Bringing Wellness into the Doctor's Office

Wellness initiatives are generally administered by company physicians, wellness companies or disease management organizations.  However, one offshoot of the Accountable Care Act is the requirement of Medicare providers to devise a Personalized Prevention Plan for Part B Beneficiaries.  This is apparently in line with the law’s intent to foster greater preventative services for the population.  Prevention is a major theme in wellness.

The visit is coined as Annual Wellness Visit (AWV). Among the benefits include the fact that the provider will administer a HRA health risk assessment  which can uncover various risk factors that if addressed early enough can prevent disease.  

Sample HRA (link -www.prochange.com)

A second major benefit is that he or she will devise a 5 year schedule outlining which screenings and immunizations a patient needs. It can replace the Welcome to Medicare Visit as a requirement for Part B patients but you are not eligible for this until after 12 months of becoming a Part B beneficiary or within 12 months of IPPE (Initial Preventative Physical Exam). It appears that CMS has this because they want the first year to be a trial (Dr. Chawla's opinion). The only drawback is that the AWV doesn’t cover any physical exams.

This represents another step in empowering the provider to become the primary furnisher of preventative services and not someone who treats sicknesses.

The physician is in the optimum place to administer powerful tools such as the HRA, which when used with follow-up counseling, has been shown in studies to help providers pinpoint risk factors that are not found during routine visits.  Furthermore, prevention planning has been shown for years to help health departments and agencies such as the CDC improve outcomes for population. Government regulations or the lure of higher reimbursement from payers is often what it takes to start such transformation. In the next several years as health reform completely rolls out we will watching to see how “sick care” changes to “well care”

YouTube videos by Dr. Chawla site links -OpeEMR Scheduling and OpenEMR SOAP Note

Stakeholder implications of the Supreme Court decision on the Accountable Care Act

The upholding of President Barack Obama's healthcare reform bill has translated into important implications for various stakeholders. In this brief article, we will examine what these are and some strategies to deal with the impending changes.

Key Implications

Patients:

·        Must enroll by 2014 for health insurance coverage or face penalties on income tax by 2015 (doesn’t apply to individuals who aren’t required to pay taxes)

·        Ability to get insurance at affordable rates by having options offered by insurance exchanges

·        Children up to age 26 will be able to stay on parent’s plan. This can serve as a trial period giving youngsters time to find their own insurance.

Insurers:

·        Prohibit community rating for setting premiums

·        Can’t discriminate children based on pre-existing conditions

Employers:

·        Must subscribe to health insurance exchanges

·        Small business less than 100 employees can face penalties for not providing insurance to employees

·        Small businesses receive subsidies to help all employees get medical coverage

States:

·      Decide whether to participate in providing Medicaid expansion to their citizens which may imply that after 2014 must impose heavy taxation to keep it sustainable

·        Those that do decide to participate in the expansion must have a way of tracking individuals who do and do not enroll

·        States will still receive current Medicaid funding from feds even if opt not to participate in expansion program

·        Must set up health insurance exchanges by 2014




(reference- www.newsday.com - NY HIE article)

Strategies to prepare

Patients- Start inquiring and understanding about various plans offered, discuss with your employer benefit changes they may make, enroll children in plans

Insurers – re-structure plans and offerings; understand the impact that health insurance exchanges may have on their business model/financial strategy

Employers- make sure all employees are being enrolled, understand which plans to accept in benefit offerings, and comply with requirements for receiving subsidies (small businesses only)

States- work fast on setting up health insurance exchanges, re-examine risk/benefits in offering Medicaid expansion coverage, and develop adequate IT systems/process for tracking who in the population is in enrolled in Medicaid.

The full after-effects of the Accountable Care Act (ACA) law will only become
apparent in the next several years as various stakeholders take actions to
either comply or react to the coverage, access and quality of care initiatives
set in motion by Obama care. If you ask, Dr. Chawla this a trial period in which the country
will see whether we can fix our healthcare system.

In future articles, we will look more by in-depth by identifying which strategic options and tactics need to employed by organizations to remain compliant with ACA mandates.