Impact of health care reform on reproductive service providers

The Affordable Care Act affects access to reproductive services in many ways. Beginning in 2014 many individuals will purchase health insurance through the State Insurance Exchanges being drawn to this market by the affordable coverage made even more so by premium subsidies available to lower income individuals. The plans being offered through these exchanges must provide coverage that meets the benefits as defined under the Essential Health Benefits. However, it still remains unclear how Essential Health Benefits will be described and specifically what, if any, reproductive services will be included. Beyond the exchanges low income individuals will have access to the expansion in Medicaid occurring in many states starting also in 2014. Each state Medicaid program is responsible for describing their extent of coverage for reproductive services. Already in place affecting many younger individuals in need of reproductive services is the Dependent 26 provision, which provides coverage to dependents up to the age of 26 under a guardian's insurance. These provisions of the Affordable Care Act may increase access to reproductive services for many individuals previously uninsured or underinsured.

Evolving strategies for optimal care management and plan benefit designs

As a prevalent, complex disease, diabetes presents a challenge to managed care. Strategies to optimize type 2 diabetes care management and treatment outcomes have been evolving over the past several years. Novel economic incentive programs (eg, those outlined in the Patient Protection and Affordable Care Act of 2010 that tie revenue from Medicare Advantage plans to the quality of healthcare delivered) are being implemented, as are evidence-based interventions designed to optimize treatment, reduce clinical complications, and lower the total financial burden of the disease. Another step that can improve outcomes is to align managed care diabetes treatment algorithms with national treatment guidelines. In addition, designing the pharmacy benefit to emphasize the overall value of treatment and minimize out-of-pocket expenses for patients can be an effective approach to reducing prescription abandonment. The implementation of emerging models of care that encourage collaboration between providers, support lifestyle changes, and engage patients to become partners in their own treatment also appears to be effective.

Patient protection and Affordable Care Act; data collection to support standards related to essential health benefits; recognition of entities for the accreditation of qualified health plans. Final rule

This final rule establishes data collection standards necessary to implement aspects of section 1302 of the Patient Protection and Affordable Care Act (Affordable Care Act), which directs the Secretary of Health and Human Services to define essential health benefits. This final rule outlines the data on applicable plans to be collected from certain issuers to support the definition of essential health benefits. This final rule also establishes a process for the recognition of accrediting entities for purposes of certification of qualified health plans.

The bare essentials. Release of LOM report leaves HHS to determine what should be covered by health benefits packages

In the wake of an IOM report on the criteria HHS should use to determine what benefits will be "essential" under reform, various stakeholders are weighing in. The National Association of Public Hospitals and Health Systems would like "enabling" services--such as language, transportation and case-management services--included, because they help make medical care more effective, says Xiaoyi Huang, left, of the NAPH.

A profile of social security child beneficiaries and their families: sociodemographic and economic characteristics

Using a rich dataset that links the Census Bureau's Survey of Income and Program Participation calendar-year 2004 file with Social Security benefit records, this article provides a portrait of the sociodemographic and economic characteristics of Social Security child beneficiaries. We find that the incidence ofbenefit receipt in the child population differs substantially across individual and family-level characteristics. Average benefit amounts also vary across subgroups and benefit types. The findings provide a better understanding of the importance of Social Security to families with beneficiary children. Social Security is a major source of family income for many child beneficiaries, particularly among those with low income or family heads with lower education and labor earnings.

Residential long-term care: public solutions to access and quality problems

Residential long-term care in Canada is characterized by unequal access and quality problems largely due to inadequate public funding and regulation, commercial involvement and its exclusion from medicare. Programs are patchwork, with variations across provinces in the availability of services, level of public funding, eligibility criteria and out-of-pocket costs borne by residents. Most provinces have cut long-term care bed capacity relative to the senior population in the past decade, without sufficiently expanding home and community care or adequately increasing staffing to reflect the higher acuity of the remaining residents. As a result, care is often rushed and underfunded, with poor working conditions leading to poor quality of care and quality of life for residents. This relationship between workers' and residents' well-being is well documented but poorly addressed. Also well researched but rarely reported are the negative impacts of privatization, at all levels: financing, ownership, management and delivery. This article describes the state of residential long-term care in Canada and proposes three policy directions: creating a pan-Canadian long-term care program, improving quality and reversing privatization.

Insurance data for research in companion animals: benefits and limitations

The primary aim of this article is to review the use of animal health insurance data in the scientific literature, especially in regard to morbidity or mortality in companion animals and horses. Methods and results were compared among studies on similar health conditions from different nations and years. A further objective was to critically evaluate benefits and limitations of such databases, to suggest ways to maximize their utility and to discuss the future use of animal insurance data for research purposes. Examples of studies on morbidity, mortality and survival estimates in dogs and horses, as well as neoplasia in dogs, are discussed.We conclude that insurance data can and should be used for research purposes in companion animals and horses. Insurance data have been successfully used, e.g. to quantify certain features that may have been hitherto assumed, but unmeasured. Validation of insurance databases is necessary if they are to be used in research. This must include the description of the insured population and an evaluation of the extent to which it represents the source population. Data content and accuracy must be determined over time, including the accuracy/consistency of diagnostic information. Readers must be cautioned as to limitations of the databases and, as always, critically appraise findings and synthesize information with other research. Similar findings from different study designs provide stronger evidence than a sole report. Insurance data can highlight common, expensive and severe conditions that may not be evident from teaching hospital case loads but may be significant burdens on the health of a population.

Cost minimization of medicare part D prescription drug plan expenditures

OBJECTIVE

To minimize out-of-pocket prescription drug plan (PDP) expenditures by Medicare beneficiaries.

STUDY DESIGN

Cost-minimization analysis.

METHODS

Trained student pharmacists from 6 California pharmacy schools provided expert guidance on Medicare Part D PDPs to beneficiaries through interventions at statewide outreach events. Demographic and insurance information for 2008 was collected via survey. Cost information for the beneficiary's current PDP for 2008 and for the least expensive PDP for 2008 was obtained using the Medicare Plan Finder tool (http://www.medicare.gov).

RESULTS

Data were collected from 250 beneficiaries at 22 outreach events. For the cost-minimization analysis, data were excluded from 72 beneficiaries who were not enrolled in a stand-alone PDP before the intervention and from another 23 beneficiaries for whom information regarding their current PDP or prescription drug profile was incomplete. Of the remaining 155 study participants, 39.4% were male, the mean (SD) age was 74.6 (8.7) years, and they were taking a mean (SD) of 5.3 (3.5) prescription drugs each month. In addition, 68 beneficiaries (43.9%) had limited or no English proficiency, and 85 beneficiaries (54.8%) were enrolled in both Medicare and Medicaid. In total, 89.7% of beneficiaries could have realized cost savings by switching to a different PDP. The median annual potential cost savings was $98 per beneficiary but this varied as a function of subsidy level.

CONCLUSION

Targeted community outreach services to Medicare Part D beneficiaries can help optimize patient selection of a PDP, thereby resulting in lower out-of-pocket expenditures.