Physicians Are Optimistic About New Payment Models

Physicians are cautiously optimistic about new payment and delivery models, such as pay-for-performance, patient-centered medical homes, and accountable care organizations, which tie reimbursement to quality and performance outcomes. Physicians say that these models may deliver better patient care and more efficient medical practices. Fifty-five percent of physicians participate in an alternate payment model, and more than one-third of them have been doing so for over three years. Eighty percent are open to an alternative payment system. Only 41% of physicians say that the fee-for-service model is optimal for delivering positive patient outcomes. That figure drops to 28% among doctors under 35.

Nurses Applaud New Sanders Plan for Healthcare for All

National Nurses United (NNU) welcomes Sen. Bernie Sanders’ plan for achieving universal healthcare. Sanders’ plan aligns with the official position of the AFL-CIO, which has endorsed single payer health care with Medicare for all. NNU executive director RoseAnn DeMoro said, “With Sanders’ Medicare for all plan we can finally have a system based on patient need, with a single standard of quality care for all, regardless of ability to pay, race, gender, age, or where you live.” She added, “His plan includes a pledge to provide comprehensive coverage, inpatient and outpatient [care], emergency care, dental care, vision [care], long-term care, prescription drugs, medical supplies, and other basic needs. [The plan includes] one medical card, no networks that limit patient choice of doctor or other provider, and no fighting with insurance companies over needed care they refuse to pay for. Contrary to those in the Clinton camp who have claimed that Sen. Sanders wants to turn our healthcare over to state governors, many of whom have refused to expand Medicaid under the ACA, the Sanders plan would be federally administrated, with national standards and national reimbursements.” Sanders said that the typical family earning $50,000 a year would save nearly $6,000 annually in health care costs.

Aetna and MemorialCare Announce New ACA

Aetna and MemorialCare Health System announced accountable care collaboration. The Aetna Whole Health product in Orange County and select portions of Los Angeles County will offer employers a health care model designed to improve quality, efficiency and the patient experience. The health care savings will be specific to each employer, with the potential to save up to 15% over comparable broad network Aetna products. The new commercial health care product, Aetna Whole Health – MemorialCare, will provide highly coordinated care from approximately 2,000 doctors, which includes more than 500 primary care providers, along with seven award-winning hospitals and over 40 urgent care centers.The plans will be available to self-insured businesses in Orange County and portions of Los Angeles County, which includes Long Beach and the South Bay, beginning Sept. 1 for an effective date of November 1st. The plans are anticipated to be available for fully insured customers in early 2016.

Covered California Adds New Health Plans

Two new health insurance companies will be joining selected regions of the California marketplace in 2016: Oscar Health Plan of California and UnitedHealthcare Benefits Plan of California. Twelve health plans are now offered through the exchange. Below is the complete list of the companies selected for the 2016 exchange:

  • Anthem Blue Cross of California
  • Molina Healthcare
  • Blue Shield of California
  • Oscar Health Plan of California
  • Chinese Community Health Plan
  • Sharp Health Plan
  • Health Net
  • UnitedHealthcare Benefits Plan of California
  • Kaiser Permanente
  • Valley Health Plan
  • L.A. Care Health Plan
  • Western Health Advantage

UnitedHealthcare will be offering coverage in California in pricing regions one, nine, 11, 12 and 13. Oscar is a new health insurance company that offers intuitive technology tools to guide members to better care. Oscar will offer plans in regions 16 and 18.

Californians in large metropolitan areas will have five to seven health insurance companies to choose from. In 2016, 99.6% of Covered California members will be able to choose from three or more carriers. All will have at least two to choose from. This is an improvement for consumers who live in areas that have historically had a limited choice of providers. In 2016, more than 90% of hospitals in California will be available through at least one health insurance company; 74% will be available through three or more companies. Additionally, several quality health care improvements were achieved as part of Covered California’s negotiating process. For more details on the plans in specific pricing regions, see the booklet Health Insurance Companies and Plan Rates for 2016, posted online at CoveredCA.com.

New Exchange Website Helps Agents Stay Compliant

CoveredCaliforniaThe California Health Benefit Exchange website,www.CoveredCA.com, is now live. California Health Underwriters (CAHU) is urging agents to visit the site and review all the marketing materials to avoid violating AB 1761 rules. AB 1761, which took effect January 1, prohibits any individual or website from attempting to hold their selves, plans or websites out as officially authorized as “Covered California” certified or approved.

