Best Hopes for ACA

One of the “best hopes” that came out of the Affordable Care Act was a provision to enhance the role of primary care providers in decreasing the overall cost of healthcare.  The logic simply is that as individuals need more access to healthcare early on, before the issues become a problem, they would be able to receive that care in one of the more less expensive ways – a visit with their primary care physician. Other first world countries follow a similar approach, even taking it one step further by making it necessary to visit your primary care physician before being allowed to see a specialist.

Just today Reuters has reported that “this program has experienced significant success with reducing cost while increasing the quality of care by keeping patients out of hospitals. ” According to CareFirst, its medical home program, in its fourth year, also delivered high-quality care, measured by yardsticks such as whether doctors gave recommended cancer screenings and immunizations. The organization said it saved $130 million or 3.5 percent compared to projected spending under standard fee-for-service.

The savings reached a level "I wouldn't have thought possible," said CareFirst President Chet Burrell. The non-profit covers 3.4 million people in Maryland, Washington, D.C., and northern Virginia.”

This program has had other significant contributions towards modern healthcare management. Primary care physicians who have historically not made nearly as much money as other physicians, especially specialist, are now seeing upwards of $148 dollars for participating in the program as opposed to the $100 dollars they might have traditionally received.

This program is largely reliant on medial data, which compares specialists rates, and alerts patients and physicians when it’s time for a check ups, medications, etc.

Unfortunately not all organizations who have participated in this program have shown success. Certainly as these organizations continue to work out the ‘kinks’ there will be more success stories. 

Share your Thoughts:

Have these changes on healthcare management and the way healthcare is being distributed impacted you personally? What can we as consumers do to establish a more viable healthcare system? What can healthcare management do to increase the quality of care and decrease cost of care for patients?

Sources:

http://www.reuters.com/article/2014/07/10/us-healthcare-medicalhome-idUSKBN0FF0AI20140710

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Thank you to Baylor University MBA in Healthcare for keeping their students engaged and aware of the changes in healthcare management and how we can impact patients and healthcare for the better. 

The Copper Plan: Another Possible Healthcare Plan?

Last week, with only four days left for those who were uninsured to enroll in the new healthcare marketplace, lawmakers were getting closer to creating a whole new level of healthcare options that would meet less than what was minimally acceptable by the Affordable Care Acts original intention. 

‘Copper Plans,’ would be a whole new option for insurance seekers who wouldn’t mind pay more out-of-pocket costs for a smaller monthly premium. This type of insurance plan was originally deemed illegal by the Affordable Care Act because they lacked the minimum coverage required by the law, and millions of individuals lost their coverage because insurance companies began dropping them.

The reason why these ‘Copper Plans’ will be cheaper is the fact that they will hold a much smaller actuarial value than their Platinum, Gold and Silver plan counterparts. That is to say, that the healthcare consumer is expected to pay a much higher amount of their expected healthcare costs over the course of the coverage.

The Walls Street Journal had this to say; “Now, some insurers and a pair of Senate Democrats are trying to change the law permanently so that individuals and small businesses can buy so-called copper plans. The plans likely would have lower premiums, but purchasers would pay more of their ordinary health costs upfront. Greater coverage would kick in for serious, unforeseen health episodes that would require, for example, a hospital stay.”

Another reason why Senate Democrats might be feeling the pressure to create such a plan, is the fact that one of the several promises of the Affordable Care Act was that this legislation would reduce premiums for the majority of Americans. However, now that less risky healthcare consumers are subsidizing more risky healthcare consumers, and the fact that these less risky consumers are only allowed to have reduced plans by a 3:1 ratio compared to the most risky consumer, the overall cost of premiums has slightly increased. These smaller actuarial plans will allow consumers to take on more of their own healthcare risks, while simultaneously reducing their monthly premiums. 

SHARE YOUR THOUGHTS:

Would you be interested in a Copper Plan? Do you think it a good idea for the consumer? Have you enrolled in an ACA healthcare plan? Did your premiums increase? Do you think healthcare management and health policy is being handled properly?

Sources:

http://online.wsj.com/news/articles/SB10001424052702303874504579373342002006318

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