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The mammogram contention has been highly debated. Many (I haven't done the study from pre to post for plans) group plans already offered the mammo with no cost sharing, kind of like your yearly dental cleaning. But, for those that didn't, it was factored into the premium, which ACA did not address. So, up front or on the back, it was still there. But, again, many plans already offered it. For Medicare, Traditional began paying full cost in 2011 and MA Plans in 2012 so it is 'trumpeted' as a big change but in effect was already there. Not putting it down and thankful it is.
Without going into the full depth, 'well care' made free at POS is kind of a misnomer and there are multiple places people can find out how that broad category was actually effected by ACA as to the requirements they actually had to change. But I won't contend the general statement. Business wise, not a lot changed, for someone who is used to drastic change, but my perspective may be different than others.
Yes, I realize that in the bold about mammograms. However, "many" isn't "all" and generally, the ones who had the lower benefit (cheaper) policies also had lower incomes and could less afford to pay for a mammogram out of pocket. I realize that is not 100% across the boards correct, just a generalization. As for your dates of Medicare adding mammos, they are both after the ACA, and the question was what changes have the ACA wrought.
In pediatrics, not having to pay co-pays for each and every immunization/well visit has been a good thing. And you know what? I don't think it really costs the ins. companies that much more!
Yeah... insurance companies have been pushing things likes that for a LONG TIME precisely for that reason. Same with nurse outreach when people leave the hospital... those annoying calls asking people how they are doing, scripts filled, any assistance needed in making follow up appointments, etc. Why? To prevent the need for readmission. It saves money.
not to shill for payors but there are whole departments at payors, at least the one I worked out for 10 years, the 2 that I had extensive w2 contracts with, the 4 I helped redesign either payor systems or EDI, etc... to work with members on things like.... yearly checkups (routine E&M), vaccines (including flu), mammos, gyno visits, the lovely male version of the gyno visit at 40/45/50, etc... and in the data world, basically tracking down members, say of kids under 5, and looking at exactly what vaccines they were behind on.
Now coverage, people have to keep in mind: the plan a person or employer buys is where the coverage is. I don't like using the analogy but if one only carries liability coverage on their vehicle, Geico won't pay if someone does a hit and run the vehicle. It's not right, wrong, or indifferent, it's just how it works.
Why do you think employers were more up in arms over ACA then the major payors? Because employer groups, and no fault to them, have been scaling back on the coverage they are buying their employees for years. And, for those that work for the payors, WE ARE THE GUINEA PIGS FOR COVERAGE. Meaning, what is being offered to the public now is what we had to live with 10 years ago. My individual deductible was 3K in 04.... when I got married, it went to 6300 in 06. People still don't see those numbers.
The only insurer who ever contacted me, or encouraged me to receive preventative care has been Kaiser. I belonged to Anthem, and BCBS for 14 years when I lived in Nevada and never heard a peep from them, my husband had an employer provided Humana health plan there and he was never contacted by them or reminded to get annual visits, etc. On the other hand, when I don't schedule a visit with Kaiser when they think I should, they email me twice and then call me on the phone.
That is great for Kaiser... I can't speak for other plans, only those I worked or contracted with. Also, time frame. I didn't get into the industry until late 2001 and didn't really start seeing a global perspective till about 04. Starting in about 07, I saw the preventive 'push'... once I got into data in 2010, that was about 45 percent of my job.
Were they always efficient about it? No. A lot of it also depended on the plan... and the cooperation with the PCP if it were HMO or NPOS acting under HMO standards (whether capitated or not).
Sorry you didn't have that personal experience. I could divulge some but, being the state you were in, that doesn't shock me as market penetration was exceedingly low. I also lived in Nevada prior to getting into the industry so that kind of makes sense. Due to the transient (migratory) nature of much of the state, outside the gaming and call centers (besides the military), all the other employer plans suffered.
Yes, I realize that in the bold about mammograms. However, "many" isn't "all" and generally, the ones who had the lower benefit (cheaper) policies also had lower incomes and could less afford to pay for a mammogram out of pocket. I realize that is not 100% across the boards correct, just a generalization. As for your dates of Medicare adding mammos, they are both after the ACA, and the question was what changes have the ACA wrought.