CAHU says that word has come down that the Exchange plans a hard crackdown on violators of AB 1761 provisions. AB 1761 was supported by all three-agent organizations as well as other consumer health advocates.

The Covered California website has been designed for ease of use by all stakeholders, including licensed agents and employers. In fact, the new website contains individual and small employer content on the Small Employer Health Options Program (SHOP) section. A newsletter about SHOP Exchange happenings is expected to launch sometime in the first quarter of 2013. The site, which is available in English and Spanish, also offers a variety of fact sheets in 11 additional languages. It provides basic information about the Exchange and a calculator to give Californians an estimate of how much help they can get to reduce their premium costs.

New Insurance Laws Aim to Protect Consumers

The California Legislature has passed several bills that have been sponsored or publicly supported by the California Department of Insurance (CDI):

• AB 1846 (Gordon) establishes a regulatory licensing framework for consumer owned and operated plans (CO-OPs), which are designed to foster the creation of consumer-driven, nonprofit health insurance organizations.
• AB 1761 (Perez) prohibits people or entities from representing, constituting, or otherwise providing services on behalf of the California Health Benefit Exchange without having a valid agreement with the Exchange.
• AB 999 (Yamada) modifies the process for LTC rate development to protect consumers from excessive premium rate volatility. It is considered one of the strongest LTC consumer protection measures in the nation.
• AB 2138 (Blumenfield) provides increased funding for district attorneys to investigate and prosecute health and disability insurance fraud in collaboration with CDI enforcement personnel.
• SB 1216 (Lowenthal) and SB 1448 (Calderon) ensure that CDI has the regulatory authority to protect consumers in response to changes brought by the globalization of the insurance business and insurer use of reinsurance.
• SB 1216 provides a framework for when a California-based insurer cedes business to a non-U.S. based reinsurer. Commissioner Dave Jones notes that the recession brought to light the need for regulators to have more authority to evaluate the risks that a non-insurance entity poses on an insurer in a holding company system.
• SB 1448 updates California’s Insurance Holding Company System Regulatory Act so the financial status of an insurer in a holding company system can be assessed.
• AB 2303 (Assembly Committee on Insurance) gives the insurance commissioner the authority to take over an insurer that the U.S. Treasury Secretary determines is insolvent or in danger of becoming insolvent.
• SB 1170 (Leno) expands restrictions on misleading advertising tactics directed at seniors and senior veterans. It would enhance the notification requirements for an agent or broker to meet with a senior in their home to sell an insurance product.
• SB 1184 (Corbett) is designed to stop unscrupulous insurance agents and brokers who charge a fee to help senior veterans qualify for veterans’ aid programs when these services are readily available for free for those who qualify. Insurance agents and brokers cannot be involved in obtaining senior veterans’ benefits with the sole purpose of financial gain.
• AB 1747 (Feuer) requires a life insurer to send a pending lapse notice to the policyholder within 30 days of nonpayment. The policyholder must be able to name one or more people to receive a copy of the pending lapse notice or termination of a policy for nonpayment of premium. People can easily lose the critical protection of life insurance if just one premium is accidentally missed, even if they have been paying premiums on time for many years, notes Commisioner Dave Jones.

Last Updated 10/20/2021

Arch Apple Financial Services | Individual & Family Health Plans, Affordable Care California, Group Medical Insurance, California Health Insurance Exchange Marketplace, Medicare Supplements, HMO & PPO Health Care Plans, Long Term Care & Disability Insurance, Life Insurance, Dental Insurance, Vision Insurance, Employee Benefits, Affordable Care Act Assistance, Health Benefits Exchange, Buy Health Insurance, Health Care Reform Plans, Insurance Agency, Westminster, Costa Mesa, Huntington Beach, Fountain Valley, Irvine, Santa Ana, Tustin, Aliso Viejo, Laguna Hills, Laguna Beach, Laguna Woods, Long Beach, Orange, Tustin Foothills, Seal Beach, Anaheim, Newport Beach, Yorba Linda, Placentia, Brea, La Habra, Orange County CA

12312 Pentagon Street - Garden Grove, CA 92841-3327 - Tel: 714.638.0853 - 800.731.2590
Email:
Jay@ArchApple.com
Copyright @ 2015 - Website Design and Search Engine Optimization by Blitz Mogul