By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    health benefits of taking a vacation to reduce stress
    Relaxing European Destinations to Reduce Stress Risks to Health
    October 11, 2021
    pain management tips
    Managing Pain Differently: Alternative Pain Management Techniques
    January 12, 2022
    5 Ways to Promote Wellness in Your Home
    April 12, 2022
    Latest News
    What To Expect On A Meditation Retreat In Miami
    February 6, 2023
    Botanical Extracts That Should be on Your Health Radar
    February 5, 2023
    Navigating Medical Care as a Wheelchair User
    February 4, 2023
    4 Common Myths and Misunderstandings About Brain Injuries
    February 5, 2023
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Kratom – a Solution for Opioid Addiction?
    February 5, 2021
    English: U.S. President delivers the while sta...
    Obama to Congress: Quality, not Quantity of Care
    February 13, 2013
    Is The Future Of Injectable Drug Delivery In Needle-Free Devices?
    February 16, 2021
    Latest News
    Why Is a Referenced Based Pricing Tool Necessary?
    February 3, 2023
    Simplifying the Genetic Testing Process: How At-Home Kits are Changing the Game
    January 25, 2023
    9 Hospitals That Have Introduced Green Initiatives
    February 1, 2023
    Why a Health Retreat Can Be the Best Medicine
    January 12, 2023
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Obamacare and Reimbursement Rates to Providers
Share
Sign In
Notification Show More
Latest News
meditation retreat
What To Expect On A Meditation Retreat In Miami
Health
Guide To Pursuing a Career in Nursing as a Foreigner in the USA
Guide To Pursuing a Career in Nursing as a Foreigner in the USA
Career
Botanical Extracts
Botanical Extracts That Should be on Your Health Radar
Health
Navigating Medical Care as a Wheelchair User
Navigating Medical Care as a Wheelchair User
Health
common misconseptions about brain injuries
4 Common Myths and Misunderstandings About Brain Injuries
Health
Aa
Health Works CollectiveHealth Works Collective
Aa
Search
Have an existing account? Sign In
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > Finance > Obamacare and Reimbursement Rates to Providers
BusinessFinanceHealth ReformPolicy & LawPublic Health

Obamacare and Reimbursement Rates to Providers

Gary Levin MD
Last updated: 2013/12/11 at 9:11 AM
Gary Levin MD
Share
6 Min Read
obamacare an covered california
SHARE

obamacare an covered californiaIn an undated press release from Sharp Health in San Diego an optimistic opinion was given for Obamacare. Several caveats however remain.

obamacare an covered californiaIn an undated press release from Sharp Health in San Diego an optimistic opinion was given for Obamacare. Several caveats however remain.

Covered California™ announced 13 diverse health insurance plans in 2014 that will offer affordable, quality health care coverage to millions of Californians. The plans reflect a mix of large non- profit and commercial plan leaders, along with well-known Medi-Cal and regional plans.

The rates submitted to Covered California for the 2014 individual market ranged from two percent above to 29 percent below the 2013 average premium for small employer plans in California’s most populous regions. This is impressive since the 2014 products include doctor visits, prescriptions, hospital stays and more essential benefits; protecting consumers from the “gimmicks and gotchas” of many insurance policies. “This is a home run for consumers in every region of California,” said Peter V. Lee, Executive Director of Covered California. “Our active negotiating will not only benefit potential enrollees to Covered California, but will benefit all Californians by making health care affordable.” (No doubt that some of the rhetoric is self-serving for Covered California.)

More Read

health insurance for young adults

Benefits of Buying Health Insurance for Your Adults

HR Must Navigate Polarizing Views in Healthcare Workplaces
Should Hospitals Use SASE or Traditional Network Security?
6 Tips for Getting Into Medical School
The Technology and Services You Need to Open Your Own Counseling Office

Once plan rates are approved by state regulators, Covered California looks forward to signing final contracts and beginning the work of enrolling millions of Californians in the following health plans:

• Alameda Alliance for Health
• Anthem Blue Cross of California
• Blue Shield of California
• Chinese Community Health Plan
• Contra Costa Health Services
• Health Net
• Kaiser Permanente
• L.A. Care Health Plan
• Molina Healthcare
• Sharp Health Plan
• Valley Health Plan
• Ventura County Health Care Plan
• Western Health Advantage

 “Covered California plans include the largest current health insurers in the individual market, as well as new entrants, regional plans and local Medi-Cal plans that want to be part of making history,” Lee said. On average, there will be five plans from which to choose. Even in rural areas where choice has been historically sparse, there will be two or three health plans. Throughout the state consumers will have a choice of Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and Exclusive Provider Organizations (EPOs). To get prices at such competitive points, winning health plans built their bids around the expectation of high enrollment, not high profit. Plans reduced profit margins down to two and three percent; embraced Affordable Care Act programs such as Accountable Care Organizations and Patient-Centered Medical Homes, that seek to improve care while lowering costs; found common ground with doctors, medical groups and hospitals on lower reimbursement rates to make care affordable.

