The document discusses the impact of the Affordable Care Act (ACA) on the newly insured population and healthcare costs. It finds that the percentage of uninsured individuals is projected to decrease significantly, with many transitioning to Medicaid, individual exchanges, or employer-provided insurance. The newly insured population is expected to have higher relative morbidity and healthcare costs compared to the currently insured, especially among older age groups, which will increase premiums. Hospitals and providers will play a key role in enrolling the uninsured by educating patients on coverage options and acting as a bridge to insurance exchanges.
This presentation will help you understand the strategies for patient enrollment & navigation and there by reduce the risk of caring for the uninsured.
This presentation will help you understand the strategies for patient enrollment & navigation and there by reduce the risk of caring for the uninsured.
Canadian government have to provide the rcmp with the resources it needsNPF-FPN
Without enough resources, it would be difficult for any organization to thrive and prosper. This is also true with the Royal Canadian Mounted Police. The police force needs to have enough financial resources in order to meet the rising demands. If the government will not address the compensation and workload issues that the police force is facing right now, it will be hard for the force to recruit new members.
ACA Healthcare legislation and attempts at increasing regulation of self-funding and stop loss coverage are driving more employers toward stop loss captives.
At the Chamber's October Small Business Roundtable Jim Curis presented our members with the latest on the Affordable Care Act - also known as Obamacare.
Value-Based Payments and Managed Care Contracting - Crash Course Webinar SeriesEpstein Becker Green
Epstein Becker Green Webinar with Attorney Basil Kim - Value-Based Payments Crash Course Webinar Series - May 31, 2016.
As value-based payment relationships continue to grow in prevalence and complexity, a question remains: How do I effectively capture this arrangement on paper?
Topics include:
* Some of the key strategic questions to deliberate with regard to contracting in a value-based payment relationship
* Considerations for contracting under a value-based payment framework.
http://www.ebglaw.com/events/value-based-payments-and-managed-care-contracting-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
http://ekinsurance.com/personal/how-to-buy-long-term-care-insurance/
Statistics indicate that over half of all people over age 50 will require long-term care.
This presentation from Mile High Healthcare Analytics assesses the future of the individual and small-group healthcare markets in a post King v. Burwell world.
This white paper explores how the health care reform bill will affect Medicare Advantage, Part D and Medicare Supplement plans, and how savvy agents can capitalize on the opportunities that will inevitably arise from this change.
An open enrollment checklist, created by eHealthInsurance, to help employees find the best personal health insurance solution for the 2012 benefit year - via http://www.eHealthInsurance.com
Canadian government have to provide the rcmp with the resources it needsNPF-FPN
Without enough resources, it would be difficult for any organization to thrive and prosper. This is also true with the Royal Canadian Mounted Police. The police force needs to have enough financial resources in order to meet the rising demands. If the government will not address the compensation and workload issues that the police force is facing right now, it will be hard for the force to recruit new members.
ACA Healthcare legislation and attempts at increasing regulation of self-funding and stop loss coverage are driving more employers toward stop loss captives.
At the Chamber's October Small Business Roundtable Jim Curis presented our members with the latest on the Affordable Care Act - also known as Obamacare.
Value-Based Payments and Managed Care Contracting - Crash Course Webinar SeriesEpstein Becker Green
Epstein Becker Green Webinar with Attorney Basil Kim - Value-Based Payments Crash Course Webinar Series - May 31, 2016.
As value-based payment relationships continue to grow in prevalence and complexity, a question remains: How do I effectively capture this arrangement on paper?
Topics include:
* Some of the key strategic questions to deliberate with regard to contracting in a value-based payment relationship
* Considerations for contracting under a value-based payment framework.
http://www.ebglaw.com/events/value-based-payments-and-managed-care-contracting-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
http://ekinsurance.com/personal/how-to-buy-long-term-care-insurance/
Statistics indicate that over half of all people over age 50 will require long-term care.
This presentation from Mile High Healthcare Analytics assesses the future of the individual and small-group healthcare markets in a post King v. Burwell world.
