Wednesday, September 29, 2010
Tuesday, August 3, 2010
Why the Nation Needs a Policy Push on Patient-Centered Health Care
In the Literature
Highlights from Commonwealth Fund-Supported Studies in Professional Journals
..........................................................................................................................................................................
August 3, 2010
Authors: Ronald M. Epstein, M.D., Kevin Fiscella, M.D., M.P.H., Cara S. Lesser, M.P.P., and Kurt C. Stange, M.D., Ph.D.
Journal: Health Affairs, August 2010 (29)8:1489–95
Contact: Ronald M. Epstein, M.D., professor and director, Rochester Center to Improve Communication in Health Care,
University of Rochester Medical Center, ronald.epstein@urmc.rochester.edu, or Mary Mahon, Senior Public Information
Officer, The Commonwealth Fund, mm@cmwf.org
Access to the full article is available at:
http://content.healthaffairs.org/cgi/content/full/29/8/1489?ijkey=HQf01wE/2r.FA&keytype=ref&siteid=healthaff
..........................................................................................................................................................................
Synopsis
Efforts to improve patient-centered care have focused on infrastructure and information technology
support. However, a true patient-centered approach depends on healing relationships among physicians,
patients, and family, with a strong foundation of communication and shared decision-making. Health
policy should focus on multiple means for improving healing relationships, including training health care
professionals and activating and enabling patients to participate in their care.
..........................................................................................................................................................................
The Issue
Although the phrase “patient-centered care” has been in existence for decades, the term entered the
health policy lexicon in 2001 with the Institute of Medicine’s Crossing the Quality Chasm. That report
identified patient-centered care as one of the six aims for high-quality health care, defining the term as
care that is “respectful of and responsive to individual patient preferences, needs, and values, and ensuring
that patient values guide all clinical decisions.” The authors of this Commonwealth Fund–supported study
in Health Affairs contend that patient-centered care has distinct, identifiable characteristics and has been
shown to control costs and improve quality. Nevertheless, the term is still not well understood in all health
care policy circles and is often conflated with merely providing infrastructure support and information
technology.
..........................................................................................................................................................................
What Is Patient-Centered Care?
Patient-centered care is not, the authors say, “just giving patients what they want, when they want it,
regardless of value or cost.” At its core, patient-centered care is about the healing relationships between
physicians and patients and patients’ families. This relationship is grounded in strong communication and
trust, highlighted by clinicians and patients engaging in a two-way dialogue, sharing information,
exploring patients’ values and preferences, and helping patients and families make clinical decisions.
These interactions strive to achieve a state of “shared information, shared deliberation, and shared mind.”
A “shared information” approach involves more than simple facts and figures. In such an approach, a
physician tailors information to an individual patient’s concerns, beliefs, and expectations, while also
considering his or her level of health literacy. “Shared deliberations” engage the patient in discussions and
decision-making to help arrive at a “shared mind”—that is, consensus on an approach to care that goes
beyond informed consent. Achieving the objectives of patient-centered care, the authors note, often
requires a coordinated team of health care professionals, patients who participate in their own care, and a
health care system that functions smoothly and provides information technology that strengthens patient–
clinician relationships.
..........................................................................................................................................................................
Why the Approach Matters
Patient-centered care is the right thing to do: it places the interests of
patients above all else and respects patients’ autonomy. The approach
has also been shown to:
• improve disease-related outcomes and quality of life;
• increase patient adherence to medications and improve
chronic disease control, without higher costs;
• boost well-being by reducing anxiety and depression, and
promote patient access and self-efficacy;
• address racial, ethnic, and socioeconomic disparities in care
and outcomes; and
• reduce diagnostic-testing costs in primary care and decrease
lawsuits against clinicians.
..........................................................................................................................................................................
How to Achieve Patient-Centered Care
Patient-centered care depends on informed and involved patients, receptive and responsive health
professionals, and a supportive health care environment. While investments in infrastructure and health
information technology can facilitate an environment for such a care approach, these two ingredients
alone are not sufficient to produce healing relationships and effective communication. Multiple players
must work to advance the goal of patient-centered care: policymakers must set specific performance
targets; educators must teach and assess interpersonal skills; consumer advocates must encourage greater
patient involvement in shared decision-making; and health care organizations must foster a culture of
patient-centeredness.
..........................................................................................................................................................................
The Bottom Line
Patient-centered care has been shown to improve outcomes and quality of life, while reducing costs and
health care disparities. Investing in infrastructure and health information technology is important, but not
sufficient, for creating a patient-centered health system.
