More about Health Care Reform

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Wellness Programs and More!

In many ways The Affordable Care Act – Heath care Reform (ACA) will cause a paradigm shift in health care. By extending the coverage of wellness and preventative exams, it is hoped that people will take better care of themselves and develop good habits for health and catch any disease process early. While some companies have instituted wellness programs that reward employees for healthy lifestyle choices, this may just be the start. For instance, a company may tell an employee who is 100 pounds overweight that if he/she joins a wellness program, sticks with the program and loses 50 pounds he/she would get a cash reward. Conversely, If individuals choose not to engage in a wellness program they may have to pay more for their healthcare coverage. People may also be charged higher premiums based on smoking.

Physician’s assistants will be put to greater use. It is beginning where people who are sick will call or email in their symptoms and a medication be prescribed without the patient being seen. Conversely due to ACA, a patient receiving a home healthcare or durable medical equipment, such as oxygen, must be seen by a physician.

Fee schedules seem to more favor the primary care doctor. Only 8% of the nation’s medical schools graduates (according to the Kaiser Foundation) go into family medicine. The greater fee schedule may cause more students to go into primary care. Also according to the Kaiser Foundation” One theory is that patients with a usual source of primary care tend to use more preventive health care and have health problems treated at earlier stages. Many experts believe that the decline in primary care has contributed to overspecialization of care, fragmentation and inefficiency in the health system. Half of specialist visits are for routine follow-up, a misuse of expensive care”

This thought has brought back and revised a 1980s HMO concept now named Accountable Care Organizations (ACO). The concept is to have a “gate keeper” (primary care physician) manage care. The hope is to better manage care by coordinating the use of specialists and “remove fragmentation and inefficiencies of our current system”.

The cost of healthcare has been a substantial issue to pass ACA reform. Already starting is more of a bundled approach of fees received by surgeons based on the outcome of a procedure, not based solely on the number of procedures. Your cost has also been a primary concern. In an effort to lower the cost of premiums for ages approaching 60, ACA requires a 60 year old to pay no more than three times that of a 20 year old. Everyone can see that this will help the 60 year old, but the 20 year’s premium will jump 50% – 100%. This is where premium subsides will help young, lower wage workers.

This will be a paradigm shift whether or not people like it, or hate it. Also, note that while much of the timeline has been implemented, the Health & Human Services Secretary has great discretion in the details of implementation of ACA. More next month on the penalties for not enrolling in coverage and what can happen as wages increase. This author strongly believes it will be in your best interest to use your health insurance agent this October as you consider your choices in ACA plans.

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Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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