(Note that many items such as Accountable Care Organizations, and Patient-Centered Medical Homes are still in development, untested, and not yet operational. which all sounds like a replay of the failed rollout of Healthcare.gov. ) 

Virtually every health plan designed a custom network for Covered California. Negotiations included a detailed review of each plan’s rates, their mix of hospitals, physicians and other providers, and their contingency plans for expanding networks in the event more consumers sign up than expected. The current list of insurers is for individual policies only.

Covered California will announce its options for small businesses to buy health insurance in June. Providers who will be approved for Covered California will be required to agree to new contracts and new reimbursement rates. The real final participants will be told when the signed contracts are ratified. Until then, all predictions are just that. I have heard from sources that the rates, even for conventional coverage under Covered California will be unique and include a sizable decrease to providers. No mention has been made about Medi-caid rates increasing….and frequently that is not known until the first payments are received by providers.”

On the provider side….looking in on Covered California and whether to participate, most providers remain very cautious, and some have a wait and see attitude delaying a decision for at least one year. In the current environment of lean reimbursements, and profit margins, there are few providers willing to risk their ‘livlihoods’ and solvency on unproven programs, rift with political promises and goals.

Previous experience with government programs have created a lack of faith and/or trust in government programs with private insurers only slightly behind.

Few providers can expand their patient base without increasing overhead or numbers of providers. Most providers are already near capacity to see patients, and will not feel the need to see this new group of patients.

The exact method of reimbursement, if it changes from fee for service to another model is unknown, and mechanisms are still not yet in place for that to occur, either.

In summary it seems foolish for any segment of health to promise success when each has its own issues and challenges that are intertwined while heading to an ‘unknown destination’.

http://healthtrain.blogspot.com/feeds/posts/default?alt=rss

TAGGED: covered california, health insurance

Sign Up For Daily Newsletter

Be keep up! Get the latest breaking news delivered straight to your inbox.
By signing up, you agree to our Terms of Use and acknowledge the data practices in our Privacy Policy. You may unsubscribe at any time.
Gary Levin MD December 11, 2013
Share this Article
Facebook Twitter Copy Link Print
Share
Previous Article Bone Marrow Donation and Compensation: My Moral Dilemma
Next Article genetic therapy for leukemia Is Genetic Therapy the Future for Treating Leukemia and Other Blood Disorders?

Stay Connected

1.5k Followers Like
4.5k Followers Follow
2.8k Followers Pin
136k Subscribers Subscribe

Latest News

meditation retreat
What To Expect On A Meditation Retreat In Miami
Health February 6, 2023
Guide To Pursuing a Career in Nursing as a Foreigner in the USA
Guide To Pursuing a Career in Nursing as a Foreigner in the USA
Career February 5, 2023
Botanical Extracts
Botanical Extracts That Should be on Your Health Radar
Health February 5, 2023
Navigating Medical Care as a Wheelchair User
Navigating Medical Care as a Wheelchair User
Health February 4, 2023

You Might also Like

Health care

Why Is a Referenced Based Pricing Tool Necessary?

February 3, 2023
at-home genetic testing method kits
Global Healthcare

Simplifying the Genetic Testing Process: How At-Home Kits are Changing the Game

January 25, 2023
green hospitals
Hospital Administration

9 Hospitals That Have Introduced Green Initiatives

January 20, 2023
benefits of going on a health retreat
Global HealthcareHealth

Why a Health Retreat Can Be the Best Medicine

January 12, 2023
//

We influence million of users and is the most authentic source of information on healthcare business and technology news.

Quick Links

  • About
  • Contact
  • Privacy
Subscribe

Subscribe to our newsletter to get our newest articles instantly!

Follow US

© 2008-2023 HealthWorks Collective. All Rights Reserved.

Removed from reading list

Undo
Welcome Back!

Sign in to your account

Lost your password?