Throughout the new Health Insurance Exchanges, health plan offerings vary in premiums, cost sharing, and provider networks. As the Affordable Care Act’s radically new regulatory and financing framework plays out in the insurance market and with consumer and employer decisions, we can expect considerable change and variability from 2014...
For health plans, the Affordable Care Act dramatically increases complexity and uncertainty in the health insurance market. One thing is clear - Obamacare turns traditional risk management practices of health plans upside down.
Predicting and adapting to the financial and operational dynamics of ACA is a daunting challenge for health plans,...
In the U.S., we usually hear about health care in Europe as an example of what the American health system is not. Universal health coverage, state-run provider networks, and rationing are the two differences that come up most often. But the U.S. and Europe share many health care policy challenges:...
Improving care integration for Medicare-Medicaid dual eligible beneficiaries is one of the many initiatives embedded in the Affordable Care Act (ACA). The health reform law created the Medicare-Medicaid Coordination Office at the Centers for Medicare and Medicaid Services (CMS), and provided funds for state demonstrations to integrate care for...
Debate about whether consumers will pay more for insurance under health reform has become political, with conservative organizations saying Obamacare will increase premiums and liberals saying it won't, at least not when you take into account taxpayer-funded subsidies for health coverage. In a new study, RAND Corporation joins the latter group....
Health insurance in America has changed dramatically in the past few years, changes that will speed up once the Affordable Care Act (ACA) major provisions take effect in 2014. It’s easy to be sucked into the details of policy change, from payment reforms, to Accountable Care Organizations (ACO), to...
Employers face a multitude of challenges under the Affordable Care Act (ACA). The ACA fundamentally changes the landscape for employer sponsored health insurance, forcing businesses to understand, navigate, and adapt to a quickly changing, highly complex, and still uncertain marketplace for health benefits. To illustrate this, here are 10...
Various economists and health care policy experts have tried to explain the recent slowdown in health spending growth. Some say it’s because of the Affordable Care Act, whose major provisions have yet to take effect. Others say it’s because of the economic slowdown, suggesting that the decrease in spending...
Risk adjustment is a key mechanism to ensuring appropriate payments for Medicare Advantage plans, Medicare Part D drug plans, and Medicaid health plans. Since health plans vary in their mix of healthy and sick enrollees, risk adjustment modifies premium payments to better reflect the projected costs of members served and...
Multi-payor medical home initiatives have many benefits. They can bring Medicare, Medicaid, and private health plans together to promote care coordination, better health outcomes, and lower costs. But they have one potential flaw: Allowing payors to coordinate payment policies could trip federal (or state) anti-trust protections to prevent price-fixing and...
