Future Practices Of Health Insurance and Managed Care

Topic: Impact Of The Patient Protection and Affordable Care Act (ACA) On Current and Future Practices Of Health Insurance and Managed Care
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Introduction
Enacted into law on 23rd of March, 2010, the Patient Protection and Affordable Care Act (ACA), is the most extensive healthcare reform legislature in the United States (US) ever since the conception of Medicare and Medicaid in 1965 (Lathrop & Hodnicki, 2014). The ACA institutes a new course for the U.S. healthcare model that includes an emphasis on preventive services and basic care. It offers insurance policies to millions of people who are currently uninsured and tries to address areas of the existing healthcare system that require improvement so that populations requirements for safe care and better health results are met (Lathrop & Hodnicki, 2014). According to The New York Times, around 48 million of America population were living without health insurance by year 2012. That figure constituted a 15.4 percent of the country’s population. The ACA purposes to give insurance to these Americans –however, the question that lingers is what does this mean for healthcare benefactors? The ACA is aimed to transform health care by encompassing coverage to the uninsured, while evaluating the patient experience, pulling down health care costs, and creating improved health outcomes (Wilson, 2014).To manage fair costs and improve the quality of healthcare, the ACA alters the way hospitals together with other health care providers are compensated for services, while holding them to new practice standards. It upholds models such as Patient-Centered Medical and Homes Accountable Care Organizations, to help in harmonizing care for an individual patient across the many settings (Wilson, 2014). In this paper, focus will be on some of the numerous changes that hospitals will undergo as a result of the ACA. Mutual themes in all of these transformations are quality, efficiency, and accountability– three of the foundations that are driving healthcare reform efforts
The Effects on Health Care Delivery in Hospitals
As a consequence; increased governing burdens, have led to health care stakeholders shifting industry practices. In order to ensure viability in the new marketplace, strategic planning and a vision of the future has become very necessary. A reassessment of the current market position, labor costs, and infrastructure is necessary to ensuring solvency as the ACA takes effect.
Mega Health Care
Besides individual physicians, group practices, and other healthcare businesses, hospitals are now merging and consolidating in order to remain relevant and strong in the industry. Mergers and acquisitions help in spreading out of the fiscal risk and increasing market share while minimizing overhead costs for billing and dues. This provides a better negotiating command with insurers, physicians, government entities, and other hospitals (Syre, 2011). Research shows that about 60 % of hospitals in the US are now in a system. In 2011, there was a both vertical and horizontal acquisition that included 432 mergers and involved 832 hospitals (Morton, 2013). For example, in Massachusetts, firms show reduced costs operation but increased costs for clients and insurers, which is a worrying drift if it holds nationwide.
Where-as these alliances help to improve quality and productivity through coordination of care, others contend that mergers and consolidation may also result in monopolies in the marketplace. This results in anti-trust distresses. Since consolidation eliminates the competitive incentives to improve care, some fear that consolidated systems may also result to a reduced quality of healthcare provided by the hospitals (Hayford, 2012).
Doctors are now selling practices, joining larger physician groups, and seeking employment in hospitals. Physicians seem to be frustrated with the increased regulations, the monetary expenses of practice, obligation, persistently growing workloads, and the whole stress at the place of work. They are therefore, choosing to relinquish independent practice. It is estimated that by 2011, about 50% of physicians were employed by hospitals, insurers, or corporations. This is considered a significant transformation in care delivery setting of a scale never seen before since the 1990s (Singer, 2013).
Direct-Care Models
Genuine distresses about the personnel shortage, oppressive protocols, reduced time with patients, and government interferences in the doctor–patient association have compelled hospital providers to begin changing independent practice models. Some hospitals are now engaged in cash-only practices all around the country with most posting price lists and demanding up-front fee for services (Kennedy, 2013). Despite the fact that the number of cash-only practices is minor, practice transformations have been growing for the past few years. Hospitals following this path have considerably reduced overhead costs by removing patient billing and claims, allowing them to regulate their own charges and care for the patients in the way that they see fitting (Kennedy, 2013). No cover concerns or third party restricts their choices about treatments or care.
A third of physicians were expected to change to such a subscription-based practice strategy by the end of the year 2013. Direct pay and concierge care are both subscription-based systems in which patients pay a periodic (monthly or annual) fee. Prices differ broadly subject to services delivered. Concierge practices offer a higher level package involving care coordination and assisting patients to discuss the system but direct-pay practices offer more restricted services for instance, same-day schedules and additional contact to doctors through phone, or e-mail (Accenture, 2012). Patients pay membership remuneration with an agreement between the hospital and patient assuring priority access and services in addition to basic care.
In most instances, patients are expected to hold onto insurance to cover fees for the doctor’s basic services. Most of the practices consent to private insurance, Medicaid, and Medicare. The HHS has advised against such practices in the past, and as the market for substitute access intensifies, there is worrying that the government will get involved to restrict or bar such practice system. Presently, as long as practitioner can confirm that the services being rewarded by the subscription charges are exceeding beyond the amenities that the physician is contracted to offer through the private insurance or government-run programs, they can evade fines for "double billing" or damages related to the insurance agreements.
With subscription-based models, hospitals can choose to moderate or minimize the panel of patients permitting for personalized, easy-going care with a definite baseline pay. Actually, some insurance firms are putting up plans for establishments that let individuals acquire the concierge alternative for increased access and payments (Wieczner, 2013). Even though the concierge care, cash-only, and subscription-based systems all endeavor to protect the individual privileges of the provider and patient while justifying financial loss, the aggregating number of these practices will upset accessibility and affordability for Americans. Inventive new practice models will warrant an access for those who can meet the expense of it (Wieczner, 2013).
Quality Health Care
Excellence in terms of quality of care has been a key emphasis in health care in the America for years, and America’s hospitals and medical authorities have per...