The Affordable Care Act (ACA) requires the Centers for Medicare and Medicaid Services (CMS) issue employer group health plan quality improvement reporting requirements. Reports shall cover specified quality improvement activities regarding plan or coverage benefit and provider reimbursement structures. Those requirements shall include efforts to improve health outcomes, ensure...
Health insurance plans are required to report their administrative expenses. For health plans in the for the large group, small group, and individual insured markets, an new report from Milliman details insurers’ administrative expenses in five categories:
Expenses for improving healthcare quality
Claims adjustment expenses
Agents and brokers fees and commissions
Direct sales...
The Affordable Care Act (ACA) requires that most Americans have health insurance that meets minimum federal requirements. Under the controversial mandate, starting in 2014, most individuals under 65 must purchase minimum essential health insurance coverage or pay a penalty to the IRS. One practical concern is that healthy individuals...
A new study highlights interesting health care cost and utilization trends for Americans under age 65 with employer-sponsored health coverage.
The Health Care Cost Institute (HCCI) analyzed data from Aetna, Humana, and United HealthCare, assessing price and utilization levels and changes, in their publication, Health Care Cost and Utilization Report: 2010....
Pharmaceutical manufacturers face an economic transformation as payors look more toward value-based – as opposed to transactional, unit-based – models for drug reimbursement. This value-based revenue model presents enormous implications for the future of pharma and biotech, impacting everything from innovation, clinical trials, pricing, and marketing.
The Health Research Institute at PwC surveyed...
The rise of uninsurance in the South and West over the past decade means those regions have the most to gain from the Affordable Care Act’s (ACA) coverage expansions, says a brief by the Urban Institute sponsored the Robert Wood Johnson Foundation. However, new taxpayer-financed health insurance coverage in the ACA...
Employers should encourage shared decision-making - which involves patients in health care decisions - as a way to reduce medical costs and improve health outcomes among employees, argues a recent brief from the National Business Coalition on Health (NBCH). Patients who have a better understanding of and are more...
Based on data from Germany’s experience with wellness programs, a recent report cautions that wellness incentives under the Affordable Care Act (ACA) could lead to higher insurance premiums for low-income and chronically ill people. The Commonwealth Fund’s brief found that one quarter of the publicly insured population participated in...
States might find it useful to have a database replete with health care service claims data to identify Medicaid fraud, evaluate disease trends, establish cost and utilization rates, and share price information with consumers. Typically such comprehensive data is difficult to gather because it comes from various public and...
The Affordable Care Act (ACA) will prohibit health insurers from denying coverage and from excluding coverage of pre-existing coverage. It will also limit how much more in premiums insurers can charge to high-cost groups compared to low-cost groups. For example, a consumer's health status and sex may not be used to set premiums, even...
