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Posts Tagged ‘health care reform’

Analysis of proposed health reform policies

prez_seal_stethHealth reform has remained a hot topic throughout the recent months leading up to the presidential election. Here is a breakdown and analysis of a few proposals put forth during the 2016 presidential campaign.

Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.

Regardless of your political affiliation, I think we can agree there are many aspects of The Affordable Care Act (Obamacare) that have mitigated the current health care crisis. The law has mandated more comprehensive coverage of health plans, for example, dependents must be eligible up to age 26, there are no more lifetime limits Read more…

Blue Cross of MA expands pay-per-performance system to PPO markets

dr_patientThe spotlight in local health care news this week shines on Blue Cross Blue Shield of Massachusetts and its continued efforts toward performance-based payment reform for doctors. This system that pays doctors based on how well they care for patients will expand to include more than one million members. For patients, this should mean a decrease in office visits and unnecessary testing, and an increase in individualized health management and post-procedural care.

Currently, a fee-for-service system accounts for 66 percent of the Massachusetts market. Specialists agree, this traditional practice – one where doctors are paid per patient visit, needle prick and procedure – encourages unnecessary testing and overbooking appointments, often under prioritizing patient health. Read more…

House votes to repeal Affordable Care Act

obamacare_repealSince the law originally passed in 2010, many Americans have been closely watching the changing political environment to see what changes happen with the Affordable Care Act (ACA or Obamacare). Employers are watching Washington with an invested interest to see what rules they will need to comply with and which rules might change.

The most recent midterm election resulted in a swing of control to the GOP. Clients are asking what impact this change might have on attempts to repeal the ACA. Regardless of the GOP’s dominance in Congress and in the House of Representatives, WGA believes that Obamacare is not going away anytime soon. Read more…

Study reveals Obamacare users no sicker than those on Commercial Group Products

January 28, 2015 Leave a comment

calc_moneyNewly published data reviewed by Reuters reveals that contrary to popular belief, Obamacare enrollees do not cost U.S. health insurers more than those with employer-sponsored insurance. Prior to the ACA’s launch, some insurers feared that individuals who purchased plans through Obamacare would be sicker than those covered by employer-sponsored group plans, be more likely to seek out costly specialists and to try to get the “most for their premium dollars.”

The analysis included thousands of 18-64 year olds with coverage under the exchanges who use ZocDoc, the free, online appointment-booking tool that’s now accessed by millions of members across the country. First year data showed that newly-insured members were scheduling PCP, women’s health and preventive care visits at a much higher percentage than commercially-covered members. Prior to Obamacare, preventive visits were likely a low-priority for the uninsured, but now that these services are free under the new law, more enrollees are taking advantage of their ability to access care. Read more…

2015 Compliance To-Do’s: Is your checklist ready?

October 15, 2014 Leave a comment

aca_magnifying_glassAs 2014 winds down, employers are longing for a reprieve in benefits compliance after having to endure a year of new, often times complex, guidance related to the Affordable Care Act (ACA), HIPAA and same-sex spouses. Unfortunately, to-do lists are only going to get longer as employers review their plans and get ready for the approaching challenges and deadlines arising in the upcoming year. Below is a summary of three main compliance issues for employers to keep on their regulatory checklists in the coming year. Read more…

“Dumping Sick Employees” – it’s legal but is it right?

September 30, 2014 2 comments

A minor but potentially significant omission from the voluminous ACA regulations may result in a material adverse impact on the risk mix and rate stability of the individuals signing up for health insurance under state and federal exchanges. As written, the ACA regulators will allow an employer who can identify their sickest chronic employees to potentially incent those members to drop their group coverage and sign up for the local state exchange. Nothing in the federal regulations today prohibits an employee from waiving their group health care and buying individual coverage on the exchange – an omission that may prove costly for the government exchanges.

It works like this: an employer has a medical plan where a handful of employees are identified with upcoming or ongoing claims in excess of a threshold, say $75,000 a year. These employees traditionally drive 70%-80% of the overall plan cost and contribute to a high rate renewal and the inability of the employer to shop for a different more affordable plan. The employer approaches those employees Read more…

More all-payer claims databases could mean more transparency

computers_techOver the past several years, many states have begun using all-payer claims databases (APCDs) to help create more  transparency throughout the health care industry. Similar to the Health Care Cost Institute’s new online consumer health care portal, APCD’s are designed to shed light on the price differences that various health care providers (doctors, hospitals, health care systems) charge for the same procedures. They require all commercial insurance carriers within a state to submit claims data and prices paid for services, and typically include medical, dental, pharmacy and mental health claims from all providers in the state. The data uses codes (rather than individual names and addresses) for privacy protection about specific patient claims, and business claims are kept private by providing only the median prices paid to providers for each service. The information helps consumers make decisions about where they go for treatment, and can also be used by insurers and large employers to design cost-effective benefit plans. In addition, state officials have used APCD’s to help develop health care policies and measure results. Eleven states (including Massachusetts) already have these systems in place, while 19 are currently developing APCD’s and another 21 more have introduced laws to create them.  Read more…