This white paper explores how the health care reform bill will affect Medicare Advantage, Part D and Medicare Supplement plans, and how savvy agents can capitalize on the opportunities that will inevitably arise from this change.
An open enrollment checklist, created by eHealthInsurance, to help employees find the best personal health insurance solution for the 2012 benefit year - via http://www.eHealthInsurance.com
Principles of Christian ministry and social action (mangneo)Oasis India
This PPT was specially designed for use in the "Christian ministry and social action" session of a training for the pastors and mission workers at Guwahati.
Getting stressed by work, family or friends? Dealing with big issues? Share what's troubling you anonymously - join the Big White Wall network at www.bigwhitewall.com
Ecorub AB Annual Report 2010 - Net loss for the year 2,9 million Swedish kronaSherman Klump
Ecorub AB Annual Report 2010. Net loss for the year 2010 is 2,9 million Swedish krona. The fiscal year 2010 Ecorub AB had revenue (turnover) of 5,7 million Swedish krona,
Affordable Care Act & its impact on physicians- Florida is the example state ...Andrew Eriksen, CMPE
This presentation is an overview of the Affordable Care Act and how it has and will continue to impact physicians. The presentation is focused on the Florida market but most of the information can be applied to any state.
The effects on insurance coverage for people living with HIV/AIDS in the Philadelphia EMA (including Philadelphia, Montgomery, Delaware, Chester, and Bucks Counties in PA and Salem, Gloucester, Camden, and Burlington Counties in NJ)
How Obamacare Health Subsidies Will Work - Are You Confused About Obamacare?Lloyd Dobson Artist
http://AIADirectQuote.com How ObamaCare Health Insurance Subsidies Will Work. Heather Loughlin is seen on Monday, May 9, 2011 in Montpelier, Vt. Loughlin was working as a vice president at the Sugarbush ski resort when she was diagnosed with multiple sclerosis. Before long, she found herself no longer able to work and buying insurance with a subsidy from the state under a current program but with a private insurer. (Toby Talbot/AP Photo)
Beginning in 2014, enormous insurance premium subsidies and payment supports will be available under the Affordable Care Act (ACA) to millions of lower-income individuals and families. While Obamacare could always be overturned before then, the law has been upheld as constitutional by the U.S. Supreme Court. And short of historic landslide victories in this November's elections by the law's largely Republican opponents, changing major aspects of it will be difficult.
Forensics and Fraud: Red Flags and War StoriesDecosimoCPAs
Principal Mike Costello, CPA•ABV•CFF, ASA, CFE, Director of Litigation Support Sharon P. Hamrick, CPA•CFF, CFE and Senior Manager Pamela S. Mantone, CPA•CFF, CFE, FCPA, CITP, CGMA co-presented the topic "Forensics and Fraud: Red Flags and War Stories" at the 2013 TSCPA FSV Conference, during which they shared from their experiences the details of various fraud schemes and methods used to detect and investigate them. - See more at: http://decosimo.com/www/announcements/540.8136/forensic-accounting-fraud-specialists-share-expertise-tscpa#sthash.eEdR6hfE.dpuf
Assurance Principal Jennifer Goodman presented "What Was the FASB Thinking?," a discussion and examples of unusual accounting rules, at the 2013 Decosimo Accounting Forum hosted by the University of North Alabama on July 19.
Principal in Charge of Assurance Department at Decosimo Tom Eiseman presented "Back to the Future Part I & II - Plans for Private Company Reporting" at the 2013 Decosimo Accounting Forum hosted by the University of North Alabama on July 19.
Unveiling the Secrets How Does Generative AI Work.pdfSam H
At its core, generative artificial intelligence relies on the concept of generative models, which serve as engines that churn out entirely new data resembling their training data. It is like a sculptor who has studied so many forms found in nature and then uses this knowledge to create sculptures from his imagination that have never been seen before anywhere else. If taken to cyberspace, gans work almost the same way.
