HealthFlock

Healthcare consumers have been hearing a lot about 2014 lately, especially with regard to what their health insurance options will be. Most know that in just over 12 months, a big change is coming to the health insurance landscape, but I’m willing to bet that the majority of that “most” doesn’t yet have a firm grasp of what a health insurance exchange is, what it will look like in Georgia, and how it will benefit their pocket books.

As an average healthcare consumer, here is my brief attempt to demystify this term, and to break down its implications for Georgia citizens.

What is a Health Insurance Exchange?
According to Kaiser Health News, a health insurance exchange (also referred to via the HIX acronym) is a state-specific marketplace/website “where individuals and small businesses can shop for coverage, which will take effect on Jan. 1, 2014, and also find out whether they are eligible for federal subsidies or for Medicaid.”

States can choose to either set up …

Continue reading Demystifying Georgia’s Plans for Health Insurance Exchange »

In 2012 most of the big questions surrounding the Affordable Care Act (ACA) were answered in 2012. The biggest questions were settled with the Supreme Court ruling in June and the election results in November. Those two events determined that the ACA will be the law of the land and will shape the future of the health care financing and delivery system. The actual shape of the health care delivery system will be determined in 2013.

In the coming months decisions by HHS, the State of Georgia, insurers, and providers will determine access to care, the cost of health care, and the health of the population.

The largest decision with respect to access to care will be the states choice on Medicaid expansion. If the state participates in Medicaid expansion the percentage of Georgians without health insurance will fall from 22 percent to less than 9 percent. Without Medicaid expansion the ACA reduces the uninsured to about 18%. Medicaid expansion is expected to cover between …

Continue reading Not Yet Ready It’s Time To Get Set »

In the upcoming edition of the Journal of Medical Practice Management, I authored an article entitled, “Four More Years”, which covered the results of the November election results, wherein President Barack Obama was elected to a second term in the White House and control of the Senate and House of Representatives was split between Democrats and Republicans respectively.  Perhaps more relevant to that column’s audience, and my audience here, I went on to offer my predictions as to how those election results will impact the healthcare industry and its various stakeholders in the coming years.

That column was written literally as the election results were coming in, which is not always the best time to editorialize or offer individual predictions about the future.  At that point in the game, there is typically still too much heated emotion and political competition that can easily prevent one from gaining a realistic understanding as to how the events transpiring will …

Continue reading Washington, the Election and the Future: What Should Americans Expect for the US Healthcare System? »

In the Spirit of Giving and the Holiday Season, I thought I would take a look at what our local hospitals give each year in the form of charity care. I searched the internet for statistics on charity care. I do not want to specifically identify a hospital, because I did not receive permission to do so. However, you can easily access the information on most hospitals websites.
This is what I found: I only had to look at four hospital systems to find a half a billion dollars in free care!! Some larger facilities are providing hundreds of millions of dollars of care each year, while smaller facilities are providing in the high millions. We can all always do more, but what other industry can you name that provides such a high level of free service to its patrons? Sure people fall through the cracks, sure there is room for improvement, but a half a billion dollars in charity care that is amazing! It is something every person who works to support this industry should be very proud …

Continue reading Giving »

I spent a good part of the last week at the mHealth Summit in Washington learning how mobile technologies (cell phones and the like) are reshaping healthcare.  If you have a smartphone, this won’t be news to you.  I feel like there is an app for most everything health-related now.  You can be sure that every pound lost, mile run, and health question asked can be recorded, tracked, and answered through your cell phone.  The wave of health apps isn’t just for consumers though; clinicians are also part of this trend and are changing the way they practice medicine.  For example, the app MIM allows a radiologist the ability to use an iPhone to take, store, and share an x-ray in any environment.

Some of the most exciting innovations are happening at organizational and system levels.  In conjunction with the Summit, the trade association HIMSS provided a roadmap for the industry (one of our own HealthFlock’s own blogger Marcus Gordon was a contributor).  When looking at …

Continue reading New Care Models – 3 Trends for mHealth in 2013 »

The American healthcare system … isn’t. It isn’t a “system.”

