Hospital and emergency room utilization is expected to increase substantially when 35-40 million Americans become newly insured through Medicaid and State Health Exchanges starting in 2014. Today, communication between primary care physicians and hospital emergency departments is poor. An excellent new study by the National Institute for Health Care Reform (NIHCR)...
Direct-to-Consumer (DTC) advertising of prescription drugs, especially new brand-named drugs, remains controversial. Some in Congress remain eager to prohibit advertising of brand-name prescription drugs to consumers in the first two years following a drug’s approval by the Food and Drug Administration (FDA). Is this a good idea or is it...
With an array of payment reforms, quality and safety requirements, massive expansion of Medicaid, and creation of the new State Health Benefit Exchange marketplace, the Affordable Care Act (ACA) presents extraordinary new challenges for compliance, especially for health plans, physicians, hospitals and health systems, and drug and device manufacturers.
In...
Hospital readmission rates are receiving increasing attention by Medicare, Medicaid, and private health plans. Research shows that a high proportion of hospital readmissions are preventable. Most hospital payment methods, most notably the Medicare Part A inpatient prospective payment system (IPPS), create strong financial incentives for hospitals to discharge patients...
Are you ready to be an Accountable Care Organization (ACO)?
Significant new opportunities and challenges face health systems, hospitals, and physician practices as they decide whether to participate in the new Medicare Shared Savings Program and join together to form an Accountable Care Organization.
Accountable Care Organizations: Your Guide to Strategy, Design, and Implementation is...
As part of the Affordable Care Act (ACA), Medicaid coverage could be expanded to cover nearly 400,000 currently uninsured American Indians and Alaska Natives (AI/AN). This population, particularly sensitive to health disparities, suffers from elevated disease burdens and poorer overall health than that of the general population. The AI/AN...
A new federally mandated tax on health insurers will increase costs for state Medicaid programs and Medicaid health plans.
In an excellent new report, PPACA Health Insurer Fee Estimated Impact on State Medicaid Programs and Medicaid Health Plans, Milliman, retained by the Medicaid Health Plans of America (MHPA), conducted an independent...
A new report examines individual eligibility for federal premium subsidies in Health Insurance Exchanges when employer-sponsored or public coverage is not available to them. Both federal premium subsidies and state or federally-run Health Insurance Exchanges are features starting in 2014 under the Affordable Care Act (ACA).
While most individuals will be required to...
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...
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...