"𝑩𝑬𝑮𝑼𝑵 𝑾𝑰𝑻𝑯 𝑻𝑱 𝑰𝑺 𝑯𝑨𝑳𝑭 𝑫𝑶𝑵𝑬"
𝐓𝐉 𝐂𝐨𝐦𝐬 (𝐓𝐉 𝐂𝐨𝐦𝐦𝐮𝐧𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬) is a professional event agency that includes experts in the event-organizing market in Vietnam, Korea, and ASEAN countries. We provide unlimited types of events from Music concerts, Fan meetings, and Culture festivals to Corporate events, Internal company events, Golf tournaments, MICE events, and Exhibitions.
𝐓𝐉 𝐂𝐨𝐦𝐬 provides unlimited package services including such as Event organizing, Event planning, Event production, Manpower, PR marketing, Design 2D/3D, VIP protocols, Interpreter agency, etc.
Sports events - Golf competitions/billiards competitions/company sports events: dynamic and challenging
⭐ 𝐅𝐞𝐚𝐭𝐮𝐫𝐞𝐝 𝐩𝐫𝐨𝐣𝐞𝐜𝐭𝐬:
➢ 2024 BAEKHYUN [Lonsdaleite] IN HO CHI MINH
➢ SUPER JUNIOR-L.S.S. THE SHOW : Th3ee Guys in HO CHI MINH
➢FreenBecky 1st Fan Meeting in Vietnam
➢CHILDREN ART EXHIBITION 2024: BEYOND BARRIERS
➢ WOW K-Music Festival 2023
➢ Winner [CROSS] Tour in HCM
➢ Super Show 9 in HCM with Super Junior
➢ HCMC - Gyeongsangbuk-do Culture and Tourism Festival
➢ Korean Vietnam Partnership - Fair with LG
➢ Korean President visits Samsung Electronics R&D Center
➢ Vietnam Food Expo with Lotte Wellfood
"𝐄𝐯𝐞𝐫𝐲 𝐞𝐯𝐞𝐧𝐭 𝐢𝐬 𝐚 𝐬𝐭𝐨𝐫𝐲, 𝐚 𝐬𝐩𝐞𝐜𝐢𝐚𝐥 𝐣𝐨𝐮𝐫𝐧𝐞𝐲. 𝐖𝐞 𝐚𝐥𝐰𝐚𝐲𝐬 𝐛𝐞𝐥𝐢𝐞𝐯𝐞 𝐭𝐡𝐚𝐭 𝐬𝐡𝐨𝐫𝐭𝐥𝐲 𝐲𝐨𝐮 𝐰𝐢𝐥𝐥 𝐛𝐞 𝐚 𝐩𝐚𝐫𝐭 𝐨𝐟 𝐨𝐮𝐫 𝐬𝐭𝐨𝐫𝐢𝐞𝐬."
Cracking the Workplace Discipline Code Main.pptxWorkforce Group
Cultivating and maintaining discipline within teams is a critical differentiator for successful organisations.
Forward-thinking leaders and business managers understand the impact that discipline has on organisational success. A disciplined workforce operates with clarity, focus, and a shared understanding of expectations, ultimately driving better results, optimising productivity, and facilitating seamless collaboration.
Although discipline is not a one-size-fits-all approach, it can help create a work environment that encourages personal growth and accountability rather than solely relying on punitive measures.
In this deck, you will learn the significance of workplace discipline for organisational success. You’ll also learn
• Four (4) workplace discipline methods you should consider
• The best and most practical approach to implementing workplace discipline.
• Three (3) key tips to maintain a disciplined workplace.
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
Premium MEAN Stack Development Solutions for Modern BusinessesSynapseIndia
Stay ahead of the curve with our premium MEAN Stack Development Solutions. Our expert developers utilize MongoDB, Express.js, AngularJS, and Node.js to create modern and responsive web applications. Trust us for cutting-edge solutions that drive your business growth and success.
Know more: https://www.synapseindia.com/technology/mean-stack-development-company.html
Affordable Stationery Printing Services in Jaipur | Navpack n PrintNavpack & Print
Looking for professional printing services in Jaipur? Navpack n Print offers high-quality and affordable stationery printing for all your business needs. Stand out with custom stationery designs and fast turnaround times. Contact us today for a quote!
