Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

Creating a wellness-based healthcare system is the focus on a new series of articles published by American Health and Drug Benefits, a peer reviewed journal. They cover a wide spectrum of topics on how to build and support prevention and wellness, particularly for chronic conditions. The ideas and information...
While most of the major health reforms start in 2014, the Affordable Care Act (ACA) imposes several new requirements in 2011 on health plans and self-insured employers. To prevent either a large increase in premiums or a significant decrease in access to health coverage, the Centers for Medicare and Medicaid...
Under the Affordable Care Act (ACA), most health plans are now required to provide preventive services to their enrollees without any co-payments or other cost sharing.  Over time, this is expected to significantly improve prevention and wellness, reducing costs and reducing incidence of preventable condtions.  However, the preventive services...
The Agency for Healthcare Research and Quality (AHRQ) has released interesting new data on increases in premiums and employee contributions for employer-sponsored health insurance coverage (ESI) from 2001 to 2009. Types of Employer-Sponsored Health Insurance Coverage: There are three types of employer-sponsored health insurance offered by employers in the U.S.: 1. ...
The Patient Protection and Affordable Care Act (ACA) requires benefit plans offer a minimum set of essential health benefits. Those include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitation and habilitative services and devices, and laboratory services. The...
The Centers for Medicare and Medicaid Services (CMS), charged with protecting Medicare’s fiscal integrity, works to recover payments made by Medicare that are the responsibility of non-group health plans. While CMS has not always been aware of all such situations in the past, 2007 legislation introduced mandatory non-group health...
As part of the $1.1 billion provided to the Department of Health and Human Services (HHS) earmarked for comparative effectiveness research (CER) under the American Recovery and Reinvestment Act (ARRA or Recovery Act) of 2009, $474 million went to HHS’s Agency for Healthcare Research and Quality (AHRQ) to support...
In previous research, Milliman, one of the nation's top actuarial firms, provided an overview of the impact made by guaranteed issue and community rating reforms on the health insurance markets within eight states in the 1990s. Retained by America’s Health Insurance Plans (AHIP), Milliman has published an update to this...
As the second-largest health care service purchaser, employers have an opportunity to use their substantial market leverage as a means to augment quality. If mobilized and motivated, employers could act as a key change agent by influencing other stakeholder groups, exercising a leadership role, and pushing community health plans...
More than 75 percent of total health care costs cover preventable chronic conditions like diabetes, heart disease, and cancer. The Affordable Care Act (ACA) mandates that self-insured employers and health plans provide common, evidence-based wellness screenings designed to reduce such conditions without charging a copayment, deductible, or co-insurance. Because health...

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