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Affordable healthcare and cost sharing

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https://www.readbyqxmd.com/read/27888437/estimated-budget-impact-of-adopting-the-affordable-care-act-s-required-smoking-cessation-coverage-on-united-states-healthcare-payers
#1
Christine L Baker, Cheryl P Ferrufino, Marianna Bruno, Stacey Kowal
INTRODUCTION: Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice...
November 25, 2016: Advances in Therapy
https://www.readbyqxmd.com/read/27681019/implementation-of-the-affordable-care-act-a-case-study-of-a-service-line-co-management-company
#2
Bethany Lanese
Purpose The purpose of this paper is to test and measure the outcome of a community hospital in implementing the Affordable Care Act (ACA) through a co-management arrangement. RQ1: do the benefits of a co-management arrangement outweigh the costs? RQ2: does physician alignment aid in the effective implementation of the ACA directives set for hospitals? Design/methodology/approach A case study of a 350-bed non-profit community hospital co-management company. The quantitative data are eight quarters of quality metrics prior and eight quarters post establishment of the co-management company...
September 19, 2016: Journal of Health Organization and Management
https://www.readbyqxmd.com/read/27294747/first-year-open-enrollment-findings-health-insurance-coverage-for-asian-americans-and-the-role-of-navigators
#3
Edwin Chandrasekar, Karen E Kim, Sharon Song, Ranjana Paintal, Michael T Quinn, Helen Vallina
The health insurance coverage established by the Patient Protection and Affordable Care Act has created an opportunity to reduce racial/ethnic disparities in healthcare. It is expected that of the 24 million individuals projected to join, nearly one-half will be non-white and one-fourth will speak a language other than English at home. Asian Americans are one of the fastest growing racial/ethnic groups in the USA. The majority are foreign born and experience limited English proficiency. The role of navigators has been shown to increase enrollment rates of public insurance programs...
September 2016: Journal of Racial and Ethnic Health Disparities
https://www.readbyqxmd.com/read/27270159/practical-solutions-when-facing-cost-sharing-the-american-cancer-society-s-health-insurance-assistance-service
#4
Katherine Sharpe, Beverly Shaw, Mandi Battaglia Seiler
The American Cancer Society (ACS) has been a leading voice for healthcare reform and an informed advocate for effective health insurance reforms. Since the implementation of the Affordable Care Act (ACA), the ACS has observed a shift in inquiries to its Health Insurance Assistance Service (HIAS) from individuals seeking coverage, to a growing problem of individuals presenting issues from being underinsured. Underinsured patients with cancer face serious financial challenges due to large co-pays and coinsurance costs...
March 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27145405/improving-patient-outcomes-with-oral-heart-failure-medications
#5
Melissa M Sherrod, Dennis J Cheek, Ashlie Seale
Hospitals are under immense pressure to reduce heart failure readmissions that occur within 30 days of discharge, and to improve the quality of care for these patients. Penalties mandated by the Affordable Care Act decrease hospital reimbursement and ultimately the overall cost of caring for these patients increases if they are not well managed. Approximately 25% of patients hospitalized for heart failure are at high risk for readmission and these rates have not changed over the past decade. As a result of an aging population, the incidence of heart failure is expected to increase to one in five Americans over the age of 65...
May 2016: Home Healthcare Now
https://www.readbyqxmd.com/read/27017203/are-the-affordable-care-act-restrictions-warranted-a-contemporary-statewide-analysis-of-physician-owned-hospitals
#6
Daniel K Lundgren, Paul M Courtney, Joshua A Lopez, Atul F Kamath
BACKGROUND: The Affordable Care Act placed a moratorium on physician-owned hospital (POH) expansion. Concern exists that POHs increase costs and target healthier patients. However, limited historical data support these claims and are not weighed against contemporary measures of quality and patient satisfaction. The purpose of this study was to investigate the quality, costs, and efficiency across hospital types. METHODS: One hundred forty-five hospitals in a single state were analyzed: 8 POHs; 16 proprietary hospitals (PHs); and 121 general, full-service acute care hospitals (ACHs)...
September 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/26920579/the-availability-and-affordability-of-orphan-drugs-for-rare-diseases-in-china
#7
Shiwei Gong, Yingxiao Wang, Xiaoyun Pan, Liang Zhang, Rui Huang, Xin Chen, Juanjuan Hu, Yi Xu, Si Jin
BACKGROUND: Orphan drugs are intended to treat, prevent or diagnose rare diseases. In recent years, China healthcare policy makers and patients have become increasingly concerned about orphan drug issues. However, very few studies have assessed the availability and affordability of orphan drugs for rare diseases in China. The aim of this study was to provide an overview of the availability and affordability of orphan drugs in China and to make suggestions to improve patient access to orphan drugs...
