Exchange Regulations Released – Essential Providers Play Leading Role

Last week, the Department of Health and Human Services (HHS) released regulations governing the establishment of Exchanges, set to begin in 2014. The rules offer guidance to states on how to establish an Exchange and provide opportunities for customizing the model to best meet the needs of state residents.

Wading Into the Deep End – Is Current High-Risk Pool Enrollment Indicative of Future?

Last week, we told you about the Pre-Existing Condition Insurance Program (PCIP), a program designed to provide insurance to high-risk individuals and those denied coverage. This week we tell you why we think the experience with the PCIP program may be indicative of problems to come once guaranteed issue goes into effect.

Few Swimmers Take Plunge Into High-Risk Pool – Feds Throw Life Preserver

The Pre-Existing Condition Insurance Program (PCIP), which passed as part of the Patient Protection and Affordable Care Act (PPACA), is now one year old and suffering from lagging enrollment. The program, which provided $5 billion in federal spending for existing and new high-risk insurance programs, was meant to help aid high-risk, uninsured individuals who were denied coverage in the insurance market (or would have had unaffordable coverage due to rate ups and surcharges) in getting coverage through 2014. In 2014, when guaranteed issue requirements go into effect, the program would sunset.

Research Aims to Reduce Over-Practicing Among PCPs

Best practices have always been emphasized by the various medical societies and academies. But under health reform, payers and providers will increasingly have to work together to make best practices the standard so as to meet the rigorous cost and quality dictates coming down the road.  Primary and preventive care will demand special attention and researchers are busy compiling the not to dos for PCPs.