What is the TDS Return Filing Due Date for FY 2024-25.pdfseoforlegalpillers
It is crucial for the taxpayers to understand about the TDS Return Filing Due Date, so that they can fulfill your TDS obligations efficiently. Taxpayers can avoid penalties by sticking to the deadlines and by accurate filing of TDS. Timely filing of TDS will make sure about the availability of tax credits. You can also seek the professional guidance of experts like Legal Pillers for timely filing of the TDS Return.
Taurus Zodiac Sign_ Personality Traits and Sign Dates.pptxmy Pandit
Explore the world of the Taurus zodiac sign. Learn about their stability, determination, and appreciation for beauty. Discover how Taureans' grounded nature and hardworking mindset define their unique personality.
Remote sensing and monitoring are changing the mining industry for the better. These are providing innovative solutions to long-standing challenges. Those related to exploration, extraction, and overall environmental management by mining technology companies Odisha. These technologies make use of satellite imaging, aerial photography and sensors to collect data that might be inaccessible or from hazardous locations. With the use of this technology, mining operations are becoming increasingly efficient. Let us gain more insight into the key aspects associated with remote sensing and monitoring when it comes to mining.
Discover the innovative and creative projects that highlight my journey throu...dylandmeas
Discover the innovative and creative projects that highlight my journey through Full Sail University. Below, you’ll find a collection of my work showcasing my skills and expertise in digital marketing, event planning, and media production.
India Orthopedic Devices Market: Unlocking Growth Secrets, Trends and Develop...Kumar Satyam
According to TechSci Research report, “India Orthopedic Devices Market -Industry Size, Share, Trends, Competition Forecast & Opportunities, 2030”, the India Orthopedic Devices Market stood at USD 1,280.54 Million in 2024 and is anticipated to grow with a CAGR of 7.84% in the forecast period, 2026-2030F. The India Orthopedic Devices Market is being driven by several factors. The most prominent ones include an increase in the elderly population, who are more prone to orthopedic conditions such as osteoporosis and arthritis. Moreover, the rise in sports injuries and road accidents are also contributing to the demand for orthopedic devices. Advances in technology and the introduction of innovative implants and prosthetics have further propelled the market growth. Additionally, government initiatives aimed at improving healthcare infrastructure and the increasing prevalence of lifestyle diseases have led to an upward trend in orthopedic surgeries, thereby fueling the market demand for these devices.
India Orthopedic Devices Market: Unlocking Growth Secrets, Trends and Develop...
Cost of the Future Newly Insured Under the Affordable Care Act (ACA)
1. www.decosimo.com
Cost of the Future Newly Insured
under the Affordable Care Act (ACA)
Ken Conner, CPA, Principal, – Healthcare Practice Leader, Decosimo, CPAs
Bobby Huffaker, American Exchange, LLC
Disclaimer: These materials are designed to provide general information. Although prepared by professionals, these materials should not be
utilized as a substitute for professional legal or accounting advice in specific situations. If legal or accounting advice or other expert assistance
is required, please consult with an attorney or certified public accountant.
2. Purpose - to review and reflect the nature and impact
of the newly insured patient and the impact of non-
group exchanges on the healthcare market
Ken Conner, Decosimo, CPAs –
From the old world of providers and the TennCare
wars
Looking from the Top down
Bobby Huffaker and David Yoder – American
Exchange
Embarking on a new world of individual enrollment
Looking from the bottom up
Introduction – déjà vu or all new
3. American Exchange is a marketplace for health
insurance that creates an effective one-stop-shop for
price comparison and enrollment options (online,
telephone) for individuals wanting to participate in
the cost savings and subsidies through the State
and Federal Health Insurance Exchanges.
Introduction – déjà vu or all new
4. Time is running short before the implementation of
ACA and the exchanges.
Uninsured and those who may lose their employer
insurance lack the information, motivation and
connectivity to choose to enter exchanges.