Patients have multiple providers. These providers rarely interact. The payment system operates in silos. And patient care isn’t coordinated.

This disjointed system is not a new challenge. In 1965, the federal government created Medicare, a program which provides coverage for certain services. Medicare Part A covers inpatient hospital services. Medicare Part B covers outpatient care like physicians’ services.

Forty years later, in 2006, the government launched Medicare Part D, which covers prescription medications. But the original Medicare program created payment and data silos for Parts A and B. Today, Medicare Part D is administered by private pharmacy benefit managers (PBMs). And the three parts (Medicare A, B and D) rarely talk to each other or share information.

So, that’s the public sector.

The payment and health information silos, unfortunately, also exist in the private sector. Most of us …

Continue reading Breaking Down Healthcare Silos: The Need of Healthcare Integration »

The healthcare and wellness industry has had quite a busy and interesting past year, certainly highlighted by the Supreme Court’s upholding of the Affordable Care Act this past June. The changes this law will spur, coupled with advances in technology and consumer empowerment, will continue to drastically reshape our healthcare and wellness landscape. Throughout this past year familiar themes rang clear, giving us insights to what will play vital roles for healthcare in our future. Below are my top ten trends for 2013:

1) Technology Paves the Way: No doubt that technology will continue to pave the way for a better overall healthcare system, providing a more efficient and effective experience between consumers, healthcare providers, insurers, and healthcare and wellness businesses. Of course technology will enable our antiquated processes to be better but technology will also propel consumers to have more engaged and interactive experiences with not only their doctors and …

Continue reading 2013 Top Ten Trends for Healthcare & Wellness »

Similar to the marketplace right before the passage of the Patient Protection and Affordable Care Act (“Healthcare Reform”) there seemed to be a pause in healthcare providers making any strategic moves as providers waited to see what would happen with the Election. In the second quarter of 2010, following the signing of the Healthcare Reform Act, billions of dollars of acquisitions and transactions occurred. Now that the Election has been decided, healthcare providers are slowly, but surely changing strategic plans and establishing clinical integration models. Because the Healthcare Reform Act will likely be implemented quickly, healthcare providers must evaluate how they deliver care. In 2013 reimbursement models will change and in 2014 the insurance payor sources will transform. Therefore, providers can no longer wait and see what will actually happen, but must act now to be ready for the changes on the near horizon.

One main focus for providers is the redesign of …

Continue reading Election Impact on Integration Strategies »

It’s that time of the year again – leftover turkey and stuffing for lunch at the office, crowded streets around the malls which make afternoon commutes even worse, and the constant bombardment of messages about the latest technology products (on sale). It is also a reminder about the time we get to spend together as families as well as the joyous celebrations of the holidays and their traditions.

Holidays also suggest that there are healthcare related implications too – let’s call it “end-of-the-year planning for healthcare”. Perhaps you might have already gone through your insurance coverage election period known as “Open Enrollment” at work already (these typically occur in the mid-Fall, prior to the holidays).

Continue reading Holidays . . . and Healthcare »

A basic tenet of economics (and logic) is that an individual will make a choice based all the possible alternatives for them, ignoring alternatives that are not available. If a person decides to drive to work rather than take a bus, that decision doesn’t change if they see people transported instantly from place to place on old episode of Star Trek. As attractive as the transporter might seem the fact that it doesn’t exist means that it doesn’t change the calculus that led the person to opt for driving.

The logic that many of the states used to justify their decision not set up exchanges or expand Medicaid under the Affordable Care Act (ACA) suggests that their choices are between implementing the ACA and some more attractive alternative. The problem is the more attractive choices either don’t exist or sound exactly like the ACA.

Under the ACA states have the option of setting up health insurance exchanges for individuals and small business. If they don’t set …

Continue reading The Irrelevance of Non-existent Alternatives »