Access and Reimbursement in the Post-ACA World
In Samuel Beckett’s tragi-comedy Waiting for Godot, Vladimir and Estragon spend their time anxiously awaiting the arrival of someone or something named Godot. Godot in many ways, is like the Affordable Care Act: something that has been inferred and referenced to since its passage in 2010.
Nearly four years out, we have found many organizations in the Access and Reimbursement landscape are a lot like Vladimir and Estragon: kicking the can a bit further down the road, awaiting someone or something to arrive to answer the myriad of questions their customers may have.
The facts are quite clear: while the implementation of the law will see government spending billions less than anticipated, a significant portion of that cost will be passed on to employers and their employees. This will affect healthcare consumers’ purchasing power, lowering their ability to maintain adherence to the medications and needed services.
Consider the following: health care consumers want to stay on their treatment regimen – they want to feel better. But consumers are struggling to adhere to dosage schedules and treatments as out-of-pocket (OOP) costs continue to rise. OOP costs rose 4.8% last year, as the 55-64 age group outspent those 18 and under three-to-one.
As is well known, Medicaid is primed for a major expansion of its roll and Exchange plans will insure many others. This could greatly impact the quality of employer-offered coverage. In 2013, many employers picked up a larger percentage of an individual’s premium and a smaller percentage of a family’s premiums, but chose plans that decreased the in-network and out-of-network coverage for their employees and dependents.
While more consumers now have insurance, the quality of their insurance results in higher OOP costs, with deductibles for individuals now averaging over $1800 and over $4200 for families, and decreases in coinsurance from 90% on average to 80% for employer-sponsored plans.
An effective access and reimbursement program can help consumers close coverage gaps with customized solutions ranging from adherence programs rebates, refund, and co-pay card programs designed to make physician prescribed treatments affordable. It should provide product locators and insurance verification programs to give covered consumers’ confidence in their coverage for newly recommended treatments. It should be credible — executed by experienced, highly-skilled, specialized access and reimbursement professionals working in a HIPAA-compliant, ISO-certified, and EHNAC-accredited environment.
Correctly designed and administered, an access and reimbursement program can improve consumers’ lives and health outcomes.Tags: ACA, access and reimbursement, healthcare