Hospitals and physicians will become the frontline to
patient questions and options, as they seek care
under the new system – after all, wasn’t it suppose
to insure everyone?
Overview
5. Do you as a hospital want to capture these patients?
Who are these patients?
How much will the hospital be paid?
How will the patient select a plan that includes a
particular hospital? Or physician?
A patient has already been treated without
insurance. How does the hospital get them to an
exchange for the next episode of care?
In limited networks, out-of-network management
needs to be proactive.
From the Hospital View
6. Five reasons that Healthcare Reform will fail
1. Health insurers will keep most of their leverage.
2. Premiums will continue to rise.
3. It will encourage job and R&D outsourcing, as
well as domestic hourly cutbacks.
4. Hospitals and physicians will be overwhelmed
with the influx of millions of newly insured
people.
5. The middle class will pay, pay, and pay some
more.
7. Five Reasons that Healthcare reform will succeed
1. It will reduce hospitals' exposure to doubtful
accounts.
2. It will bring 16 million previously uninsured
Americans under the Medicaid umbrella.
3. It will cap insurers' profits and require them to
spend 80% of premium costs on health-care
services.
4. It will expand the benefits of the average health
plan.
5. It will promote preventive health-care visits and
should therefore reduce long-term care costs.
8. Who are the Uninsured?
CMS, Audience Segmentation for the Emerging Health Insurance Marketplace
9. 1. Individual Health Agent- Contracted by the Health
Insurance Companies
2. Navigator- Federal Government Employee
1. Navigator is a federally funded employee to help
educate individuals on how the exchanges work.
2. Navigators will not make eligibility determinations
and will not select Qualified Health Plans (QHP) for
consumers or enroll applicants into a QHP.
How do the uninsured find coverage?
10. Key Findings - What is the anticipated enrollment for
the currently uninsured under the ACA?
% Uninsured Pre-ACA % Uninsured Post-ACA
TN 15.0% 5.3%*
US 16.6% 6.8%*
TN 15.0% 8.6%
US 16.6% 9.5%
*Represents an average oftwo models.
Assuming All States
Expand Medicaid
Assuming No States
Expand Medicaid
The percentage of uninsured individuals in the U.S.
are projected to decrease from 16.6% to 6.8% or 9.5%
without Medicaid expansion, after three years of
exchanges and insurance restrictions.
This compares to a decline from 15% to 5.3% or 8.6%
without Medicaid expansion in TN.
11. Key Findings -
Non-group participants will have to rise from
281,000 to 654,000 (or 132 percent).
Size of Non-
Group Pre-ACA
Size of Non-
Group Post-ACA
% of Non- Group
in Exchange
TN 281,421 $532,091 81.7%
US 11,931,125 $25,618,984 80.4%
TN 281,421 $654,610 85.0%
US 11,931,125 $30,149,705 83.4%
Assuming All States
Expand Medicaid
Assuming No States
Expand Medicaid
12. TN $260 $380 46.4%
US $314 $413 31.5%
TN $260 $372 43.4%
US $314 $405 28.9%
Assuming All States
Expand Medicaid
Assuming No States
Expand Medicaid
Average Non-Group
PMPM Pre-ACA
Average Non-Group
PMPM Post-ACA
% Change in Non-Group
PMPM
The non-group cost per member per month are projected
to increase 31.5% in the U.S. and 46.4% in TN.
Value in the State of Tennessee – $2.0 billion less the
amount lost from those losing employer coverage.
High risk pool members.
Increased morbidity from selection by those currently
uninsured who now purchase group coverage.
Key Findings - what is their relative morbidity, and
what could reasonably be expected for relative costs
13. How the Exchange Works
The four levels of coverage available are based on
“actuarial value.” Actuarial value is a measure of the
level of protection a health insurance policy offers
and indicates the percentage of health costs that for
an average population, would be covered by the
health plan. The four levels provided in PPACA are:
Bronze Silver Gold Platinum
60% 70% 80% 90%
14. How the Tax Credit Work
The government will proved a tax credit for
those between 133-399% of the FPL based on
a percentage of income.
