By Roger Linnett
The following is part of a continuing series, summarizing the benefits that will go into effect in 2012 as part of the Affordable Care Act. Unless otherwise noted, benefits take effect as of Jan. 1. As in the previous article, benefits are categorized under three headings:
Increasing Access to Affordable Care
Accountable Care Organizations-
Any patient who has multiple doctors probably understands the frustration of lost or unavailable medical charts, duplicated medical procedures or having to share the same information over and over with different doctors. ACOs are designed to lift this burden from patients, while improving the partnership between patients and doctors in making health care decisions.
Medicare beneficiaries whose doctors participate in an ACO will still have a full choice of providers and can still choose to see doctors outside of the ACO. Patients will have access to information about how well their doctors, hospitals or other caregivers are meeting quality standards in five key areas:
- Patient/caregiver experience of care
- Care coordination
- Patient safety
- Preventive health
- At-risk population/frail elderly health
According to the analysis of the proposed regulation for ACOs, Medicare could potentially save as much as $960 million over the next three years.
Alleviating Disparity in Healthcare-
Not all Americans have equal access to health care. Low-income Americans, racial and ethnic minorities often have higher rates of disease, fewer treatment options and reduced access to care. They are also less likely to have health insurance. The Affordable Care Act will help reduce disparities by making improvements in:
1-Medicare and some private insurance plans will cover recommended regular check-ups, cancer screenings and immunizations at no additional cost to eligible patients.
2-New investments for community health teams to manage chronic diseases such as diabetes, kidney disease, heart disease and cancer.
3-New funds for home visits for expectant mothers and newborns to reduce Infant mortality and post-birth complications.
Diversity and cultural competency
Health plans will be required to use language services and community outreach in underserved communities, particularly in Hispanic communities, which have high numbers of uninsured.
Health care providers for underserved communities
Increased funding for community health centers, which provide comprehensive health care for everyone no matter how much they are able to pay. The new law will support 16,000 new primary care providers.
Improving Quality and Lowering Costs –
1-For those enrolled in Medicare Part D, in 2012 the lower limit of the “donut hole” increases from $2840 to $2930, after that Medicare will cover 50% of brand-name drugs and 14% of generics until your total out-of-pocket cost reaches $4,550. Medicare then covers 95% of all further drug expenses until the end of the year.
2-The law institutes a series of changes to standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information, reducing paperwork and administrative burdens, cut costs, reduce medical errors and, most importantly, improving the quality of care. Effective October 1, 2012
3-The law also establishes a hospital Value-Based Purchasing program (VBP) in Original Medicare. This program offers financial incentives to hospitals to improve the quality of care. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients’ perception of care. Effective October 1, 2012
4-The law creates a voluntary long-term care insurance program – called CLASS — to provide cash benefits to adults who become disabled. According to Health and Human Services Secretary Kathleen Sebelius implementation of this program will be delayed,effective October 1, 2012
Insurance Company Accountability
Insurance discrimination will be banned, so people who have been sick can’t be excluded from coverage or charged higher premiums. Women will no longer have to pay higher premiums because of their gender. New funding will be available to collect information on how women and racial and ethnic minorities experience the health care system, leading to improvements that will benefit these groups.
Information for this article was compiled from: whitehouse.gov., kaiserhealthnews.org., and healthcare.gov.