..........................................................................................................................................................................
Citation
R. M. Epstein, K. Fiscella, C. S. Lesser, and K. C. Stange, “Why the Nation Needs a Policy Push on
Patient-Centered Health Care,” Health Affairs, Aug. 2010 (29)8: 1489–95.
..........................................................................................................................................................................
This summary was prepared by Christopher J. Gearon and Deborah Lorber.
Highlights from Commonwealth Fund-Supported Studies in Professional Journals
..........................................................................................................................................................................
August 3, 2010
Authors: Ronald M. Epstein, M.D., Kevin Fiscella, M.D., M.P.H., Cara S. Lesser, M.P.P., and Kurt C. Stange, M.D., Ph.D.
Journal: Health Affairs, August 2010 (29)8:1489–95
Contact: Ronald M. Epstein, M.D., professor and director, Rochester Center to Improve Communication in Health Care,
University of Rochester Medical Center, ronald.epstein@urmc.rochester.edu, or Mary Mahon, Senior Public Information
Officer, The Commonwealth Fund, mm@cmwf.org
Access to the full article is available at:
http://content.healthaffairs.org/cgi/content/full/29/8/1489?ijkey=HQf01wE/2r.FA&keytype=ref&siteid=healthaff
..........................................................................................................................................................................
Synopsis
Efforts to improve patient-centered care have focused on infrastructure and information technology
support. However, a true patient-centered approach depends on healing relationships among physicians,
patients, and family, with a strong foundation of communication and shared decision-making. Health
policy should focus on multiple means for improving healing relationships, including training health care
professionals and activating and enabling patients to participate in their care.
..........................................................................................................................................................................
The Issue
Although the phrase “patient-centered care” has been in existence for decades, the term entered the
health policy lexicon in 2001 with the Institute of Medicine’s Crossing the Quality Chasm. That report
identified patient-centered care as one of the six aims for high-quality health care, defining the term as
care that is “respectful of and responsive to individual patient preferences, needs, and values, and ensuring
that patient values guide all clinical decisions.” The authors of this Commonwealth Fund–supported study
in Health Affairs contend that patient-centered care has distinct, identifiable characteristics and has been
shown to control costs and improve quality. Nevertheless, the term is still not well understood in all health
care policy circles and is often conflated with merely providing infrastructure support and information
technology.
..........................................................................................................................................................................
What Is Patient-Centered Care?
Patient-centered care is not, the authors say, “just giving patients what they want, when they want it,
regardless of value or cost.” At its core, patient-centered care is about the healing relationships between
physicians and patients and patients’ families. This relationship is grounded in strong communication and
trust, highlighted by clinicians and patients engaging in a two-way dialogue, sharing information,
exploring patients’ values and preferences, and helping patients and families make clinical decisions.
These interactions strive to achieve a state of “shared information, shared deliberation, and shared mind.”
A “shared information” approach involves more than simple facts and figures. In such an approach, a
physician tailors information to an individual patient’s concerns, beliefs, and expectations, while also
considering his or her level of health literacy. “Shared deliberations” engage the patient in discussions and
decision-making to help arrive at a “shared mind”—that is, consensus on an approach to care that goes
beyond informed consent. Achieving the objectives of patient-centered care, the authors note, often
requires a coordinated team of health care professionals, patients who participate in their own care, and a
health care system that functions smoothly and provides information technology that strengthens patient–
clinician relationships.
..........................................................................................................................................................................
Why the Approach Matters
Patient-centered care is the right thing to do: it places the interests of
patients above all else and respects patients’ autonomy. The approach
has also been shown to:
• improve disease-related outcomes and quality of life;
• increase patient adherence to medications and improve
chronic disease control, without higher costs;
• boost well-being by reducing anxiety and depression, and
promote patient access and self-efficacy;
• address racial, ethnic, and socioeconomic disparities in care
and outcomes; and
• reduce diagnostic-testing costs in primary care and decrease
lawsuits against clinicians.
..........................................................................................................................................................................
How to Achieve Patient-Centered Care
Patient-centered care depends on informed and involved patients, receptive and responsive health
professionals, and a supportive health care environment. While investments in infrastructure and health
information technology can facilitate an environment for such a care approach, these two ingredients
alone are not sufficient to produce healing relationships and effective communication. Multiple players
must work to advance the goal of patient-centered care: policymakers must set specific performance
targets; educators must teach and assess interpersonal skills; consumer advocates must encourage greater
patient involvement in shared decision-making; and health care organizations must foster a culture of
patient-centeredness.
