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DEADLINE EXTENDED DUE TO STRONG OBAMACARE ENROLLMENT NUMBERS

By: Nicola Heredia, CHS Marketing Coordinator

In order for Americans to have insurance coverage on Jan. 1, individuals must have enrolled in an insurance plan by Dec. 15. Due to unusually high demand, the federal government announced a 48-hour extension to give federal exchange customers more time to sign up.

According to Kevin Counihan, CEO of the marketplace, there were approximately 1 million consumers that provided contact information in order to hold their place in line either through the site or call center. The grace period was provided to help those individuals enroll in time for Jan. 1 coverage.

“The spike in interest we are seeing in the last few days tells us there is continued demand for quality, affordable coverage,” said Peter Lee, executive director of California’s exchange, in a CNBC article. “We have already enrolled more consumers this year for Jan. 1 coverage than we did last year.”

Many states that run insurance marketplaces independent of the government took similar approaches by offering a deadline extension. Encouraging Americans to enroll by the mid-December deadline ensures that there will be no coverage interruption between their current plan and the newly selected 2016 plan.

The question remains to be seen as to whether or not the spike in enrollment was due to the Dec. 15 deadline. The government is expecting 10 million Americans to enroll and have paid coverage by the end of 2016, which is only slightly higher than the 2015 numbers.

The pace of enrollment appears to have increased from last year, according to the Obama administration. As of last week, the government reports that approximately 8.3 million Americans have signed up for a plan through the insurance marketplace.

“New customers are up one-third over last year,” said President Obama, according to a Wall Street Journal article. “And the more who sign up, the stronger the system becomes – and that’s good news for every American who no longer has to worry about being just one illness or accident away from financial hardship.”

This year’s numbers cannot be directly compared to last years for a few reasons. Hawaii is now using the federal exchange this year, so adding another state would increase numbers. Additionally, the open enrollment period started two weeks later in 2015.

Although demand for coverage is clearly present, the exchanges are still not seeing the level of participation that was expected when the law first came to fruition. Initially, the law predicted that by 2016 there would be 20 million Americans enrolled in the exchanges.

Open enrollment runs through the end of January, so there is still time for the government to hit that 10 million mark.  The administration has already announced that there will not be a special enrollment period like last year, so Americans either need to sign up now or wait till next year.

“I am still feeling concerned about low enrollment this year,” said Caroline Pearson, senior vice president at Avalere Health, in a Wall Street Journal article. “Surely, the administration will hit its 10 million goal, but I am not sure enrollment will be a lot higher. I am not ready to call this a big success.”

With increased rates and higher deductibles, experts were concerned that Americans may decide against paying for medical coverage and take the risk of receiving a fine from the government for being uninsured. Although enrollment numbers may end up higher then last year, there is a still a big uninsured population that the government is failing to reach.

Although there was an effort to focus on outreach for this year’s enrollment season, a recent Kaiser Family Foundation study shows that many uninsured Americans are simply unaware of the details. Approximately 65 percent are unaware of deadlines for signing up for coverage. Additionally, only two in 10 individuals have been contacted about enrolling.

The lack of knowledge among uninsured Americans is a major obstacle that the government must tackle in order to see higher enrollment numbers. Whether individuals have misconceptions that coverage is affordable or they are unaware of how to apply for insurance, something must be done to reach out to this population in order for this law to truly be considered a success.

PAYERS AND PROVIDERS BUSINESS MODELS ADJUST IN POST-ACA ERA

By: Nicola Heredia, CHS Marketing Coordinator

Evolution of health care and the creation of the insurance marketplace has required the industry as a whole to take a look at how they operate. Succeeding in the post-ACA era has forced companies to adjust their business models in order to retain customers.

One of the most effective ways to make decisions that can ultimately change how business is done is to refer to hard facts and data to help guide the decision-making process. For example, insurance companies do not just make-up annual rates. Instead, data is referred to in order to estimate costs for the upcoming year.

ACA Evolving Health Care

With it comes to health care, the U.S. has traditionally been known for expensive health care costs and wasteful spending.  The ACA put forth new regulations to help minimalize costs by holding each entity responsible in different ways.

Providers now have a greater incentive to maintain patients’ health. More regularly monitoring care and eliminating unnecessary emergency room visits are two ways that providers can help reduce unnecessary medical expenses.

When it comes to the payer side, they are continuing to educate and motivate their customers to be advocates for their own health in order to reduce the number of chronic illnesses and other costly medical issues. Incentivizing their customers to be healthy will reduce their overall costs in the long-term.

The other component to consider is the customers themselves. They now have the ability to compare customer service, quality of care and overall medical costs. Payers and providers must be cognizant of this in order to retain business.

Key Benefits of Data

In any industry, there are financial risks that need to be accounted for within the business. According to a LifeHealthPro article, the adoption of analytics is vital in order for payers to be successful in the post-ACA era.

“Leading payers are making important strategic moves to prepare for a world dominated by analytics,” said the article. “Although they have mountains of data at their fingertips, what’s lacking is a dynamic, interconnected system of data stores.“

Information will be able to predict a wide variety of things. Identifying an individual who may need more care can allow for early intervention to address the illness before it gets worse, and potentially, more costly.

The world of health care analytics is quickly becoming an important factor for both payers and providers. The more data that is compiled, the more decisions that can be made based solely on facts.

An article published on Frog-Dog.com identifies the top seven factors that are growing the demand for health care analytics.

  • Increased overall medical expenses
  • Need for accurate forecasts to better prepare
  • Desire to determine individual’s medical risks
  • Assistance detecting fraud
  • Ability to track physicians' performance
  • Monitor health programs effectiveness
  • Analyze education tools and their results

The more data that can be utilized to help develop regulations, rates and care standards, the more successful a payer or provider will be in the post-ACA era. Learning to lean on health care analytics will help to make more accurate estimates about customers and patients in order to be prepared for any financial risks that may occur.

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