Anticipating Changes in Health Care for 2014

Whether it’s insurance coverage or the advisability of having certain tests, the health-care landscape is ever-changing. USA Today recently surveyed experts in the field to come up with seven things they say are significant health-care changes to watch for in 2014.

With the advent of 2014, of course, major changes were wrought by the Affordable Care Act (“Obamacare”): Insurers no longer may exclude people from buying insurance because of pre-existing conditions; they may not charge older people significantly higher premiums than younger people; they may not charge women more than men; and they must share pricing and benefits information to their consumers by comparisons they understand.

Here are the experts’ ideas about the changes affecting health care in 2014:

  • Private exchanges. Insurers will introduce more private exchanges to the workplace, and employees will begin to understand they must control their own health costs instead of relying on benefit-heavy insurance plans, according to Alan Cohen, chief strategy officer for Liazon, a company that provides private exchanges.
  • Employer mandate. Employers will start addressing the requirement that companies with more than 50 employees provide health insurance for their employees, according to Hector De La Torre, executive director of the nonprofit Transamerica Center for Health Studies.

    More employers and insurers will offer wellness discounts, which are meant to encourage employees to take better care of themselves in order to get lower insurance premiums, he said. (Evidence for the effectiveness of these programs, however, is fairly thin.)

  • Pricing transparency. Political wrangling aside, the health-care industry is proceeding with the assumption that the ACA is here for good, according to Ceci Connolly, managing director of business consultant PwC’s Health Research Institute.

    That means there will be more transparency in the pricing of health services. The ACA requires insurers to tell customers how much they are expected to pay in out-of-pocket costs, but most health-care providers don’t list prices for treatments. (See our blog, “Why Don’t Medical Procedures Have Price Tags?”) Some states are requiring providers to do that, Connolly said.

  • New rules and higher enrollments. Expect a surge in enrollments on government health-care exchanges, said Ellen Nelson, at Catamaran, a pharmacy benefit manager serving 25 million people. She believes that forthcoming rules and guidance from the Department of Health and Human Services about the ACA will prompt the wave of activity.

    She also believes the March 31 deadline will be extended, but just to be safe, if you’re still planning to enroll in a government exchange plan, don’t wait until the end of March, or you’ll probably run into the kind of delays we saw at the end of last year.

  • Electronic records. Adoption of electronic health records will increase in 2014 and spur industry-wide change, according to Rainu Kaushal, chairwoman of the Department of Healthcare Policy and Research at Weill Cornell Medical College. A big driver of this practice is the electronic record requirement for physicians who want to participate in Medicare.

    Although electronic records receive mixed reviews depending on whom you talk to (some people say they improve the coordination of care, others say recording errors are magnified by easier transmission), Kaushal believes their increased use will result in higher quality and better efficiency because providers will be better able to track what works – and what doesn’t.

  • Shrinking networks. Insurers will continue to limit their networks of health-care providers, often by including only providers with which they can negotiate better rates, said Kev Coleman, head of data and research at HealthPocket, a technology company that compares and ranks health plans.

    For many people, Coleman said, and especially those purchasing insurance for the first time, smaller networks don’t matter. But for people with providers they like, or with chronic or serious conditions, ensuring that their docs, sufficient specialists and convenient facilities are included in new plans is important, maybe even critical.

  • States will drive change. Medicaid, which is run by the states, will have the most impact on local price structures, according to Ray Scheppach, project director for Virginia’s Health Care Cost Containment Commission and a former deputy director of the Congressional Budget Office.

    Medicaid administrators, he said, might transition from fee-for-service pay models to accountable care organizations (networks of providers that communicate and coordinate patient care to ensure better care) and medical homes (patient-centered primary care), in which payment is based on low-cost, quality-outcome methods. Providers in these models often are reimbursed according to the quality and efficiency of their care.

    Some states will decide this year whether to expand their Medicaid programs, as allowed by the ACA, and their numbers will determine much about the character of the program.

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