The amount of the credit that a person can
receive is based on the premium for the lowest
cost silver plan in the exchange.
The amount of the tax credit varies with
income such that the premium a person would
have to pay for the silver plan would not
exceed a percentage of their income.
15. Amount of Premium Limited by Income
Income Level Premium as % of Income
133-150% 3-4% of income
150-200% 4-6.3% of income
200-250% 6.03-8.05% of income
250-300% 8.05-9.5% of income
300-400% 9.5% of income
16. Penalties
$95 in 2014 (1%), $325 in 2015 (2%) and $695 (2.5%)
of household income in 2016.
For those who do not pay taxes, the penalty will
come off of the refund.
Forced from Employers Dropping Coverage
Only way to have access to the subsidy is through
individual Market - Employers will give employees
stipend to enter the exchanges.
Incentives to Enter the Exchange
17. How the Tax Credit Works
Pat has a family of four and he is 45 years old and has an income
in 2014 that is $35,657 (149% of the federal poverty level).
The cost of the second lowest cost silver plan in the exchange in
Pat’s area is projected at $10,500.
Under PPACA, Pat would not be required to pay more than 4% of
income or 1,426.
amd
Coverage Bronze Silver Gold Platinum
Premium $9,450/787.50 $10,500/875 $11,550/962.5
0
$12,705/1058.
7
Credit
Available
$9,074 $9,074 $9,074 $9,074
Cost of Plan $376/31.33 $1426/118.83 $2,476/206.33 $3,631/302.58
The tax credit available to pat would be 9,074 (premium minus limit Pat
must pay).
The Bronze plan will only cost Pat 31.33 per month for a family of four.
Figures come from KFF
18. So What Does It Look Like to an Individual
Coverage Bronze Silver Gold Platinum
Premium $9,450/787.50 $10,500/875 $11,550/962.5
0
$12,705/1058.
7
Credit
Available
$9,074 $9,074 $9,074 $9,074
Cost of Plan $376/31.33 $1426/118.83 $2,476/206.33 $3,631/302.58
19. Notes
Urgent Care Copays are 35% or $20 for the platinum plan and D&C for the other medal plans
Emergency Room Copays are $100 for the platinum plan and D&C for the other medal plans
Actuarial Value has been calculated using the value calculator put out by HHS
Patient Copays
20. How the Cost Sharing Subsidies Work
Cost-Sharing subsidies protect lower income people
with health insurance from high out of pocket costs
at the point of service.
These subsidies are available for families at or below
250% FPL, making them eligible to enroll in health
plans with higher actuarial values.
Income Level Exchange
Coinsurance
Actuarial Value
100-150% FPL 70% 94%
150-200% FPL 70% 87%
200-250% FPL 70% 73%
21. No single state’s projections were considered a
“typical” scenario. Wisconsin was chosen because
of its familiarity to several member of the oversight
committee.
The following analysis is based on an example state
(Wisconsin).
Example State
22. What is the anticipated enrollment for the currently
uninsured under the ACA?
Question 1
Age
Under 19 59.6%
19-24 26.9%
25-34 44.7%
35-44 44.7%
45-54 39.8%
55 & over 30.2%
%Remain
Uninsured
23. Projected transitions in coverage:
Many individuals previously covered by small
employers (2-50) will transition into the employer or
individual exchange (31%).
Many individuals previously enrolled in other non-
group coverage will enroll through the individual
exchange (42%) or Medicaid (10%).
Question 1
24. Projected transition from uninsured:
26% will enroll in Medicaid
19% will enroll in the individual exchange
14% will enroll in employer coverage through the
exchange or privately
40% will remain uninsured
Under the age of 19 (60%)
Excellent self-reported health status (43%)
Question 1
25. What is the newly insured’s relative morbidity
compared to the currently insured? What could
reasonably be expected for relative costs?