..........................................................................................................................................................................
The Bottom Line
Patient-centered care has been shown to improve outcomes and quality of life, while reducing costs and
health care disparities. Investing in infrastructure and health information technology is important, but not
sufficient, for creating a patient-centered health system.
..........................................................................................................................................................................
Citation
R. M. Epstein, K. Fiscella, C. S. Lesser, and K. C. Stange, “Why the Nation Needs a Policy Push on
Patient-Centered Health Care,” Health Affairs, Aug. 2010 (29)8: 1489–95.
..........................................................................................................................................................................
This summary was prepared by Christopher J. Gearon and Deborah Lorber.
Monday, July 5, 2010
Health Reform: Summary of New Requirements for Tax-exempt Hospitals and Health Systems
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA) (Pub. L. No. 111-148). PPACA imposes four new substantive requirements that a hospital must satisfy to maintain its tax exemption:
• Conduct a community health needs assessment once every three years and adopt an implementation strategy to meet the identified needs
• Needs assessment must “take into account” input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge or expertise in public health
• Assessment may be based on current information collected by a public health agency or nonprofit organization
• Assessment must be made widely available to the public
• Two or more related or unrelated hospitals may jointly conduct a needs assessment
• Failure to comply results in an excise tax penalty of up to $50,000
• Adopt, implement, and publicize a financial assistance policy that must include:
• eligibility criteria for such assistance, and whether it includes free or discounted care
• the basis for calculating the amounts charged to patients
• the method for applying for financial assistance
• collection actions that will be taken in the event of nonpayment (including reporting to credit agencies)
• measures to widely publicize the policy within the hospital community
Also, the hospital must adopt a written policy to provide emergency medical care to all individuals regardless of their ability under the financial assistance policy
• Limit charges for those qualifying for financial assistance:
• Hospitals must limit charges for emergency or “other medically necessary care” provided to individuals who qualify for financial assistance to “the amounts generally billed” to individuals with insurance
• Hospitals may not use gross charges (i.e., charge master rates)
• The amounts billed may be based on the best ( or an average of the three best) negotiated commercial rates, or Medicare rates
• Refrain from extraordinary collection actions before making reasonable efforts to determine whether a patient qualifies for financial assistance
• Examples of “extraordinary collection actions” includes lawsuits, liens on residences, arrests, body attachments or other similar collections practices
In addition, PPACA imposes three new mandates that will increase the flow of data from tax-exempt hospitals to the IRS, and from IRS/Treasury to Congress:
• Tax-exempt hospitals must include and disclose additional information on Form 990 Schedule H (community needs assessment implementation and financial audits)
• IRS must review every exempt hospital’s community benefit activities as reflected on its Form 990/Schedule H at least once every three years
• Treasury Secretary must report annually to Congress on comparative levels of hospital charity care, and complete a Congressional study on emerging trends after five years
Organizations subject to the new requirements include:
• Any 501(c)(3) organization which operates a facility which is required by State to be “licensed, registered or similarly recognized as a hospital”
• Any other organization which the Treasury Secretary determines “has the provision of hospital care as its principal function or purpose constituting the basis” for its tax status
Also, organizations that operate more than one hospital facility must meet the requirements “separately with respect to each such facility”
These new provisions are generally effective for taxable years beginning after the date of enactment.
• E.g., if a hospital’s fiscal/tax year begins on July 1, the new requirements go into effect at that time
• Effective date for completion of community needs assessment is delayed (consistent with the “once-every-three-years” requirement) to taxable years beginning two years after the date of enactment
In summary, the new health reform law imposes significant additional requirements on tax-exempt hospitals and health systems. The Treasury Department is expected to issue implementing regulations soon.
Written by: VHA Inc. is a nationwide cooperative owned and governed by community-owned health care systems and their physicians.
