Affordable Care Act Spectrum- Looking Beyond Exchanges
One of the most important pieces of any healthcare initiative is preventative care- preventative services such as cancer screenings not only save money but save lives. Previous to the ACA many Americans had difficulty accessing preventative care such as colorectal cancer screenings. Since the ACA was enacted in 2010 18 million people have received preventative care they could not previously afford. Services such as a colorectal cancer screening were 160 dollars for a Medicare member before the ACA and are now free. When patients are able to be treated early in the onset of illness treatment costs are decreased dramatically vs. receiving care late in the illness. Preventative care improvements under the ACA also include things like flu shots, vaccinations, well-baby and well child visits, blood pressure and cholesterol monitoring, alcohol abuse screenings, depression screenings and counseling.
Another piece worth mentioning is the significant savings on prescription drugs as a result of the ACA. Since 2010 5.4 million senior citizens and people with disabilities have saved 4.1 billion on prescriptions. Seniors on Medicare have saved 798 dollars on average annually.
A third key piece of the ACA are new rules surrounding electronic billing, payments and reconciliation for claims adjudication. Today, on average a provider spends 3 weeks a year cumulatively on billing, 2/3 of his office dedicated to billing. With an increase in electronic transaction enrollment these costs can be reduced. The ACA is proposing new EFT and ERA rules, automating posting vs. manual reconciliation which is predicted to save up to 9 billion over next ten years in admin costs. Also the ACA will mandate a standardized era enrollment, requirement for timeline between eft and era. Deadline for rules 1/1/2014. For decades payers have delivered the payment and EOB in timelines that make is extremely difficult for providers to post effectively and efficiently. Often billing departments are over 2 months behind waiting for a payment to come in for an eob that was received or vice versa.
Exchanges are an important piece of the Affordable Care Act, but it is very important to keep in mind there are other core initiatives to watch. Increases in electronic submission, payment and automation of posting/reconciliation are crucial to making healthcare run correctly. These new electronic and automation initiatives could present great opportunities for vendors with the right ability and experience.