unaware of the kinds of intimate details about their households that insurers and hospitals may use to try to sway their treatment decisions.”

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Report: 7M People Can Get ObamaCare Early

The Hill reported: “Almost 7 million people can sign up for health plans under ObamaCare even before the new enrollment period begins in November, according to an advocacy group.”

“Enroll America, an ObamaCare enrollment group with close ties to the White House, said Wednesday that millions of adults are eligible to sign up for insurance before Nov. 15 because they have moved, gotten married, had children, lost insurance or become American citizens.”

“Even though millions of Americans got covered before open enrollment closed earlier this year, we’re not resting on our laurels since seven million consumers might have the opportunity to get covered even now through a special enrollment period,” said Anne Filipic, president of Enroll America.

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Federal Health-Exchange Plans to Automatically Renew

The Wall Street Journal article noted “The Obama administration plans to automatically renew for next year the health plans and premium subsidies that consumers obtained through the Affordable Care Act’s federal insurance exchange.”

“The move, which will apply to most of the five million people who selected insurance through HealthCare.gov for 2014, will make it easier for consumers to stay in their plans and retain tax credits lowering the cost of coverage. It also will relieve pressure on the federal exchange, which was crippled during parts of its first enrollment period.”

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Will Your Employer Switch to A “Private Exchange”?

We are getting familiar with “public exchanges” under Obamacare.

The Wall Street Journal article noted “Most U.S. employers will continue to sponsor health benefits for their employees over the next few years, but the way that benefits are provided may begin to shift for many workers, according to a report.”

“These private exchanges, modeled around the Affordable Care Act’s state exchanges, allow employees to ‘shop around’ for different plans and insurance companies, depending on how much their employer is willing to subsidize healthcare…”

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Can Corporations Shift Workers with High Medical Costs … to Online Insurance Exchanges?

The Kaiser Health News article noted “…Employers are inquiring about it and brokers and consultants are advocating for it.”

“Health spending is driven largely by patients with chronic illness such as diabetes or who undergo expensive procedures such as organ transplants. Since most big corporations are self-insured, shifting even one high-cost member out of the company plan could save the employer hundreds of thousands of dollars a year — while increasing the cost of claims absorbed by the marketplace policy by a similar amount.”

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Beware of Consumer Directed Health Plans!

The Health Affairs article reported on Consumer Directed Health Plans, noting:“Consumer-directed health plans (CDHPs), which feature a high deductible and a personal health savings account, can reduce medical spending by employers and consumers.”

“Patients enrolled in CDHPs had fewer episodes of care over the same time period than patients enrolled in traditional plans. Furthermore, these patients were found to have fewer visits to specialists, fewer hospitalizations, and lower use of brand-name drugs — all of which lowered their costs.”

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