In pediatrics, not having to pay co-pays for each and every immunization/well visit has been a good thing. And you know what? I don't think it really costs the ins. companies that much more!
Yes and no about ACA and dates... date signed and date implemented are 2 separate things, unfortunately. Private did not have to add until 2012 but implementation had another 90 day grace period although, actually... that was such a simple system fix that it literally would take 5 minutes write a system wide system update for remove that benefit from a benefit matrix (those are really general terms as every adjudication system terms things differently). As a 'whole' in the industry, the effect has been minimal. That's not me 'digging' in my heals... that's just the numbers and observation. Again, ACA had some good things, and some bad, but overall, it was no sweeping reform... some incremental changes. Medicaid expansion had a bigger, in my opinion, effect industry wide from a coverage, access care, and financial perspective.
But I don't disagree at POS payment. Actually, I never quite 'got it'... I mean, I understand cost share but wth is $10 even at 50,000 encounters for a large payor? Administratively, it cost more to implement the RARC and CARC' to accurately reflect that $10 copay (I know amount is a generalization. I don't either of us are actually in disagreement about the effectiveness of preventive services).
Yes, I realize that in the bold about mammograms. However, "many" isn't "all" and generally, the ones who had the lower benefit (cheaper) policies also had lower incomes and could less afford to pay for a mammogram out of pocket. I realize that is not 100% across the boards correct, just a generalization. As for your dates of Medicare adding mammos, they are both after the ACA, and the question was what changes have the ACA wrought.
In pediatrics, not having to pay co-pays for each and every immunization/well visit has been a good thing. And you know what? I don't think it really costs the ins. companies that much more!
What I DO VEHEMENTLY DISAGREE WITH IS.... I want to see a triple axel or a triple sow-kow (sp?). Come on, you were the best in history!
Yeah I'm familiar with the tort reforms here in Texas. It may have reduced costs to doctors but to date, those savings have not been passed along to patients. Our medical costs have risen right along with everyone else's. I remember the push to get that passed. Politicians were falling all over themselves promising it would make healthcare affordable.
Before tort reform doctors were LEAVING Texas. Since tort reform the number of doctors in Texas has been rapidly increasing. This increase access to medical care for everyone. This is especially the case in rural communities. More doctors means more competition for common checkups and procedures and this will drive down prices.
And individuals DO benefit:
CHRISTUS Health, a not-for-profit Catholic health system with hospitals throughout Texas, saved so much on its liability costs that it expanded its charity care by $100 million per year starting in 2004.
The total health care facilities expansion in the state attributable to HB4 (tort reform) exceeds $10 billion.
Things in Texas are definitely better after tort reform than before tort reform.
Universal healthcare would not be necessary if we would instead eliminate all health insurance and allow the resultant inflated cost of healthcare to decrease to market rates, eg: what the market can pay for it in cash. Universal healthcare isn't a big jump from the socialized medicine that we have now called health insurance. If someone needs healthcare and can't pay for it in cash, we could cultivate a loan system to help cover the cost. However, theoretically, the cost for anything would never be relatively that high.
Doctors and hospital administrators would have to be okay with less pay.
Before tort reform doctors were LEAVING Texas. Since tort reform the number of doctors in Texas has been rapidly increasing. This increase access to medical care for everyone. This is especially the case in rural communities. More doctors means more competition for common checkups and procedures and this will drive down prices.
And individuals DO benefit:
CHRISTUS Health, a not-for-profit Catholic health system with hospitals throughout Texas, saved so much on its liability costs that it expanded its charity care by $100 million per year starting in 2004.
The total health care facilities expansion in the state attributable to HB4 (tort reform) exceeds $10 billion.
Things in Texas are definitely better after tort reform than before tort reform.
Good ole Christus Health.
I will say Texas has some of the most stringent rules for private payors as well.... cleans claim payment, turn around, G&A rules, DOI penalties. Those advocating a Federal System could learn a lot from Texas.
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