The Affordable Care Act has brought many reforms and provision to health insurance all designed to improve the quality and efficiency of health care in the United States and all while cutting down the administrative costs and waste. On this page, we are going to take a look at the improvements the Affordable Care Act has brought about, specifically to the quality of health care. For years now, individuals, small businesses, the self-employed – along with many others – have found it near impossible to be able to find affordable health care. Leaving them in situations where an illness or injury could leave them financially destitute and their futures unknown. Now, with the Affordable Care Act, not only is insurance going to be more affordable, it’s also going to improve the quality of both health insurance and health care. The following are some of the key features of the Affordable Care Act that focus on quality:
Uniformity: Previously, health insurers were able to use any ‘terminology’ they chose when it came to the policies they issued. Now, the Affordable care act has made all insurers adhere to a uniform glossary. In addition to this, there must also be a uniform Summary of Benefits and Coverage (SBC) from each insurer. This allows consumers to clearly compare each insurer to the other in an “apples to apples” fashion, with much less confusion.
Relief for Medicare Beneficiaries: In previous years, Medicare beneficiaries had a gap in coverage for prescription drugs – commonly known as the ‘Donut Hole’. In 2010 those beneficiaries received a one-time tax free rebate of $250. In addition, the donut hole would shrink significantly by 2013 and will disappear altogether by January 1, 2020.
Preventive Care and Health Screenings: The Affordable Care Act includes provisions where all insurers must offer Essential Health Benefits. Insurers are prohibited from charging co-payments, deductibles and co-insurance for these services. Essential health benefits packages must include services and items such as immunizations, preventative care, health screenings, ambulatory patient services, mental health treatment, substance abuse treatment, maternity care, newborn care, prescription drugs, rehabilitative services, chronic disease management, wellness services and pediatric services, including dental and vision care.
Quality not Quantity: How many times have you been to the doctor’s office and felt that you were just part of an assembly line? The doctor running from patient to patient and you don’t feel as though you’ve had any quality – or quantity of time with your medical professional. The Affordable Care Act will change that. Payments to physicians and medical facilities will be based on the value of the care offered and not the volume. The Readmissions Reduction Program goes into effect as of this day. Essentially the program is designed to force hospitals to correctly treat a patient the first time they are hospitalized for a medical condition, or face penalties when readmission for the same health problem is required.
Innovation: In January 2011, the Center for Medicare and Medicaid services is responsible for developing the Center for Medicare and Medicaid Innovation. The Center is tasked with designing an innovative payment and delivery model.
Cost Cutting: The Independent Payment Advisory Board has been set up to find ways to reduce waste in the health insurance system. The aim is to improve health care, as well as to expand access to high-quality care.
Reduction of Paperwork and Administrative Costs – Another goal of the cost cutting measures is to reduce the amount of paper work, administrative costs and medical errors. To further this measure, standardize billing is also mandated. All of this, will lead to the adoption of new rules for the secure, confidential, electronic exchange of health information.
Integrated Health Systems: Offers incentives to physicians to join “Accountable Care Organizations.” These organizations will help better coordinate in-patient care and improve the quality of health care. Another essential goal of the Accountable Care Organizations is to help prevent disease and reduce unnecessary hospital admissions.
Small Business Health Insurance Tax Credits: The Affordable Care Act has made provisions for a health insurance tax credit for small businesses effective January 1, 2014. More than 4 million small businesses will benefit from this tax credit. The first phase will offer credit up to 35% of the employer’s contribution in health insurance for employees (25% if the business is a non-profit). The second phase will provide credit up to 50% of the employer’s contribution (35% if the business is a non-profit).
Checking Health Care Fraud: Resources have been allocated to eliminate health care fraud. New screening procedures have been designed for health care providers to eliminate both fraud and waste in health care.
Checking Health Disparities: The Affordable Care Act provides for the collection and reporting of racial, ethnic and language data by federal health care programs to check disparities in health care.
Expanding Authority to Bundle Payments: A national pilot program has been launched to encourage hospitals, doctors, and other health care providers to submit a single bill for care. This will also improve the coordination and quality of patient care. Through this ‘bundle payment’, hospitals, doctors, and other health providers would be paid a flat rate for a single episode of care.
More Affordable Health Care: The act aims at making health care more affordable by offering tax credits as well as lowering the eligibility guidelines for Medicaid and CHIP for lower income families and for those adults of a lower income who do not have children.
Health Insurance Marketplace: The creation of health insurance market place will enable consumers to buy health insurance directly in the Health Insurance Marketplace. It will offer transparency and competitiveness resulting in quality improvement of health care.