ACA Marketplace Enrollment

The Health Insurance Marketplace monthly enrollment report issued this week contained some interesting information. It is too early, and the information is too limited, to really make definitive pronouncements about the Affordable Care Act, but there some results that may be indicative of the health insurance markets of 2015 and beyond.

The big news was the rapid increase in enrollments in the health exchanges over the last month. Enrollment in the health care in Georgia grew from about 6,000 to 58,611 in the month of December. This increase reflects both the desire of consumers to have coverage by January 1, 2014 and the improved functioning of website.

Much of the coverage of the enrollment numbers centered on the age distribution trying to discern if Marketplaces were going to attract a sufficient number of younger healthier enrollees to balance out the older sicker enrollees who now have access to affordable coverage. In Georgia about 26 percent of the …

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Healthcare: The Customer Experience Imperative

We have all heard the phrase “customer experience” and the importance many organizations are placing on it. But what does that exactly mean? It’s more than just “customer service.” You might be thinking, “We don’t have a ‘customer experience’ strategy at our company.” Rest assured every organization has a customer experience … it just might be that yours currently stinks.

Forrester defines customer experience as “how customers perceive their interactions with your company.” Wikipedia defines it as, “the sum of all experiences a customer has with a supplier of goods and/or services, over the duration of their relationship with that supplier. This can include awareness, discovery, attraction, interaction, purchase, use, cultivation and advocacy.”

Of course both are correct. At its core, customer experience is how your customers feel about your brand or organization throughout every single interaction. And in today’s digital, social and mobile …

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New Years’ Resolutions

NY resolutionsEach year, millions of us make so-called “New Years’ Resolutions” or a list of things that we would like to accomplish in 2014. While most of us include things like “eat less and exercise more” on our list of resolutions, this year, my New Years’ Resolutions include:

Advancing Intellectual Honesty: I work regularly in the public arena. I write and speak a great deal about the need for legitimate healthcare reform including transforming our medical malpractice litigation system. In advancing a proposal to eliminate all medical malpractice lawsuits and replace it with an administrative solution similar to workers’ compensation, there has been wholesale fabrication and outright deception involved by some of those opposed to the issue. In discussing public policy options, there needs to be transparency and those engaged in the debate should have facts versus conjecture.

Gallup, the polling people, asked Americans to rate the honesty and ethical standards of …

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Healthcare Confidence Lessons from Target and PayPal

What type of healthcare facility would you rather put your personal health and financial information in the hands of? One like PayPal, who proactively reaches out to assure you its doing everything it can to protect your information, or one like Target, that alerts you to a breach several weeks after the fact? Health data breaches not only mean legal headaches and potentially very large financial penalties, but they also negatively impact a hospital’s brand, in turn causing …

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Healthcare Milestones for 2013

Now is the time of year when we look back at the highs and lows from 2013. In healthcare, there is a lot to talk about, but today we will focus on three important healthcare objectives. In 2013, the Healthcare Reform Act focused on changing reimbursement models and laid the groundwork for health insurance exchanges to commence in 2014. These changes led to three main milestones.

First, in 2013, provider integration flourished because of reimbursement changes. The bundled payment demonstration program commenced while payments to primary care providers increased. Bundled payments require providers to work together to treat a patient under a best practice protocol to reduce the costs so the providers can split one payment for the full delivery of care provided to the patients. As with most of the demonstration programs, bundled payments also require providers to report quality data to the Centers for Medicare and Medicaid Services (“CMS”). Similar to other programs …

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What are the positive aspects of the Affordable Care Act?

The debate will continue for quite a period-of-time whether the Affordable Care Act achieved its objectives and was cost effective. While political parties and individuals posture the pro’s and con’s of the Affordable Care Act, there are some positive aspects.

Whether you loved or liked the previous healthcare insurance business model, the Affordable Care Act addressed three notable deficiencies. The following are those deficiencies and how the Affordable Care Act addressed them:

First – people with pre-existing medical conditions could not purchase insurance or it was cost prohibitive.

People with pre-existing medical conditions were not able to purchase insurance or the price was cost prohibitive. A number of individuals have pre-existing clinical conditions through no fault of their own. It could be a matter of genetics or other factors beyond their control. It is unreasonable to penalize individuals under these circumstances and put them at a financial …

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2013: A Year of Debate and Delay

Historian Barbara Tuchman created Tuchman’s law: “The fact of being reported multiplies the apparent extent of any deplorable development by five- to tenfold (or any figure the reader would care to supply)”. That law applies directly to the events of 2013.

We started the year with tiptoeing away from a fiscal cliff. That political crisis would reappear later in the year, but the fear in January was that we would continue to kick this can of long-term budget deficits down the road. The problem is the major driver of Federal budget deficits is health care expenditures. Social Security, defense, and all other spending are projected to remain largely constant as a percentage of GDP. That means you could slightly lower future deficits by cutting other spending, but if health care costs aren’t addressed all long-term structural deficits will remain. Congress faces very few options in the current budget debate that would credited as reducing future Federal health …

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Still Work to do in EHR Adoption

Nearly 79% of primary care physicians are using some form of electronic health record (EHR) in their practices. This number continues to jump significantly from year to year. It surely is a testament to the innovative work that various sectors of the HIT industry have put into adoption efforts. It also speaks to the hard work that has been done by providers and their professional organizations to use Health Information Technology (HIT) tools to improve clinical outcomes for their patients. On the other side of the fence, there remains the 20% of providers who do not have EHRs. Medical Economics reports that, in 2012, among this group 48% said they did not plan to purchase an EHR. This is a 16% increase from 2011. These physicians are often referred to as “EHR holdouts”. Surveys show that most of these providers are the more elder physicians and physicians in small practices.

I am sure the term “hold out” is not meant to be derogatory but it could be interpreted by …

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Spreading Holiday Cheer and Health IT Job Growth

A conversation with Navicure CEO Jim Denny on why Atlanta is a great place for health IT, and could be even better if the right kind of growth continues.

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What To Be Thankful For in Healthcare Reform

As we approach Thanksgiving, we focus on giving thanks. Notwithstanding the rough, confusing and troubling roll-out of Healthcare Reform, there are some benefits that we can be thankful.

First, Healthcare Reform is focused upon improving quality care for patients. Specifically, Healthcare Reform implemented new payment models that pay providers based upon healthcare outcomes for patients instead of a fee for each patient. One example is the shared savings program. Under this program, providers integrate together to deliver care based upon patient centered protocols. The providers then report on the quality metrics for their patients and if the costs are reduced and the patient outcomes improve, the providers will receive a share of the savings achieved by reducing the costs to the government. The integration of providers together with an agreed upon approach to treat the patient should improve communication between the healthcare providers.

Healthcare Reform is also …

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