Tag Archives: Affordable Care Act

Benefits of preventive services known, but older adults not using them

As the health care industry moves toward value-based reimbursement, the use of preventive services seems obvious. It’s become obvious, at least, to a number of health plans who are incentivizing the use of well visits, screenings, and other preventive programs to keep patients healthy. In January 2013, states that offered preventive programs at low or […]
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Prevention takes more than an apple a day

“An ounce of prevention is worth a pound of cure.” It may be a cliché, but it is also a truism. Today, prevention in health care is more important than ever. Several key changes are pushing payers and providers more deeply into preventive services for the populations they serve. The rise of value-based care is […]
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Excessive incarceration of individuals with mental health and substance use disorders: Jail diversion programs may be the answer

The number of individuals with mental illness and substance use disorders in U.S. jails and prisons is troubling, with estimates ranging from 360,0001 to more than a million.2 At least 30 percent of incarcerated adults have a serious mental illness, and approximately 65 percent have a substance use disorder. Twenty-five percent have both.3 Now, an […]
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Suspend Medicaid benefits of the incarcerated rather than terminating them

When individuals are incarcerated, most states terminate Medicaid benefits. Problems arise, however, as prisoners are about to be released. Administrative delays and state regulations often result in a gap of several weeks before coverage resumes — a critical period of time for former inmates struggling with mental illness, addiction or a host of high-level chronic […]
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King v. Burwell: How should payers move forward after the ruling?

With the U.S. Supreme Court handing down its decision today in the Affordable Care Act case King v. Burwell, health insurers can turn their full attention to preparing for their continued participation in the health insurance exchanges. Ruling to retain policies in accordance with the current PPACA law as written allows the tax subsidies to […]
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Plans should take full advantage of technology, operations to manage exchange markets

As Affordable Care Act (ACA) exchange markets evolve, health plans managing these markets face certain realities: many exchanges have not functioned as anticipated, technology has not always panned out, pricing often has been driven by poor data and inadequate risk assessment, and the market has been in a state of flux. However, during the transition […]
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Accelerating the progression toward an integrated clinical model

As we sit post-ACA, it has become apparent that we have entered one of the most dynamic times in all of health care. Risk for all stakeholders has been on an accelerated course since 2010, but managing risk looks different depending where you are in the health care space. Providers — whether hospitals or physician […]
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The King vs. Burwell case: Implications for ACA and issuers

On March 4, the U.S. Supreme Court heard oral arguments on the case of King vs. Burwell. The Supreme Court’s decision, expected to be delivered in late June or early July, could have far-reaching effects on the Affordable Care Act (ACA) and the millions of Americans who depend on it. The suit maintains that the government […]
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Aligning network adequacy to meet greater expectations

With the passing of the Affordable Care Act (ACA) and the advent of the health insurance marketplace, network adequacy has come under greater scrutiny. Increased emphasis getting the right providers to consumers is leading health plans away from expansive networks to a narrow, more efficient network design that better serves member needs. Not lost in […]
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