The Centers for Medicare & Medicaid Services released a proposed rule this week establishing proposed “Navigator” standards under the Affordable Care Act. Navigators are organizations that will be providing information to consumers about health insurance, the new Health Insurance Marketplace, qualified health plans, and public programs. In other words, Navigators will be providing assistance to consumers shopping for coverage plans in the new Marketplace.
Archive for the ‘Affordable Care Act’ category
Public Health tracks the number of healthcare workers – physicians, dentists and psychiatrists – to make sure we have enough to take care of the community. In Arizona we’ve been challenged to recruit and keep those professionals – and we have numerous Health Professional Shortage Areas. Just to eliminate the current shortages, we’d need an additional 313 primary care physicians, 250 Dentists, and 136 Psychiatrists… and a new study shows that we’ll need even more as AZ aligns Medicaid eligibility with the Affordable Care Act. The study estimates the country will need about 52,000 more primary care physicians to meet the nation’s health care needs through 2025. The biggest reason for the increase is the growing population, but the number of people getting older and the insurance change impact the number too.
Fortunately, we have some creative people working on solutions here in Arizona. This month our Health Systems Development shop along with the Arizona Alliance of Community Health Centers and the UA’s Center for Rural Health brought together folks from the healthcare industry, academia, Arizona Area Health Education Centers, and clinicians to discuss strategies to address the shortage of healthcare workers in Arizona. The group showed strong support for the National Rural Recruitment and Retention Network (3RNet) – a tool that helps businesses solve healthcare workforce issues. The 3RNet Program invites healthcare facilities in Arizona to register and use 3RNet as a recruitment tool. Agencies that use 3RNet can post and update vacancies and post videos or pictures of their facility or their community to better market and attract candidates. If you have questions about the program, you can contact Ana Roscetti, Workforce Section Manage, at Ana.Lyn.Roscetti@azdhs.gov or 602-542-1066.
The US Dept. of Health & Human Services released 3 new Affordable Care Act proposed regulations this week… including: 1) A proposed Rule regarding coverage requirements for pre-existing or chronic conditions; 2) A proposed Rule outlining policies and standards for coverage of essential health benefits; and 3) A proposed Rule implementing and expanding employment-based wellness programs to promote health and help control health care costs.
The Fed’s put out a series of pretty simple and easy to read 1-page fact sheets this week that summarize some of the aspects of the Affordable Care Act. There are Fact Sheets for Families with Kids; Health Care Providers; Folks with Disabilities; Seniors; Small Business Owners; and Young Adults. At the bottom of each fact sheet there’s a link to a special ACA website for each of these categories. You might want to share these with your Stakeholders in these categories.
The Affordable Care Act provided $1.5B nationally (through September 2015) to the National Health Service Corps to train and recruit more primary care providers via scholarships and loan repayment assistance. It’s a federal program been building healthy communities by connecting primary health care providers to areas of the United States with limited access to care since 1972.
The Corps basically brings health care to those who need it most because of limited access to care. Today, there are more than 10,000 providers who commit to serve in underserved communities and serve many of the country’s most vulnerable populations. In Arizona, the new expansion provides the opportunity for communities to use the Corps for recruitment and retention of primary care providers in medically underserved areas.
Locally, our Bureau of Health Systems Development collaborates with the Arizona Association of Community Health Centers to provide tools and successful models for recruitment and retention to Chief Medical Officers, Medical Directors, Human Resources Directors, Clinic Administrators, and other staff involved in recruitment and retention. You can find the full list of events happening in Arizona to celebrate the upcoming Annual Corps Community Day.
The future health insurance exchange plans (as well as most other commercially available plans) will need to offer a standardized (state-specific) Essential Benefit Package once the Affordable Care Act kicks in on 1/1/14. There are 10 key service categories that future plans will need to cover- including behavioral health services.
States were responsible for picking a plan from a set of existing options to serve as their state’s “benchmark” plan by last week. Arizona picked the State Employee EPO plan as the benchmark plan that most insurance plans will need to cover (at a minimum) on and off the exchange. Future exchange health plans (as well as most other commercially available plans) will need to be “substantially equal” to the state employee benchmark plan in the scope, limitations and exclusions (e.g. visit limits). I think the plan is a good choice because it has a robust behavioral health component with fewer limitations, restrictions and exclusions than most other options- and already covers behavioral health services at parity (meaning behavioral health has the same level of coverage as physical health).
Obviously there’s a lot more to it than that… and folks can get a lot more in-depth info about what an Essential Health Benefit is and what it means in this document- which provides an Arizona specific analysis of the issues and the various services that’ll be covered under the future benchmark plan.