• Conduct a community health needs assessment once every three years and adopt an implementation strategy to meet the identified needs
• Needs assessment must “take into account” input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge or expertise in public health
• Assessment may be based on current information collected by a public health agency or nonprofit organization
• Assessment must be made widely available to the public
• Two or more related or unrelated hospitals may jointly conduct a needs assessment
• Failure to comply results in an excise tax penalty of up to $50,000
• Adopt, implement, and publicize a financial assistance policy that must include:
• eligibility criteria for such assistance, and whether it includes free or discounted care
• the basis for calculating the amounts charged to patients
• the method for applying for financial assistance
• collection actions that will be taken in the event of nonpayment (including reporting to credit agencies)
• measures to widely publicize the policy within the hospital community
Also, the hospital must adopt a written policy to provide emergency medical care to all individuals regardless of their ability under the financial assistance policy
• Limit charges for those qualifying for financial assistance:
• Hospitals must limit charges for emergency or “other medically necessary care” provided to individuals who qualify for financial assistance to “the amounts generally billed” to individuals with insurance
• Hospitals may not use gross charges (i.e., charge master rates)
• The amounts billed may be based on the best ( or an average of the three best) negotiated commercial rates, or Medicare rates
• Refrain from extraordinary collection actions before making reasonable efforts to determine whether a patient qualifies for financial assistance
• Examples of “extraordinary collection actions” includes lawsuits, liens on residences, arrests, body attachments or other similar collections practices
In addition, PPACA imposes three new mandates that will increase the flow of data from tax-exempt hospitals to the IRS, and from IRS/Treasury to Congress:
• Tax-exempt hospitals must include and disclose additional information on Form 990 Schedule H (community needs assessment implementation and financial audits)
• IRS must review every exempt hospital’s community benefit activities as reflected on its Form 990/Schedule H at least once every three years
• Treasury Secretary must report annually to Congress on comparative levels of hospital charity care, and complete a Congressional study on emerging trends after five years
Organizations subject to the new requirements include:
• Any 501(c)(3) organization which operates a facility which is required by State to be “licensed, registered or similarly recognized as a hospital”
• Any other organization which the Treasury Secretary determines “has the provision of hospital care as its principal function or purpose constituting the basis” for its tax status
Also, organizations that operate more than one hospital facility must meet the requirements “separately with respect to each such facility”
These new provisions are generally effective for taxable years beginning after the date of enactment.
• E.g., if a hospital’s fiscal/tax year begins on July 1, the new requirements go into effect at that time
• Effective date for completion of community needs assessment is delayed (consistent with the “once-every-three-years” requirement) to taxable years beginning two years after the date of enactment
In summary, the new health reform law imposes significant additional requirements on tax-exempt hospitals and health systems. The Treasury Department is expected to issue implementing regulations soon.
Written by: VHA Inc. is a nationwide cooperative owned and governed by community-owned health care systems and their physicians.
Sunday, July 4, 2010
Premiums for new 'high risk' pool could be steep
By RICARDO ALONSO-ZALDIVAR
The Associated Press
Thursday, July 1, 2010; 12:18 AM
WASHINGTON -- President Barack Obama's new health coverage for uninsured people with health problems won't be cheap - monthly premiums as high as $900, administration officials said Wednesday.
Prices will vary by state and type of coverage from a low of $140 a month to as much as $900, said Richard Popper, deputy director of a new insurance office at the federal Health and Human Services department. Officials provided details of the plan, which starts enrolling people Thursday.
The price range is so wide because premiums will be keyed to standard individual health insurance rates in each state, which can differ dramatically because of medical costs and the scope of coverage. Independent experts estimate premiums will average around $400 to $600 a month. Younger people will pay less.
"There are going to be meaningful premiums that are going to be required to stay in this plan ... in the hundreds of dollars," said Popper, with the Office of Consumer Information and Insurance Oversight.
Despite the cost, consumer advocates are urging uninsured people with health problems to sign up soon, because they cannot be turned away for medical reasons. Family members may be able to help with premiums.
The Pre-Existing Condition Insurance Plan will start taking applications Thursday in many states, the rest by the end of the month. Coverage will be available as early as August 1.
Consumers can go to a new government website, HealthCare.gov, to find out about the program and other coverage options in their state. Twenty-nine states and Washington, D.C., will administer their own plans. The federal government will run the program in the remaining 21 states.
The new plan is a stopgap for vulnerable people locked out of the private insurance market because of medical problems. It's intended to remain available until 2014, when core health care overhaul provisions take effect. At that time, insurers will be barred from turning away people in poor health, low- and middle-income households will get subsidized coverage, and most Americans will for the first time be required to carry health insurance.
To qualify for the pre-existing condition plan, people must be uninsured for at least six months and have been turned down for coverage by a private insurer because of a medical problem. U.S. citizens and legal residents are eligible.
The biggest question hanging over the program is whether the $5 billion allocated will be enough.
Millions of people meet the basic qualifications for coverage, and technical experts who advise Congress and the administration have warned the funds could be exhausted as early as the end of 2011.
HHS officials sidestepped questions about what would happen if the money runs out. One option is for the government to limit enrollment.
