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Posted by on Jul 28, 2014 in Highlight | 0 comments

Weekly Health Insurance Industry Highlights


Catch up on healthcare news and gain insights from our own industry gurus.

Federal Appeals  Courts come to opposing rulings on health insurance tax subsidies

Federal appeals court panel rules that subsidies may not be provided in states that did not set up a Health Insurance Exchange

A federal appeals court panel in the District ruled that the tax subsidies may not be provided in at least half of the states.
The three-judge panel of the D.C. Circuit Court of Appeals sided with plaintiffs who argued that the language of the law barred the government from giving subsidies to people in states that chose not to set up their own insurance marketplaces. Twenty-seven states decided against setting up marketplaces, and another nine states partially opted out.
The government could request an “en banc” hearing, putting the case before the entire appeals court, and the question ultimately may end up at the Supreme Court. But if subsidies for half the states are barred, it represents a potentially crippling blow to the health-care law, which relies on the subsidies to make insurance affordable for millions of low- and middle-income Americans. 

Less than two hours later, a panel of the U.S. Court of Appeals for the 4th Circuit, based in Richmond, handed down a contradictory ruling on the issue in a separate case, raising the possibility of yet another high-stakes battle over the law playing out before the Supreme Court. THE WASHINGTON POST | FEDERAL APPEALS COURTS ISSUE CONTRADICTORY RULINGS ON HEALTH-LAW SUBSIDIES

What is a quality provider?

Vitals finds that doctor reviews show customer service outweighs medical expertise

The Vitals Index analyzed 1,000 recent reviews of doctors by their patients and found that first impressions matter greatly to patients. The words “office” and “staff” were two of the most common words used. Patients also mentioned “waits” at the office.
Interpersonal skills and bedside manner experiences with the doctor were also frequently discussed in reviews. The words “called,” “explained” and “listened” each appeared over 100 times. In contrast, the word diagnosed only appeared 40 times.
“These softer metrics reinforce the importance of a patient feeling heard and valued,” said Mitch Rothschild, CEO of Vitals. “They’re more than just a feel-good measure, too. Studies show that the better the patient experience, the better the clinical outcome.”

Research shows that consumers value the doctor-patient relationship, while experts focus on outcomes

A new survey conducted by the Associated Press-NORC Center for Public Affairs Research shows that Americans do not think that information about the quality of health care providers is easy to come by, and they lack trust in information sources that tend to produce such indicators. When it comes to what being a quality health care provider means, there is a disconnect between how experts and consumers define it. Most Americans focus on the doctor-patient relationship and interactions in the doctor’s office, with fewer thinking about the effectiveness of treatments or their own health outcomes. Further, individuals report that they value provider quality over cost and are willing to pay more for higher-quality doctors, but when asked directly in the survey, few report having done so. The nationally representative survey, conducted with funding from the Robert Wood Johnson Foundation, also shows that those without insurance face more challenges in finding provider quality and cost information. This survey of American adults seeks to better understand their perceptions of health care provider quality, what they think provider quality means, how accessible such quality information is, how much they trust that information, and the connection between provider quality and cost. The study produces new and actionable data during a crucial period of the Affordable Care Act’s implementation. Interviews were conducted with 1,002 adults age 18 and over. ASSOCIATED PRESS | FINDING QUALITY DOCTORS: HOW AMERICANS EVALUATE PROVIDER QUALITY IN THE UNITED STATES

Accurate and accessible consumer information key to making narrow networks work

Narrow networks must be accompanied by transparency

After the Affordable Care Act, health plans have fewer tools available that allow for lower-cost coverage options. But one way plans can promote affordability is by offering consumers a range of provider network choices.
And that’s just what different network sizes are – choices. The reality is consumers have a range of network options in the new marketplaces, all meeting the adequacy standards required under law. A recent study found that 90 percent of consumers had the option to purchase plans with a broad network. At the same time, consumers who may value lower premiums over a larger set of providers can access plans with networks tailored to maximize affordability. Research has shown that these network arrangements can offer savings of up to 20 percent for consumers by focusing on quality and efficiency.
However broad a network they desire, it’s the consumers’ choice. But the ability to make proper choices requires transparency. We understand that, ultimately, these options are only as beneficial to consumers as their understanding of them.


A panel discussion on network adequacy discussed the importance of accurate and accessible consumer information on network providers

Narrow networks are a reality of the new health insurance landscape. Nearly half of all insurance plans sold on the public exchanges in 2014 were narrow network plans, defined as those with less than 70% of area hospitals included, according to an analysis by the research firm McKinsey & Company.

But given that reality, insurers and providers need to do a better job of providing consumers with accessible, easily understandable information about networks when they shop for coverage. That was the message conveyed by participants in a panel discussion about network adequacy on Monday in Washington sponsored by the Alliance for Health Reform. MODERN HEALTHCARE | PROVIDERS, INSURERS GRAPPLE WITH NARROW-NETWORK BACKLASH

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