2/16/2012 6:58 PM ET|
Health care reforms coming in '12
From accountable care organizations to insurance rebate checks, changes are under way for both providers and consumers.
It will be a busy year for health care reform, as the Patient Protection and Affordable Care Act, commonly referred to as the Affordable Care Act, continues to reshape America's health care system. It became law in 2010.
"The broad consensus is that we need to move away from an outdated fee-for-service system that rewards volume and toward a system where doctors and hospitals are rewarded for improving quality, value and health outcomes," says Robert Zirkelbach, a spokesman for America's Health Insurance Plans, or AHIP, an industry trade group.
While this year's five major reforms lay the groundwork for a more efficient and sustainable health care system, "from the patient perspective, a lot of this is behind the scenes," says Dr. Glen Stream, the president of the American Academy of Family Physicians.
One change some consumers will welcome: a rebate check from those health insurers that failed to spend a sufficient portion of premiums directly on patient care last year.
A giant wrecking ball still hangs over this construction site, however: the Supreme Court decision on a 26-state constitutional challenge to the health reform. The justices will take up the issue in late March and are expected to rule by late June.
Here's what's going on with health care reform in 2012:
Accountable care organizations
Already in effect
On Jan. 1, the Affordable Care Act started providing a financial incentive for physicians, hospitals and health care providers that voluntarily join together to form accountable care organizations, or ACOs, and coordinate care for patients with Medicare. Under the law, ACOs that demonstrate improved quality and outcomes in care, lower costs and patient priority will share the savings with the Medicare system.
ACOs are expected to save Medicare $960 million over three years, according to HealthCare.gov.
"This addresses one of the main issues, which is the excess cost that we have compared to other First World countries," says Stream.
Today, more than 50% of Medicare patients have at least five chronic conditions, which may include diabetes, arthritis, hypertension and kidney disease, according to HealthCare.gov.
Zirkelbach says ACOs can drive down the costs of working with multiple doctors as well as improve care.
"We have a readmissions crisis in this country, particularly in Medicare, where 30% of patients that are discharged from hospitals end up back in the hospital within 30 days," he says. "A lot of that has to do with the fact that there is no incentive to ensure that they're getting the appropriate follow-up care."
ACOs are designed to change that.
Fewer disparities in health care
Effective: March 2012
Not all Americans have equal access to or similar outcomes from health care, according to HealthCare.gov. Depending on your race, ethnicity or income level, you may have a higher incidence of certain diseases, fewer treatment options and reduced access to care and insurance.
Countering decades of disparity is a tall order, but the Affordable Care Act aims to do so by accelerating data collection, funding community health centers, increasing racial and ethnic diversity in the health care professions and, by 2014, providing affordable health insurance for all through insurance exchanges.
"More and more health plans are tracking (these) data to first identify and then help address these gaps in care," says Zirkelbach.
"It's a huge issue," says Anna Lambertson, the executive director of the Kansas Health Consumer Coalition, a statewide advocacy group in Topeka. "Health disparities include women's access to health insurance and being charged higher premiums because of gender. If we can find a way to help people navigate the health care system so they are not going to the ER to receive routine care, we can actually lower costs."
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The very idea of government provided healthcare comes right out of Mein Kampf. Government cannot provide "free" healthcare. It can only deny, or steal the the money to pay for it from someone else.
If this is not true why didn't Obama just MANDATE that those without healthcare be FORCED to buy it? The 30 million leeches on the rest of us will never let go. These are the risks that would drive the costs sky high for the rest of us.
Most employers will be dropping their healthcare coverages in the next few years. It will be far cheaper to pay the government "fines and penalties" than to provide coverage. I know I will be doing just that.
The quality of healthcare of course will be rationed eventually. Like Medicaid today, healthcare workers will not want to treat those with "government" insurance. I am sure then government will try to make it illegal to deny treatment. This of course will control healthcare workers pay.
Socialism always fails. One need only look to Europe. The USA is bankrupt and will collapse within 20 years. This will Obama and the Democrats legacy...