2016: Orphanet Journal of Rare Diseases
https://www.readbyqxmd.com/read/26903017/resource-effective-strategies-to-prevent-and-treat-cardiovascular-disease
#8
REVIEW
J D Schwalm, Martin McKee, Mark D Huffman, Salim Yusuf
Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries. The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in low- and middle-income countries. Barriers at the patient, healthcare provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps...
February 23, 2016: Circulation
https://www.readbyqxmd.com/read/26598303/contraceptive-coverage-and-the-affordable-care-act
#9
REVIEW
Mary Tschann, Reni Soon
A major goal of the Patient Protection and Affordable Care Act is reducing healthcare spending by shifting the focus of healthcare toward preventive care. Preventive services, including all FDA-approved contraception, must be provided to patients without cost-sharing under the ACA. No-cost contraception has been shown to increase uptake of highly effective birth control methods and reduce unintended pregnancy and abortion; however, some institutions and corporations argue that providing contraceptive coverage infringes on their religious beliefs...
December 2015: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/26062323/acos-in-real-life-a-reflection-on-the-medicare-shared-savings-program
#10
Craig R Behm
The Medicare Shared Savings Program introduced Accountable Care Organizations (ACOs) as one potential method for meeting the often-cited triple aim of better individual care, improved population health, and lower cost. Built on concepts originating from HMOs and then Medicare Advantage plans, ACOs provide incentives based on total cost of care rather than any individual provider's cost. Early quality and cost results are mixed, and, more importantly, so is physician response. The ACO program still has potential to be a bright spot for the future of healthcare, but until there is widespread physician engagement, achieving the triple aim is likely to remain elusive...
March 2015: Journal of Medical Practice Management: MPM
https://www.readbyqxmd.com/read/25960464/wa42%C3%A2-proving-its-worth-changing-public-policy-for-palliative-care-end-of-life-care-and-bereavement-through-advocacy-and-communications
#11
Angela Edghill, Miriam Donohoe
BACKGROUND: The 2015 palliative care budget is €72 million (Euros) but up to €1.3 billion spent on end of life care annually - much of this larger figure unplanned and uncoordinated. Geographic and other inequities evident in palliative care provision. AIM: Build support for the development and implementation of a National Strategy on Palliative Care, End of Life and Bereavement. METHOD: Multi-layered approach to raising awareness and building consensus: Targeting the correct audience who can make change happen Presenting robust evidence including costs justifying reform and investment Demonstrating that issues affect a significant number of people Sharing experience and knowledge Knowing their policy priorities Staying resilient - advancing and introducing new angles to argument Engaging directly as advocates within the political system at all political levels - developing relationships with politicians Identifying advocates in the public service to promote policy change Using a variety of new and existing projects and programmes Encouraging patients and families to be self-advocates - using a novel project for discussing and recording future care preferences Supporting healthcare professionals to become effective advocates for patients Creating alliances to lobby for policy development Using media opportunities to sell the message RESULTS: The recognition of the importance of a strategic approach to palliative and end of life care acknowledged in Parliamentary Committee Report affords an opportunity to develop further policy and practice...
April 2015: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/25772675/an-economic-model-assessing-the-value-of-microneedle-patch-delivery-of-the-seasonal-influenza-vaccine
#12
Bruce Y Lee, Sarah M Bartsch, Mercy Mvundura, Courtney Jarrahian, Kristina M Zapf, Kathleen Marinan, Angela R Wateska, Bill Snyder, Savitha Swaminathan, Erica Jacoby, James J Norman, Mark R Prausnitz, Darin Zehrung
BACKGROUND: New vaccine technologies may improve the acceptability, delivery (potentially enabling self-administration), and product efficacy of influenza vaccines. One such technology is the microneedle patch (MNP), a skin delivery technology currently in development. Although MNPs hold promise in preclinical studies, their potential economic and epidemiologic impacts have not yet been evaluated. METHODS: We utilized a susceptible-exposed-infectious-recovered (SEIR) transmission model linked to an economic influenza outcomes model to assess the economic value of introducing the MNP into the current influenza vaccine market in the United States from the third-party payer and societal perspectives...
September 8, 2015: Vaccine
https://www.readbyqxmd.com/read/25508845/scaling-cost-sharing-to-wages-how-employers-can-reduce-health-spending-and-provide-greater-economic-security
#13
Christopher T Robertson
In the employer-sponsored insurance market that covers most Americans; many workers are "underinsured." The evidence shows onerous out-of-pocket payments causing them to forgo needed care, miss work, and fall into bankruptcies and foreclosures. Nonetheless, many higher-paid workers are "overinsured": the evidence shows that in this domain, surplus insurance stimulates spending and price inflation without improving health. Employers can solve these problems together by scaling cost-sharing to wages. This reform would make insurance better protect against risk and guarantee access to care, while maintaining or even reducing insurance premiums...
