Healthcare Business Week in Review: ACA, NCQA Reviews, Post-Acute Care Programs, ICUs Perform Under Pressure

Friday, October 11th, 2013
This post was written by Cheryl Miller

The Affordable Care Act (ACA) continues to make headlines, as many online health insurance marketplaces struggle to meet the overwhelming consumer demand of healthcare seekers, and, at least at press time, the government continues to wrestle its merits as the country remains in shutdown mode.

Nearly 85 percent of the health plans offered in the health insurance marketplaces that were scheduled to launch last week are accredited by the National Committee for Quality Assurance (NCQA), the organization reports. Officials say the surge of nearly 60 health plans seeking accreditation prior to the October 1st launch date was one of the largest in NCQA’s 23-year history. Hundreds of other plans that already held NCQA accreditation modified it in order to participate in the exchange marketplaces.

Those who stand to benefit the most from the ACA are newly-insured consumers under an expanded Medicaid program, according to a new RAND Corporation study.

While out-of-pocket medical expenses for most Americans will decline with the new healthcare law, the estimated 11 million Americans who become newly-insured under Medicaid can expect to save approximately $1,420 annually in out-of-pocket expenses, researchers say. Those Americans who become newly insured but don’t qualify for government subsidies will most likely see the largest increases in medical spending as they begin paying premiums for health coverage.

The report also details the findings of states that have chosen not to expand Medicaid, and discusses the clearest benefit of the law.

In other news, two healthcare organizations, naviHealth and Cigna-HealthSpring, have joined forces to maximize their acute patient care and outcomes and help reduce escalating costs. The collaboration will utilize naviHealth’s technology (which facilitates better evidenced-based decision-making), and acute inpatient case management processes for Cigna-HealthSpring members receiving skilled nursing facility (SNF) services. Expected benefits of the partnership for Cigna-HealthSpring and its members include improved patient satisfaction with personalized care plans, and more informed and efficient care delivery.

Informed and efficient care delivery also prompted researchers from Penn Medicine to study whether busy intensive care units (ICUs) discharge patients more quickly than usual, compromising patient care and outcomes.

Anticipating increased numbers of patients requiring critical care resources, and a projected shortage in critical care providers, researchers assumed there would be increased competition for ICU beds among greater numbers of more seriously ill patients, and shorter periods of time available in the ICU, leading to declining health outcomes. But researchers found the opposite: reductions in the number of U.S. ICU beds could yield considerable cost savings without reducing the quality of care. The study’s findings have important implications for planning U.S. critical care capacity, researchers note.

It’s not too late to participate in our online survey, Health Risk Assessments in 2013. Sophisticated analytics behind today’s health risk assessments or health risk appraisals (HRAs) provide employers, payors and providers an aggregate view of population health and the raw material for the development of prevention and lifestyle change programs. Tell us how your organization uses HRAs to improve population health by October 15, 2013 and get a FREE executive summary of the compiled results.

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