And for the record, in Washingtion state, you can in fact show proof of financial responsibility instead of auto insurance. http://www.tre.wa.gov/documents/mvprf.pdf
It is absurd to suggest that if one doesn't support this legislation that he/she wants poor people to die. It just offends reasonable people who would be otherwise open to your point of view.
If you support the legislation, that's great, but this extreme attack-oriented stuff just discredits your opinion....you're definitely entitled to disagree/agree whatever, but this your with me or against me thing is something the Dems were awfully fond of attacking the last Admin over and that was in the context of terrorism, which was certainly more justifiable than in this case.
Tell me why its different from the auto insaurance mandate and i know your arguement that only car owners have to have it but why can't i own a car and not have insurance if i'm capapable of paying for any accident i might have. Its the same thing.
The difference is that your car could hit something or someone else and they would have no way to get repaid if you didn't have car insurance. If you don't have health insurance then the consequences *should* be born only by you. We all know that the medically uninsuied still get health care at others expense, which is ultimately how they justify the mandate.
Hey old man.
The killing begins in 2014 when the full effect of the mandate comes into effect and a massive new group of formerly uninsured bogs down the health care system with costs we can't possibly pay.
One point that was overlooked in this article is called personal responsibility...I work in healthcare and see it on a daily basis....we have no money to buy healthcare but we have the latest I-phone with fancy ring tones, we have expensive sneakers, we can buy our cigarettes etc but we have no money to pay for our own care. I am tired of being responsible for paying for those who could but chose not to...and now you want me to pay a tax on my healthcare benefits that I got to work for daily so I can give more to these kinds of people...I think not. My husband is self-insured and we manage to pay $650.00 every month for his healthcare and also pay what is not covered under his policy so don't tell me you have no money to pay!
The purported " Investments & programs patients want", as quoted above, are a complete an utter fabrication; there have been exactly ZERO preventative initiatives that I've received in 10 years.
We are, as Robert Samuelson recently noted in the WaPo, ..."a nation that is the world's largest insurer, with the world's largest standing military". Those have become the 2 priorities, with room & money for nothing else.
There is one good thing in Obamacare..."The Pre-Existing Condition Provision"...That phrase should have never been allowed to exist in the insurance industry! The rest is uncalled for beancounter/academia re-inventing the wheel. Add the Mandate perspective into the mix and you've ignited a pwoderkeg...
I hope the SCOTUS trashes this dimwitted attempt at Healthcare reform and it is repealed in its entirity...
Jonathan Swift's modest proposal from the grave notwithstanding, my humble opinion is that we don't need to choose between these extremes. If we really are going to look at things in a binary way--it is either this or death to the poor, then I think we've lost the discussion in some ways.
I thought the Right was the "black or white" point of view...I guess not.
Once again were being fooled into thinking were getting something for nothing. These people stay up nights trying to find ways of putting it to us and there are dumb people out there who actually think the government is on our side .. Its all about control people this healthcare act lie. This is what socialism is all about. Government control of the production and distribution of goods. Is that getting threw to you big thinkers out there??? Let me ask all you asleep at the wheel thunder heads this,, Has your life improved under any of the last four presidents to the point you have more money in your pocket to spend and gas prices have improved or food prices and goods have stopped rising year after year.How about taxes have they gone down?? Oh and the biggest one, have you lost anymore of your freedom from these guys we send to Washington to protect that. If your not concerned about any of this then you will surely get the bone heads you elect. Have a nice day and be sure to tell the kids your watching over them so uncle sam doesn't take away there future.
Not surprising that there is some good in this very flawed legislation...for me it goes too far and the slanted review like this one where the negatives are ignored just weakens it further in my view. Most of us genuinely want access to healthcare by all, and I want access to sobriety for all drunks as well as motivation for all lazy folks. It really comes down to how we pay for healthcare and what is the outcome for those that don't seem to care.
Do we deny healthcare for those that can't work...No. Do we make every employer offer some form of healthcare plan...perhaps. Do we give folks who won't work the same healthcare...Probably not.
It is essential to the overall good of our society that there be clear rewards for extra effort...sure let's set a baseline/minimum standard if we can find the $'s for it, but we can't penalize folks for working hard... the left seems to just not get that part of the equation.
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