Question 2
Age
Under 19 80.6%
19-24 97.8%
25-34 61.8%
35-44 76.5%
45-54 254.9%
55 & over 92.1%
%Change in
Average Costs
26. If you did not have health insurance during the past
two years, what healthcare services would you have
delayed or postponed indefinitely?
Prescription drugs
Physician visits
Outpatient procedures
Emergency room visit
Would you have been as quick to have a test such as
an MRI performed or would you wait to see if the
injury got better?
Would you have the same attitude towards your
children’s healthcare?
Asks yourself
27. Number of physicians visits per 1,000 individuals
under the age of 65:
For the uninsured - approximately 1,366.
For the currently insured - 3,282.
Hospital stays for the insured are more than double
that of the uninsured.
Part of the difference in utilization rates is due to the fact that the
uninsured are on average younger than insured individuals.
Question 2
28. Two anticipated effects of extended coverage:
An increase in access to primary care will result in
savings due to a reduction in preventable emergency
room visits and hospitalizations.
A general increase in the use of elective services
such as primary care, corrective orthopedic surgery,
advanced diagnostic tests, and other care that the
uninsured either forgo or delay.
Question 2
29. The research on “pent-up” demand for health care
services as individuals become newly insured has
shown mixed results:
A study of near-elderly uninsured approaching
Medicare eligibility found:
Pent-up demand for physician care (30% more physician
visits in first two years of Medicare enrollment).
But not for hospital inpatient care.
A study of near-elderly uninsured prior to Medicare
eligibility found:
Elevated hazard of diagnosis for nearly every chronic
condition and increased utilization after age 65.
Pent-Up Demand for Services
30. A study of children newly enrolled in Medicaid found:
No evidence of pent-up demand.
A study based on the one-year effects of the Oregon
Medicaid lottery found:
No evidence of a larger initial utilization effect.
However the longer run impact could differ from one-year
effects.
Pent-Up Demand for Services
31. How will premium rates in the non-group market be
impacted by the new population mix? How will
health care costs be impacted by the presence of the
high risk pools under the ACA, and how are current
costs impacted by current state high risk pools?
Question 4
Age Avg. Monthly Cost Avg. Monthly Cost
Under 19 $167 $189 13.0%
19-24 $172 $186 8.3%
25-34 $219 $322 47.1%
35-44 $227 $380 67.5%
45-54 $322 $688 113.8%
55 & over $384 $896 133.2%
Non-Group under
ACA Change in Average
Monthly Cost
Non-Group Under
Current Law
32.
33. Influx of 25 million new patients.
Cost Sharing Subsidy- now the government is
helping with uninsured out of pocket, the hospitals
should collect exchange copays upfront at the time
of check in.
BCBSTN will allow its consumers to choose the
network; P, S, and new E network in the exchange.
Will have more details on the reimbursement rate of
the E network with BCBSTN when the contract is
finalized on 6-1-2013.
Why Providers Participate
35. Be creative in how you reach the uninsured before
they reach you
American Exchange has partnered with Liberty Tax
Service to identify individuals eligible for tax credit
Point of service intervention
Easy access via a call center
Outbound responses
Inbound transfers
Reaching the Individual
36. Clearwave has a kiosk based self-service
registration solution that:
• Reduces provider costs associated with registration
and eligibility verification
• Reduces patient wait times
• Reduces claims denials
• Increases cash collections
• Improves patient satisfaction
Reaching the Patient
37. Clearwave presents patients with an “Opt-In” screen.
If a patient wishes to be contacted about options for
health insurance, they are provided with a HIPAA
Authorization to allow the provider to share patient
contact information with American Exchange.
We are now putting providers in the driver seat for
outreach to the patients.
It is in the Provider’s best interest to increase the
percentage of insured patients.
Provider will also have access to detailed information on
how many current patients will be entering the insurance
exchanges.
Reaching the Patient
40. H. Kennedy (Ken) Conner, CPA
Principal – Healthcare Practice Leader and Alabama
Practice Development
Direct - 423.267.4084
kenconner@decosimo.com
On LinkedIn:
http://www.linkedin.com/in/kenconner