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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“Fixed Indemnity Plans” – Not so Fast

The Wall Street Journal article noted “The federal government … announced … that it would require people who wanted to buy a particular type of insurance called ‘fixed indemnity plans’ to demonstrate first that they also had traditional health-insurance coverage.”

“Fixed indemnity plans typically pay a limited cash benefit, with no deductible, to people who are hospitalized or encounter other medical costs. But the federal government said it was concerned that people might confuse those plans with standard health-insurance plans, and that the fixed indemnity plans alone couldn’t be considered to be coverage under the law’s requirement for most people to have insurance or pay a penalty.”

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Some Plans Will Not Pay for a Doctor Visit before You Meet Your Annual Deductible

Just when you thought that maybe you sort of understood the cost of an Obamacare health care insurance policy, a Kaiser Health News article noted: “This could be the next shoe to drop, as people don’t realize that if they’re buying a bronze plan, they may have to pay $5,000 out of pocket before it contributes a penny…”

“Experts worry that some enrollees will be discouraged from seeing doctors if they have to pay the full charge, rather than simply a copayment.”

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Value-Based Insurance

“If patients insist on medical procedures that science shows to be ineffective or unnecessary, they’ll have to pay for all or most of the cost.”

We all “demand” tests and prescriptions from out doctors and it is often easier for them to comply than argue. Now there may be a price to pay.

The Reuters article reported on “value-based” insurance with this vignette:

“When Tanner Martin, 17, developed excruciating back pain last year, he was sure he needed an X-ray to find out what was wrong. So was his mother, who worried that the pain might indicate a serious injury that could cause permanent disability.”

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“Under REFERENCE PRICING the Employer or Insurer Sets a Maximum Contribution … Toward the Payment for a Test or Treatment.”

The Wall Street Journal explored the health care insurance concept of Reference Pricing.

“The employee or enrollee can select any hospital or clinic but must pay the difference between the contribution limit and the actual price.”

“Reference pricing serves as a reverse deductible. Rather than the patient paying up to a defined limit and then the insurer covering the remainder, the insurer pays up to a defined limit and the patient pays the remainder. This has the remarkable feature of exposing the patient to the variation in prices for treatments that are above deductible thresholds. And the patient’s contribution isn’t limited by an annual out-of-pocket maximum.”

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