The next 2 years will be a time of transition for how vaccines are delivered and paid for in the US- as national policy shifts to the new order under the Affordable Care Act. In the short-term there’ll be some transition challenges- but in the long run- it should be easier to keep up our vaccination rates.
In a couple of weeks, the CDC will stop allowing federally purchased vaccines to be used for immunizing privately insured kids. They’re doing this to ensure that federal vaccine only go to those who have no other options for vaccination… and to assure that all insured children are vaccinated through their insurance policy rather than taking advantage of free federally purchased vaccine.
In the past, county public health clinics that get federally purchased vaccine through our Immunization Program have used federally purchased vaccine to ensure that any child who has not been able to access vaccine elsewhere is able to get immunized, even when the child is insured. Because not all counties will have a mechanism to bill private insurance companies for services- some might not be fully ready to immunize privately insured children next week… meaning that insured children will need to receive all of their immunizations in their medical home. The second policy change will be implemented mid-year 2013… when the CDC will stop allowing underinsured kids to get immunized for free with federal, except at specified locations. “Under-insured” means that a child has insurance, but the insurance doesn’t cover one or more immunizations. Those are the short-term challenges.
The good news is that there’s still plenty of federal vaccine for Vaccines for Children eligible kids (including kids on AHCCCS), the uninsured and Native Americans. The best news is that it’ll be easier to maintain high vaccination rates starting in January of 2014 because the Affordable Care Act provides for “first dollar” coverage for vaccines for all kids… plus there’ll be fewer under-insured children. So, the real key is to get over the 2013 hump- because beginning in January of 2014 things will get easier.
Chronic diseases like heart disease, cancer, stroke, and diabetes cause 70% of deaths in the US these days… absorbing 75% of the $2.5T spent on annual medical care costs. When it comes to employee healthcare expenses- the indirect costs of poor health like absenteeism, disability, and reduced work output can be several times higher than direct medical costs. In fact, productivity losses from health problems cost employers $1,685 per employee per year!
One of the provisions in the Affordable Care Act includes incentives for employers to implement worksite wellness programs to help them keep their workforce healthier. When done well (using evidence-based and best practices) worksite health programs have a 3:1 payoff. Like the odds?
The Affordable Care Act contains some elements that will make worksite wellness programs more common and robust over the next couple of years. There are basically 2 kinds of worksite wellness programs. I’ll call them Wellness and Wellness Lite. A “Wellness Lite” program doesn’t require a participant to meet any standard related to health status to receive a reward. For example… a wellness program could include a gym membership or tobacco cessation program but doesn’t require participants to actually lose weight or quit smoking.
A Wellness program requires people to meet a health status standard to get a reward. For example- an employer could ask employees to certify that they haven’t smoked during the previous year. Enrollees who don’t could be assessed an annual surcharge of 20% of cost of the employee’s health insurance coverage. Rewards may be in the form of premium discounts or rebates, lower cost-sharing requirements, waiving a surcharge, etc. Under the Affordable Care Act, wellness program rewards can be as high as 30% of the cost of the employee health plan- potentially going to 50% in the future.
Our AZ Healthy Worksites web page provides businesses with information and tools to help them develop and implement an effective worksite wellness program. For example, the Program Design page lists the eight steps for developing, implementing, and evaluating a comprehensive worksite program. We’ve also contracted with the Arizona Small Business Association & Viridian Health Management to develop a new toolkit for AZ businesses. Viridian and the Arizona Small Business Association will teach businesses how to do effective wellness programs, understand their own particular issues/data, and develop effective strategies. In all, our contract tasks the team to train 500 AZ employers. Finally- the CDC is jumping into the fray with a variety of resources, which you can see at their worksite wellness hub website.
Several prevention-related health services will be covered without cost sharing in new health plans as of a couple of weeks ago as a result of the Affordable Care Act. The changes are designed to help lower costs and outcomes for a variety of preventative women’s services. Previously, some insurance companies didn’t cover some of the new preventive services, while some women had to pay deductibles or co-pays. The new rules in the health care law requiring coverage of these services take effect at the next renewal date.
Some of the new services include: 1) Well-woman visits; 2) Gestational diabetes screening for pregnant women; 3) Domestic violence screening and counseling; 3) Breastfeeding support, supplies, and counseling; and 4) Sexually transmitted infections and HIV counseling for sexually-active women. The list of required services are based on recommendations from the Institute of Medicine, which relied on independent physicians, nurses, scientists, and other experts as well as evidence-based research to develop its recommendations. These preventive services will be offered without cost sharing beginning today in all new health plans. Group health plans and issuers that have maintained grandfathered status and certain nonprofit religious organizations (like churches and schools) aren’t required to cover the new services.