I’ve blogged a couple of times recently about the Affordable Care Act. Here are a few more provisions of the law. A more detailed description of the law and what it means for you and your family can be found at http://consumerreportshealth.org/insurance:
-All pieces of the law will be in place 1/1/14;
-Health insurance benefits are regulated differently by each state, so your rights depend on where you live;
-Insurers can’t impose a lifetime limit on your benefits; annual benefit limits are phasing out, too;
-If you disagree with a benefit decision by your insurer, new independent appeals give consumers a standard, reliable way to dispute coverage decisions.
-Health insurers can’t arbitrarily cancel your coverage if you get sick.
-You can now obtain preventive care such as annual exams and cancer screenings with no out-of-pocket costs.
-Note: New rights of appeal, free preventive care, and phased out annual limits don’t apply to many grandfathered plans (those issued prior to 3/23/2010).
-Children under age 19 can’t be denied coverage because of their health status.
-Insurers can’t exclude coverage for treatment related to a child’s pre-existing condition.
-Children up to age 26 can remain on a parent’s health insurance plan, and they do not need to be financially dependent on their parents. They are not required to live with parents, be unemployed, unmarried, or a student.
The Affordable Care Act and a slow economic recovery are forcing healthcare systems to reevaluate existing efficiency models. Transforming a healthcare system should yield cost and productivity savings, and these savings can be passed on to patients.
Looking at the efficiency planning process for a target audience of healthcare finance leaders, there are a few core suggestions:
-Align strategic imperatives for the company and physicians;
-Remember the company’s core area of business;
-Define a starting point and create clear objectives; and
-Develop a strategy that engages front-line employees to change the culture of the organization.
In other words, set clear objectives that align all employees with the strategic values of the company. The most fundamental piece of integration is the shared strategic plan. This will create efficiencies and in turn yield cost savings, reduce queue times, et cetera.
A provision of the Affordable Care Act that paves the way for Accountable Care Organizations (ACO’s) will probably help to make large hospital systems and medical networks more profitable (for info on ACO’s, see my post last week). ACO’s emphasize quality, efficiency, and shared resources: a value-based system rather than a payment-based system.
Lowered Medicaid payments from the Federal Government are also forcing providers to look at ways to increase revenue without sacrificing quality. Another way to increase efficiency is to integrate support activities and coordinate care with physicians, which should increase quality of care while lowering costs.
How will improved quality benefit patients as well as hospital systems? Higher quality via increased efficiency and better communication between all employees will translate to reductions in the length of hospital stays. When better medical care keeps patients out of the hospital or reduces the time spent once admitted, the turnover rate is faster. This frees up more beds. For example, if you can reduce the length of stay by 10 per cent and you have 1,000 beds, you just created the equivalent of 100 beds every day. Improving throughput has massive benefits.
Last week I mentioned a few provisions of America’s New Health Care Law that pertained exclusively to women’s health. This week focuses on insurance companies and coverage protection.
Under the Affordable Care Act:
-Lifetime insurance limits are prohibited for most benefits on any health plan or insurance policy as of 9/23/2010.
-Children can no longer be denied coverage due to pre-existing conditions such as asthma or diabetes.
-Insurance companies can’t charge women more than men for the same coverage.
These provisions address the issue of companies dropping insureds when they need the care most. I do not necessarily agree with all aspects of the new Health Care Law, but at face value I don’t see a downside to these reforms. As I see it, they help to make health care more accessible and affordable for women, children, and anyone in need of expensive medical care.
Here are a few quick facts about the new Health Care Law and improving a woman’s access to health care. This is from the Affordable Care Act*:
1) Mammography has helped to reduce the number of breast cancer deaths in the U.S. by nearly 1/3 since 1990. Under the new Health Care Law, insurance companies now must cover a variety of screenings and preventive care- for free, at no cost to the patient.
2) Since many women skip their screenings because they’re cost prohibitive, free wellness visits and screenings should further reduce breast cancer deaths.
3) Some of the screenings that must be provided by insurers: Cervical cancer screening, breast cancer mammography every 1 to 2 years for women over 40, and human papillomavirus (HPV) testing every three years for women with normal cytology results who are 30 years or older.
4) Starting 8/2012, insurance companies must cover physician visits so that women may receive these preventive services.
*Although these are only facts and I personally think free preventive mammograms and cervical cancer screenings are a good idea, I should mention that this info was pulled from a mail flyer I received from the Democratic National Committee…..so potentially negative impacts of the Affordable Care Act were not mentioned.