Popper estimated about 200,000 people would be enrolled in the program at any one time, but other HHS experts estimated that 375,000 would sign up this year, and the Congressional Budget Office says the total could reach 700,000 in 2013.
The Associated Press
Thursday, July 1, 2010; 12:18 AM
WASHINGTON -- President Barack Obama's new health coverage for uninsured people with health problems won't be cheap - monthly premiums as high as $900, administration officials said Wednesday.
Prices will vary by state and type of coverage from a low of $140 a month to as much as $900, said Richard Popper, deputy director of a new insurance office at the federal Health and Human Services department. Officials provided details of the plan, which starts enrolling people Thursday.
The price range is so wide because premiums will be keyed to standard individual health insurance rates in each state, which can differ dramatically because of medical costs and the scope of coverage. Independent experts estimate premiums will average around $400 to $600 a month. Younger people will pay less.
"There are going to be meaningful premiums that are going to be required to stay in this plan ... in the hundreds of dollars," said Popper, with the Office of Consumer Information and Insurance Oversight.
Despite the cost, consumer advocates are urging uninsured people with health problems to sign up soon, because they cannot be turned away for medical reasons. Family members may be able to help with premiums.
The Pre-Existing Condition Insurance Plan will start taking applications Thursday in many states, the rest by the end of the month. Coverage will be available as early as August 1.
Consumers can go to a new government website, HealthCare.gov, to find out about the program and other coverage options in their state. Twenty-nine states and Washington, D.C., will administer their own plans. The federal government will run the program in the remaining 21 states.
The new plan is a stopgap for vulnerable people locked out of the private insurance market because of medical problems. It's intended to remain available until 2014, when core health care overhaul provisions take effect. At that time, insurers will be barred from turning away people in poor health, low- and middle-income households will get subsidized coverage, and most Americans will for the first time be required to carry health insurance.
To qualify for the pre-existing condition plan, people must be uninsured for at least six months and have been turned down for coverage by a private insurer because of a medical problem. U.S. citizens and legal residents are eligible.
The biggest question hanging over the program is whether the $5 billion allocated will be enough.
Millions of people meet the basic qualifications for coverage, and technical experts who advise Congress and the administration have warned the funds could be exhausted as early as the end of 2011.
HHS officials sidestepped questions about what would happen if the money runs out. One option is for the government to limit enrollment.
Popper estimated about 200,000 people would be enrolled in the program at any one time, but other HHS experts estimated that 375,000 would sign up this year, and the Congressional Budget Office says the total could reach 700,000 in 2013.
Saturday, July 3, 2010
Six-Month Medicare Patch Slows Medicare Meltdown for Now
Statement Attributable to:
Cecil B. Wilson, MD [1]
President, American Medical Association
"The six-month Medicare patch Congress passed today is a very temporary reprieve for seniors and baby boomers who rely on the promise of Medicare. Delaying the problem is not a solution. It doesn't solve the Medicare mess Congress has created with a long series of short-term Medicare patches over the last decade - including four to avert the 2010 cut alone.
"Seniors are already experiencing access problems as a result of the complete congressional mismanagement of Medicare over the years. About one in four Medicare patients looking for a new primary care physician are having trouble finding one. About one in five physicians are already limiting the number of Medicare patients they treat because of the instability and uncertainty of Medicare payment.
"In December, the Medicare physician payment cut will be a whopping 23 percent, increasing to nearly 30 percent in January. Congress is playing a dangerous game of Russian roulette with seniors' health care. Sick patients can't wait. Congress must replace the broken payment system before the damage is done and cannot be reversed.
"The baby boomers begin entering Medicare in six months, and if the physician payment problem isn't fixed, these new Medicare patients won't be able to find a doctor to treat them.
"End the political posturing and fix the problem: Health care for America's seniors hangs in the balance. Congress needs to fix the broken Medicare physician payment system so physicians can continue to do what they love - care for patients."
Cecil B. Wilson, MD [1]
President, American Medical Association
"The six-month Medicare patch Congress passed today is a very temporary reprieve for seniors and baby boomers who rely on the promise of Medicare. Delaying the problem is not a solution. It doesn't solve the Medicare mess Congress has created with a long series of short-term Medicare patches over the last decade - including four to avert the 2010 cut alone.
"Seniors are already experiencing access problems as a result of the complete congressional mismanagement of Medicare over the years. About one in four Medicare patients looking for a new primary care physician are having trouble finding one. About one in five physicians are already limiting the number of Medicare patients they treat because of the instability and uncertainty of Medicare payment.
