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Affordable Care Act Discussion » What other Affordable Care Act-related issues affect healthcare in the Garden State?

January 22, 2014
With so much focus on the workings (or not) of, it is easy to lose sight of other important changes in NJ healthcare. Top of my list is the wave of hospital consolidation that is ongoing. This could be a double edged sword. Larger hospital systems may be able to move more aggressively to improve care coordination and patient outcomes, but at the same time it could lead to higher prices as hospitals gain leverage in rate negotiation with insurers. It is an important trend to watch.
January 23, 2014
One of the key silent issues is the financial impact as those with very high deductibles and co-payments present for care. These high deductibles and co-payments have essentially transferred the financial risk to providers who have to seek reimbursement from patient who may be unaware of this huge shift. Their options are: 1 - collect up front from patients who may not have the resources, or 2 - chase down patients for collections. In either case, there will be great disappointment and perhaps, anger.
January 27, 2014
In order to compete on price, Health Plans are creating "narrow networks" (that's not the marketing term) for the products offered on Marketplace. This trend will carry over to other commercial markets. This raises many questions for regulators, employers and consumers. What constitutes an adequate network? Is that definition changing in order to control pricing on health insurance prices? Are the decisions to keep a hospital or provider in network based on fee for service prices or the total cost of care? What about quality? What weight is given to quality of care when putting together a network? These questions must be answered because out of network benefits are becoming a thing of the past.

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