2014: Yale Journal of Health Policy, Law, and Ethics
https://www.readbyqxmd.com/read/25486714/scaling-cost-sharing-to-wages-how-employers-can-reduce-health-spending-and-provide-greater-economic-security
#14
Christopher T Robertson
In the employer-sponsored insurance market that covers most Americans; many workers are "underinsured." The evidence shows onerous out-of-pocket payments causing them to forgo needed care, miss work, and fall into bankruptcies and foreclosures. Nonetheless, many higher-paid workers are "overinsured": the evidence shows that in this domain, surplus insurance stimulates spending and price inflation without improving health. Employers can solve these problems together by scaling cost-sharing to wages. This reform would make insurance better protect against risk and guarantee access to care, while maintaining or even reducing insurance premiums...
2014: Yale Journal of Health Policy, Law, and Ethics
https://www.readbyqxmd.com/read/25464871/new-technology-and-illness-self-management-potential-relevance-for-resource-poor-populations-in-asia
#15
Henry Lucas
Advances in technology have made it possible for many standard diagnostic and health monitoring procedures, traditionally carried out by qualified personnel within medical facilities, to be reliably undertaken by patients or carers in their own homes with a minimum of basic training. There has also been a dramatic increase in the number and diversity of both sources of information on health issues and the possibilities for sharing information and experiences over ICT-based social networks. It has been suggested that these developments have the potential to 'empower' patients, reducing their dependence on providers and possibly improving their quality of care by increasing the volume and timeliness of diagnostic data and encouraging active self-management of their condition, for example through lifestyle changes...
November 2015: Social Science & Medicine
https://www.readbyqxmd.com/read/25444653/annual-report-on-health-care-for-children-and-youth-in-the-united-states-national-estimates-of-cost-utilization-and-expenditures-for-children-with-mental-health-conditions
#16
Celeste Marie Torio, William Encinosa, Terceira Berdahl, Marie C McCormick, Lisa A Simpson
OBJECTIVE: To examine national trends in hospital utilization, costs, and expenditures for children with mental health conditions. METHODS: The analyses of children aged 1 to 17 are based on AHRQ's 2006 and 2011 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) databases, and on AHRQ's pooled 2006 to 2011 Medical Expenditure Panel Survey (MEPS). All estimates are nationally representative, and standard errors account for the complex survey designs...
January 2015: Academic Pediatrics
https://www.readbyqxmd.com/read/25429161/applications-of-business-analytics-in-healthcare
#17
Michael J Ward, Keith A Marsolo, Craig M Froehle
The American healthcare system is at a crossroads, and analytics, as an organizational skill, figures to play a pivotal role in its future. As more healthcare systems capture information electronically and as they begin to collect more novel forms of data, such as human DNA, how will we leverage these resources and use them to improve human health at a manageable cost? In this article, we argue that analytics will play a fundamental role in the transformation of the American healthcare system. However, there are numerous challenges to the application and use of analytics, namely the lack of data standards, barriers to the collection of high-quality data, and a shortage of qualified personnel to conduct such analyses...
September 2014: Business Horizons
https://www.readbyqxmd.com/read/25338761/obamacare-what-the-affordable-care-act-means-for-patients-and-physicians
#18
REVIEW
Mark A Hall, Richard Lord
The Affordable Care Act's core achievement is to make all Americans insurable, by requiring insurers to accept all applicants at rates based on population averages regardless of health status. The act also increases coverage by allowing states to expand Medicaid (the social healthcare program for families and people with low income and resources) to cover everyone near the poverty line, and by subsidizing private insurance for people who are not poor but who do not have workplace coverage. The act allows most people to keep the same kind of insurance that they currently have, and it does not change how private insurance pays physicians and hospitals...
2014: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/25197682/prevention-under-the-affordable-care-act-aca-has-the-aca-overpromised-and-under-delivered-comment-on-interrelation-of-preventive-care-benefits-and-shared-costs-under-the-affordable-care-act-aca
#19
Carol Molinari
This policy brief discusses preventive care benefits and cost-sharing included in health insurance provisions of the Affordable Care Act (ACA) legislation and highlights some consequences to Americans and the country in terms of healthcare costs and value.
August 2014: International Journal of Health Policy and Management
https://www.readbyqxmd.com/read/25197679/interrelation-of-preventive-care-benefits-and-shared-costs-under-the-affordable-care-act-aca
#20
Robert Brent Dixon, Attila J Hertelendy
With the implementation of the Affordable Care Act (ACA), access to insurance and coverage of preventive care services has been expanded. By removing the barrier of shared costs for preventive care, it is expected that an increase in utilization of preventive care services will reduce the cost of chronic diseases. Early detection and treatment is anticipated to be less costly than treatment at full onset of chronic conditions. One concern of early detection of disease is the cost to treat. In reality, the confluence of early detection may result in greater overall expenditures...
August 2014: International Journal of Health Policy and Management
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