Health Insurance Exchanges - Working Through the Kinks

Dr. Jitesh Chawla feels that health insurance exchanges are a honest attempt to fix all the on-going problems with trying to provide the proper access and coverage to Americans that were created by insurance companies. But, like any new initiative, there are kinks that need to be worked out as this article explains.

The Health Insurance Exchanges, central pieces of the Patient Protection and Affordable Care Act (PPACA), opened as scheduled on October 1 amid debate in Congress and a government shutdown over the future of the law. The launch of the Exchanges along with open enrollment for Americans came just after the government released premium rates for 33 federal Exchanges.

Technical Problems in Accessing Exchanges

Consumers seeking online access to federally-facilitated Exchanges (FFE) faced intermittent outages and error messages throughout the first day of enrollment. Some state-based Exchanges, including those in California, New York, Maryland and Colorado had similar issues with their websites. Traffic to these sites was very high, leading many of the sites to slow down considerably. Similarly, those seeking assistance by phone also encountered long wait times.

Many proponents of the law, including those who are helping to develop the Exchange systems, have warned of glitches as the Exchanges roll out over the next several months. Many of these predictions proved accurate as large numbers of Americans logged on to the Exchange websites to browse coverage options. As initial curiosity over the Exchanges subsides in the coming weeks, it will be easier to more accurately assess the functionality of the websites.

Rates Announced

On September 24, the U.S. Department of Health and Human Services (HHS) released an issue brief outlining the premium rates in the 36 states with either an FFE or a partnership Exchange. Since data concerning premium rates is complex and ambiguous, supporters of PPACA hail the rates as a success for the health reform law, while opponents view them as a major failure.

The issue brief outlines the number of Qualified Health Plans (QHPs) offered in each state and the average premium rates that enrollees would pay for different plan tiers. Average premium rates are detailed for a 27-year-old (before and after tax credits are assessed), and a family of four with a specified income of $50,000 per year. Rates for the lowest bronze, silver, gold and catastrophic plans as well as the second lowest silver plans are described. The average number of QHPs offered in the 36 states is 53 with as many as 106 plans offered in Arizona and as few as seven in Alabama.

Update: On October 1, the U.S. Department of Health and Human Services posted premiums for over 17,000 plans being offered in the 36 states where the federal government is operating an Exchange. The premiums are listed for different geographic regions, age groups and different family sizes. Metal levels and plan type information is also provided.  This list provides people the ability to compare plans within and between states. Click here to access this resource.

To see the full article, please click this link.

Please join Jitesh Chawla, MD. in the discussion by posting your comments on this blog post.

Retail Medical Clinic

The Retail Medical Clinic: Healthcare trend analysis by Dr. Jitesh Chawla

Is there a consumer-driven market business trend offering a cost-effective and highly convenient means of receiving care for basic and routine conditions? Retail health clinics such as those found in CVS or Walmart might be the answer. The appeal of such clinics is increased access to care (generally open from 10-12 hours/day, on weekends). This set-up is ideal for busy working people and the care received complements that given by the patient’s primary care doctor. Furthermore, the total charges billed to the patient are shared up front. The patient demographics are pretty similar to those in those elsewhere, with 80 percent insured and 20 percent uninsured. Retail clinics will only treat minor problems and perform preventative care (immunizations, etc.) –the rest must be referred out.



A SWOT analysis provides a framework by looking at the advantages, disadvantages and opportunities for improvement regarding a particular business venture. As relates to retail health clinics, the SWOT results are below.

Strength:


• Reduces barriers to access to service (increased wait times in ER, doctor’s office)


• Cost transparency facilitates patient decision-making


Weakness:


• Not part of the local health care system and provider network, thereby, more difficult to track data for quality of care studies. Although this is the current state of affairs, it certainly leads to an opportunity of being part of an Accountable Care Organization going forward.


• Interrupts continuum of care established with primary care physician


Opportunities:


• Potential to improve low-income patients’ access to basic preventive and low-level acute services.


• Staffed primarily by nurse practitioners. This is important with the current shortage of primary care physicians, and even fewer physicians going into primary care, resulting in a shortage of as many as 44,000 physicians in the fields of general internal medicine and family medicine by the year 2025


Threats:


• In June 2007, the American Medical Association (AMA) asked state and federal officials for an official probe of retail health clinics. The AMA cited, among other objections, the potential conflicts of interest posed by joint ventures between store-based health clinics and pharmacy chains, since retail health clinic employees could write prescriptions to help pharmaceutical sales.


• May erode a patient’s “medical home” by fostering a dependence on the clinic rather than an ongoing relationship with one primary care physician.


Closing Comments

 With health care reform, many of these clinics may not get patients since health coverage could become universal. However, on the other hand, many could be forced to enlist into high-deductible plans and so end up coming to these clinics which would make more sense (since costs are transparent to the patient).

In a healthcare system that is as complicated as the one here in the United States, there are always new ideas generated on how to optimize delivery of services. No one form of healthcare delivery is ideal but the important thing is to be adaptable to changes in the environment. Retail clinics, whether they are the new successful consumer-driven market trend or not, definitely have made their mark in American healthcare.


-by Dr. Jitesh Chawla


Dr. Jitesh Chawla is a Family Practice Physician with a focus on quality service. Dr. Chawla is particularly popular for his lecture on the developments in the field of health policy, healthcare reform, practice management and quality service. As a student of Healthcare Administration, Dr. Chawla presents unique insights ranging from practical challenges that clinicians face to opportunities that lie untapped in delivering world class healthcare.

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

Challenges in Healthcare

Dr. Jitesh Chawla comments on the challenges in healthcare

As the picture below depicts, healthcare is a complex and challenging web of co-depenedant systems. In this series of posts, Dr. Jitesh Chawla brings along solid, on-the-ground experience and insightful perspective about the many challenges facing the healthcare industry.

Some of the biggest challenges around healthcare include cost, access and quality.

Cost: Spending on new medical technology and prescription drugs has been cited as a top contributor to the increase in overall health spending. Such advances can lead to consumer demand for more intense, costly services even if they are not necessarily the best treatment or most cost-effective. On a consumer level, this translates into high healthcare premiums.

Access: US healtcare continutes to suffer from lack of quality healthcare professionals in underserved areas. However there are other aspects of access, such as timely access to diagnosis, reports and personalized healtcare services.

Quality: Medicine is as much art as it is science hence making it difficult to putting a tag on quality. There is a lot of subjectivity in diagnoses and treatment. The first steps in tackling the quality challenge is getting medical experts together to reach a consensus on which metrics work best, when they should be measured and set benchmarks for quality improvements. Healthcare organizations regardless of the size, patient panel can successfully balance the cost-quality pendulum by finding more effective ways to drive productivity and manage capacity in existing operations.

Dr. Jitesh Chawla is a Family Practice Physician with a focus on quality service. Dr. Chawla is particularly popular for his lecture on the developments in the field of health policy, healthcare reform, practice management and quality service. As a student of Healthcare Administration, Dr. Chawla presents unique insights ranging from practical challenges that clinicians face to opportunities that lie untapped in delivering world class healthcare.