"In December, the Medicare physician payment cut will be a whopping 23 percent, increasing to nearly 30 percent in January. Congress is playing a dangerous game of Russian roulette with seniors' health care. Sick patients can't wait. Congress must replace the broken payment system before the damage is done and cannot be reversed.
"The baby boomers begin entering Medicare in six months, and if the physician payment problem isn't fixed, these new Medicare patients won't be able to find a doctor to treat them.
"End the political posturing and fix the problem: Health care for America's seniors hangs in the balance. Congress needs to fix the broken Medicare physician payment system so physicians can continue to do what they love - care for patients."
Friday, June 18, 2010
Let the AMA open the door for foreign medical students and physicians to work in primary care today.
The affordable care act today created a stimulus package for creating new primary care physicians, physician’s assistance, nurse practitioners, and nurses. A new generation of health professional to help in the shortage of primary care doctors as projected by the AMA.
So by the year of 2016, we will have an influx of health professions to serve today’s 47 million uninsured. This is a major step for the future of this nation healthcare but I can’t help to wonder about today.
Today we still need access to healthcare. Hospitals emergency rooms are still the only recourse for the uninsured, and the numbers of uninsured continue to rise. Small businesses continue to offer no benefit or with large deductibles policies. The working individuals continue to take the risk of not buying insurance and depending on the emergency room, since they cannot be turned down.
Yet the AMA continues to make it difficult for foreign medical students and foreign physicians to get into an AMA-approved residence program in the US. The success rate is 25%, if you attend medical school in another country to be able to practice medicine in the US. At a time when the AMA projects a shortage of 21,000 primary care doctors, they have not changed their policy in how they view foreign medical student and physicians. Why not make it easier an open the door for these foreign medical student and physicians to work in a community residency program in the primary care field today.
Each community Dept of Health Services should evaluate alternative in sponsoring a foreign medical student and foreign physician to get AMA to approve and license these Doctors to work to provide care for the uninsured in their own community.
So by the year of 2016, we will have an influx of health professions to serve today’s 47 million uninsured. This is a major step for the future of this nation healthcare but I can’t help to wonder about today.
Today we still need access to healthcare. Hospitals emergency rooms are still the only recourse for the uninsured, and the numbers of uninsured continue to rise. Small businesses continue to offer no benefit or with large deductibles policies. The working individuals continue to take the risk of not buying insurance and depending on the emergency room, since they cannot be turned down.
Yet the AMA continues to make it difficult for foreign medical students and foreign physicians to get into an AMA-approved residence program in the US. The success rate is 25%, if you attend medical school in another country to be able to practice medicine in the US. At a time when the AMA projects a shortage of 21,000 primary care doctors, they have not changed their policy in how they view foreign medical student and physicians. Why not make it easier an open the door for these foreign medical student and physicians to work in a community residency program in the primary care field today.
Each community Dept of Health Services should evaluate alternative in sponsoring a foreign medical student and foreign physician to get AMA to approve and license these Doctors to work to provide care for the uninsured in their own community.
Wednesday, June 16, 2010
Unlike self-insured, fully-insured employers must decide old vs. new with their current plans
Well the regulations are finally out on the "grandfather plans". Large corporations who are self insured can continue their current plan designs without any fear of CHANGE. They can change administrator, reinsurers, and other vendor they choose. So to be self insured under the Affordable Care Act on March 23, 2010 is where all large corporations should have been to have the greatest flexibility of choice. Just keep your present benefit design, modify the plan document and negotiate, negotiate, and negotiate with every vendor to lower cost or change them.
The large corporations who are fully insured are not so fortunate. The modifications of the plan, to keep in compliance with the Affordable Care Act will create increase in the premium with very little negotiating power, flexibility or choice. They are at the mercy of the insurance carrier, only able to negotiate premium. If they elect to change to another carrier, this automatically makes them lose the grandfather status. Fully -insured companies must decide to stay or not stay with their current plan. The renewal rate of the current plan vs. the new rate of the new plan will tell the story. This also applies to midsize and small companies as well.
The large corporations who are fully insured are not so fortunate. The modifications of the plan, to keep in compliance with the Affordable Care Act will create increase in the premium with very little negotiating power, flexibility or choice. They are at the mercy of the insurance carrier, only able to negotiate premium. If they elect to change to another carrier, this automatically makes them lose the grandfather status. Fully -insured companies must decide to stay or not stay with their current plan. The renewal rate of the current plan vs. the new rate of the new plan will tell the story. This also applies to midsize and small companies as well.
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