Affordable Care Act & Health Insurance Exchanges

by User Not Found | Sep 01, 2013
State-run health insurance exchanges are finding difficulty keeping at least one major insurance carrier interested. As the insurance exchange marketplace opens under the Affordable Care Act, insurance companies are fleeing some state’s individual marketplaces

State-run health insurance exchanges are finding difficulty keeping at least one major insurance carrier interested. As the insurance exchange marketplace opens under the Affordable Care Act, insurance companies are fleeing some state’s individual marketplaces. Aetna has announced it has opted out of New Jersey’s state exchange on September 10, after pulling out of exchanges in other states, including California and New York.

This trend began in May, when Aetna, Cigna and United Healthcare announced they would not be participating in California’s exchange. In July, Aetna sent out a letter to its policyholders informing them that the new law had revamped the healthcare system “as we know it” and that policyholders should brace for higher prices.

Wellmark Blue Cross and Blue Shield opted out of Iowa’s exchange, and other carriers followed suit across the 16 states and District of Columbia that had decided to launch their own state-run marketplaces.

There are a lot of regulations in the law that make health insurance costly for companies. The latest wave of insurers exiting the individual market is likely just the beginning. The number of companies backing out of the state-operated insurance exchanges has raised questions about their viability. However, the U.S. Department of Health and Human Services has been steadfast in saying the exchanges will go live as scheduled on October 1st.

The exchanges are on-line marketplaces where small businesses and individuals can shop for health insurance coverage. They’re a feature of federal health care reform scheduled to go live this fall.

Consumers can start making choices on their exchanges October 1, 2013 but they won’t take effect until January 1, 2014. So far, there are 19 State-based Exchanges, 7 states are planning for Partnership Exchange, and 25 states are defaulting to the Federal Exchange.

Because we have very few public and private exchanges in operation, though there are a few, it’s hard to predict with certainty what impact they will have on providers. One possibility will be a renewed push for narrow networks. It will be hard to compete successfully in the exchange markets created under the ACA’s rules, but one way to do it is with a narrow network product that can offer superior medical management and cost controls.

The Affordable Care Act requires that health insurance exchanges be operational by January 1, 2014. With an anticipated 30 million people being added to the health insurance market, healthcare providers must understand and prepare for the impact of the exchanges.

Providers should review managed care contracts, which may require amendments or not even apply to the new products that plans will offer after the exchanges go into effect. Providers must also examine the rate and fee schedules to determine what will be covered by the exchanges.

September 2013

Whole-Body CT to Treat Patients in Shock

German researchers have found that using whole-body CT for patients in shock showed a substantially lower mortality rate. The data of 16,719 severely injured patients from throughout Europe were studied. Subjects were divided into three groups: those with severe shock, moderate shock and those without shock. Over 5,000 patients were given a whole-body CT scan after being admitted to the hospital. 1,821 patients were in severe shock and 4,280 were in moderate shock. The scans averaged between three to six minutes to perform. The patients in shock that had the whole-body CT scans showed significantly lower mortality rates. The researchers concluded that a patient in shock has a 25% greater chance of survival if he/she has a whole-body CT scan. The scan allows for targeted treatments and pinpoints bleeding injuries for faster and more accurate treatment.

Professor Peter Biber-haler, M.D. expects use of this concept to further decrease mortality rates for major trauma patients.

Joe Calandra CMO, Midwest Imaging Professionals
Joe Calandra - CMO, Midwest Imaging Professionals
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