For decades, checking into a hospital was a high-risk venture. Patients were as likely to die from a doctor’s error, a bad drug reaction or serious infection picked up from a catheter than from major scheduled surgery or medical treatment.
Tag Archives: ACA
The Downside of Merging Doctors and Hospitals
The lesson is simple: Coordinating your own care is still a good idea. Don’t count on the health system to do it for you.
Hospitals moving slowly toward value-based pay, Health Catalyst survey says
The majority of health systems have either zero or less than 10 percent of their care tied to the type of risk-based contracts.
Impact of antitrust suit against CHS could ripple nationwide
http://www.charlotteobserver.com/news/local/article83142307.html
A win for the U.S. Justice Department could establish an important legal precedent. Hospitals nationwide might have to remove contract provisions that limit competition. That could result in lower prices for patients.
Healthcare reform, value-based pay bolsters credit ratings, for now, experts say
While reforms tied to the Affordable Care Act have most healthcare providers focusing on quality and efficiency, financial experts say the dramatic change in business model is driving improvement in credit ratings. But worries still persists about just how stable those changes are.
According to Martin Arrick, a managing director at Standard and Poor’s, said a number of factors are affecting ratings trends, although the outlook in general appears to improving. S&P had been negative on the healthcare sector a couple of years ago, mostly because of pressure on operating margins, but that outlook has since reverted back to stable.
“We still see pressure on operating margins, but there are two big things,” said Arrick. “One is that hospitals have done a good job containing costs and keeping their margins generally solid. Two is Medicaid expansion.”
The Ripple Effects Of Medicaid Expansion
http://healthaffairs.org/blog/2016/06/07/the-ripple-effects-of-medicaid-expansion/
The 19 states that continue to decline federal funding to offer Medicaid coverage to more uninsured residents are missing out on more than just improvements to their uninsured and uncompensated care rates. In fact, the ability of providers in Medicaid expansion states to deliver care to their most vulnerable patients has notably improved.
Residents of Medicaid expansion states—both adults and children—are more likely to have insuranceand thus more likely to have a usual source of care and less likely to have unmet health care needs or problems paying medical bills. Furthermore, Medicaid expansion has helped the financial bottom line forsafety-net clinics and hospitals because more of their patients can afford to pay for their care.
Demand for short-term health insurance policies continues to grow
Short-term health insurance policies continue to increase in demand even though they don’t include benefits such as prescription drugs or maternity coverage, can reject applicants based on their medical history, according to a report from The New York Times. This is also the kind of plan the Obama administration had hoped to get rid of with the ACA. Purchasers of these temporary policies are usually filling a coverage gap and need a basic policy to cover an emergency without the higher costs of regular health policies.
Clinton’s Plan to Extend Medicare Raises Red Flags
Hillary Clinton last month dusted off a long-standing proposal of hers to expand health care coverage by allowing uninsured people 55 and older to qualify for Medicare – the government health care program for the elderly.
Her proposal potentially could help nearly 13 million Americans below the age of 65 who are currently without insurance. It also provided the former secretary of state with a rejoinder to rival Sen. Bernie Sanders’ call for supplanting Obamacare with a European-style national health insurance program he called “Medicare for All.”
Advanced Analytics: A Triple Win for Payers
http://www.healthcarefinancenews.com/sponsored/advanced-analytics-triple-win-payers
Virtually every organization working in healthcare – payers, hospitals, physicians, and employer group health plans – must do more with fewer resources. That’s especially true for payers.
The Affordable Care Act may have created what Gartner Research estimates to be a $33 billion opportunity for payers in the form of new individual customers, but it also generated new demands. For starters, payers are now held to a higher standard for administrative spend. The ACA’s Medical Loss Ratio (MLR) provisions require payers to spend at least 80 percent and 85 percent of premium dollars, for individuals/small groups and large employer group health plans respectively, on medical care and quality activities or issue a rebate to customers. As intended, this limits profits, salaries and broker commissions and administrative spend on business activities such as customer service, network and product development, and information technology.
In many markets, premium pressures have increased. As the result of the ACA and healthcare exchanges, there is a much higher level of transparency about individual and small group premiums, often leading to price competition. Large employer group health plans too have more options, including contracting directly with provider groups, all of which translates to premium challenges for most payers.
Elliot, Dartmouth-Hitchcock merger could face antitrust challenge
The recently announced decision by Dartmouth-Hitchcock in Lebanon and Elliot Health Systems in Manchester to pursue an alliance is just the latest move in a wave of consolidation that’s altering the health-care landscape in the Granite State.
HENRY KOTULA 