The preliminary numbers look like the Affordable Care Act (ACA) is going to work as intended. Insurers were required to declare if they were going to and what plans and premiums they would offer in the individual exchanges by early May. In Georgia, seven insurers are participating in all or parts of the state. The premiums and plans they are offering resemble those currently offered by large employers.
A central question is whether the private insurance market as reconfigured by the ACA will be sustainable. A sustainable private insurance market is possible only if adverse risk selection is managed. Adverse risk selection is the fact that individuals with the highest demand for health insurance are those with the greatest health care needs. No insurance market can be sustained if the only people purchasing insurance are those about to file a claim.
Currently almost 95 percent of those with private health insurance coverage purchased that coverage through an employment-based
What is” it” you ask? Healthcare Reform
The picture in Georgia appears to be pretty bleak. The State has chosen not to expand Medicaid. Early estimates predict the cost of Health Insurance on the exchanges may be 45% higher, than the ridiculously high cost Georgians are already paying for Health Insurance. Any chance of an affordable plan will likely come with a deductible of $5,000 or more. Employers are dropping coverage left and right in favor of the penalty, which in reality is not really a penalty because it is cheaper. Employers, who are opting to keep their group plans, are facing substantial premium and deductible increases, as well. It is not looking good for anyone, especially those who most need it, from a cost perspective.
However, the average member of society- the one who does not work in the industry- does not understand, and they are not ready for what lies ahead. My question to you as a Healthcare Leader is what are we doing about it? Our patients, clients,
Defensive medicine occurs when physicians order tests, procedures or consultations of doubtful clinical value in order to protect themselves from costly and frivolous malpractice suits. Doctors detest the very thought of being sued so they find every means possible to avoid litigation.
And that includes ordering numerous unnecessary and expensive tests and procedures.
While not all Georgia physicians practice defensive medicine, the overwhelming majority do. According to a recent survey conducted by Oppenheim Research, 82 percent of Georgia doctors say they perform unnecessary tests, procedures and referral consultations exclusively to avoid a medical malpractice claim.
A 2010 Gallup Poll of physicians found that one-in-four healthcare dollars is spent on defensive medicine. A great deal of money is “wasted” on the practice of defensive medicine. Last year, Georgians were subjected to $14 billion of unnecessary tests, procedures or consultations with little or no clinical or
It is hard to believe, but we are quickly approaching the second half of 2013. 2014 will have the greatest impact on the healthcare delivery system, because it is the year that the Healthcare Reform Act insurance requirements will be implemented. The insurance changes potentially expand patient coverage and offer new payer sources through the health insurance exchanges; ultimately, impacting providers’ reimbursement. As always, when the money sources change, what providers offer for services, staffing and allocation of resources adjusts. With all of these moving parts, below is a list of top 5 changes that need to be addressed by all providers.
1. Health Insurance Exchanges
In accordance with the Healthcare Reform Act, health insurance exchanges must be operational by January 1, 2014. Each State has an opportunity to either establish its own health insurance exchange or to allow the Federal government to administer the exchange. The health insurance exchange is
Memorial Day is a time to reflect – to thank our service men and women who have so bravely sacrificed in order to defend our moral virtues across the globe. It is also a day to recognize that on the battlefield, decisions are often made with both gut instinct and decades of experience and data. This also holds true for health related decisions in the field – and off of it – where real time data, previously not available to clinicians, help make the healthcare decision-making pathway much more conclusive.
As healthcare buzz goes, “Big Data” has got to be one of the most thrown around phrases of the moment, nipping at the heels of “Obamacare” and maintaining a slight edge over “patient engagement.” I’m also fairly confident it is one of the least understood phrases in healthcare right now. It is used in every part of the industry – from physicians to vendors to payers, and even by some patients. But, as with any industry, subtle shifts in definition occur as different groups throw the phrase around.
We are on the cusp of a new era of healthcare technology and services. The incremental reduction of reimbursement for services, anticipated increase of patient volume and reimbursement tied to clinical outcomes is the tipping point of driving healthcare providers to rethink their service delivery model. Healthcare is historically slow to change the manner they do business until it is tied to reimbursement. An example is the shift in the market when managed care was introduced driving organizations to change their business practices. The current market shift of tying clinical outcomes to reimbursement is forcing healthcare providers to explore how they need to change their business practices to be profitable and serve the community in a quality manner.
mHealth technology is quickly moving towards market adoption and commoditization. We are seeing numerous prototypes and proof-of-concept solutions where a smart phone with software and biometric sensors are delivering real-time
A recent study published in the New England Journal of Medicine* on the Oregon Medicaid program has elicited reactions fitting for that twilight zone at the intersection of academic research and politics. Kaiser Health News characterized the paper as serving a “Rorschach test for how partisans and health policy wonks view the health care law”**
Oregon did a limited expansion of Medicaid in 2008 by offering coverage to individuals who met income and other eligibility requirements and were winners of a lottery. That meant that about 30,000 adults were newly enrolled in the Medicaid program out of 90,000 eligible. The state thus created a classic experiment with a control group and a treatment group.
The study found significant differences in the two group’s access and utilization of health care, a substantial improvement in mental health outcomes for the Medicaid covered population, a significant reduction in financial strain on covered families and significant increase in
“Everybody knows that kids need “baby shots” – immunizations that protect against once-common childhood diseases. The shots are required for school entry, so most children are up-to-date by the time that they are five years old. But what many of their parents and grandparents don’t realize is that adults need immunizations as well. And the adults lag far behind the kids in getting the shots that they need.” This quote from Daniel Blumenthal M.D. of Morehouse School of Medicine was stated to address a bill currently pending in the Georgia legislature which would permit pharmacists to administer adult immunizations that are currently off-limits. Today, pharmacists can administer flu shots for adults but many other shots must be given in the physician’s office.
Vaccinations are one of the few advances in science and health care that have been able to prevent and or eradicate certain diseases. Think about it! We take a pill for Hypertension but it doesn’t go away, the same with
For years now, we have held on to the hope that health information technology (health IT) solutions would translate into better health outcomes. We have indeed seen signs that physicians and hospitals which deploy health IT solutions like electronic health records (EHRs) provide better care.
We have also hoped that the day of an interoperable platform would allow healthcare professionals and facilities to access individual patient’s health information. Some progress has been made in a couple of states in terms of creating a legitimate health information exchange (HIE). However, the process of building, implementing and sustaining an HIE needs accelerating in most states including Georgia.
But as data is gathered, stored and analyzed, we have new, emerging opportunities which have promise. The term “big data” has surfaced as a new buzzword in healthcare.
Data is growing and moving faster than healthcare organizations can consume it. Most medical data is unstructured but is very