In the better-value chain, where healthcare services are offered at an affordable cost, the importance of any change can be gauged only after it succeeds at its core mission. If the mission is to increase transparency of how insurance companies work, the decrease in unsatisfied consumers would define it. If the mission is to disseminate information to masses, the knowledge level of target audience would be the benchmark. How does a health insurance exchange stand in terms of its importance in the better-value chain?

Exchanges are supposed to sell insurance: A marketplace that consumers and small businesses can utilize to find affordable health insurance options available in their area. So, why consumers would go to health insurance exchanges and buy health plans?

1.    Health insurance exchange will create retail competition for the health insurance companies.

2.    Consumers will have more choices because most insurance companies would not want to be left out of a major distribution channel for their products.

3.    Health insurance exchanges will have information and transparency while selling health insurance plans. This will encourage consumers to come to them for buying.

4.    Health insurance exchanges are required to be non-profit and are expected to operate with the buyer as the prime beneficiary in mind. This gives the buyers an added peace of mind while buying from the exchange…

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Change is the only constant in this world, they say. But when it comes in such a magnitude, it needs to be recognized, talked about, analyzed and acted upon. The US healthcare system is seeing a shift from wholesale to retail side. It has a definite impact on the insurers and so on the dynamics of the health insurance industry in the country. The question is: are the insurers ready to tap the changing market that could mean change in strategy and planning, and perhaps the organizational structure also?

When we talk about wholesale side and the retail side, the level of decision-making authority and financial responsibilities are considered. Financial responsibility of individual consumers would mean retail side while responsibility of the intermediaries of these consumers would mean the wholesale side. With the implementation of healthcare reforms, individuals will be encouraged to make decision about the health insurance products they want to choose and buy even if their employers offer the coverage to them. This encouragement brings tremendous change in the way insurers sell health insurance, which traditionally focus on the wholesale side of the business…

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Till now, health IT (HIT) has remained an economic outcast in the system that is all set for an overhaul—an overhaul that could mean affordable health insurance possible for one and all. But how could a robust system sustain such a renovation and modernization without potent tools? Pretty strangely, the US budget for HIT has been low, though it could mean an efficient healthcare system and a saving worth noticing.

The IT departments of healthcare industry do suffer from poor infrastructure and advancement. An estimate mentions that industries outside the healthcare system spend around seven times more than the health industries to develop their IT departments.

According to a report by the adoption of electronic health records could produce efficiency and safety savings of $142 billion in U.S. physician offices and $371 billion in U.S. hospitals till 2020. However, this could mean a cost of around $156 billion over five years, with an additional $48 billion in operating costs.

Throwing a casual look won’t do justice to these statistics. If it is possible, HIT deserves more attention and cogent efforts to make sure the results are accrued…

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Customer Relationship Management (CRM) is now a much talked about subject. Like lots of tools and equipments required for mountaineering and hiking projects, CRM has become an important strategic tool for businesses to climb the success-ladder. Without doubt, it finds mention in present days’ business related articles, strategy write-ups, and books geared to give guidance to budding business owners.

While we talk about insurers, it is important not to overlook the importance of CRM for their success. With stiff competition growing in the health insurance sector, it is challengingly imperative for insurers to acquire, retain and support their customers through the sales they make. Winning the trust of customers is of prime importance in today’s business world…

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Healthcare reforms bring lots of good news for the consumers. No annual limits, no exclusion due to preexisting condition, no discrimination against the children, etc. However, to implement these changes proposed by the healthcare reforms, the insurers have to bear the brunt.

Without doubt, there are multiple obligations imposed on the insurers to make sure they comply with the healthcare reforms; otherwise, a penalty of the order of $100 per day could be levied on them.

Though the healthcare reforms could mean more business for the big insurers, who are looking to expand their hold on the market; yet the costs could increase, and the profit will take the reverse route. Even if insurers are able to earn some money by strategizing or with better planning, they are required to spend at least 85% of subscriber premiums on medical costs in large group coverage plans; and at least 80% for individual and small group plans beginning in 2011. By large, there is hardly any profit for insurers post healthcare reforms…

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Healthcare exchanges: Impact on insurance companies, agents and brokers

Healthcare reforms are backed with strong belief due to the objectives they carry, including establishing a Competitive insurance market, Providing free preventive care, Regulating the cost of insurance and Expanding coverage to the uninsured U.S. citizens, etc. Among these, the first one was achieved by proposing the setting up of Healthcare exchanges.  As predicted by many, these exchanges would be the key to healthcare reforms. They are expected to generate competition, greater access, choice, portability, and affordability of health insurance products for individuals and small businesses.

What are Healthcare exchanges?

Beginning in 2014, consumers including individuals and small businesses will be able purchase health insurance from the new health insurance exchanges established by the Act. These are created to provide alternate options to purchase health plans…

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Small businesses, not only in the US, play an important role in job growth and innovation. Medium and large businesses often thrive on the small businesses to provide complementary as well as supplementary services. The spirit of entrepreneurship finds its roots in the favorable atmosphere provided for the growth of small businesses.

Small businesses have to pay higher premiums as compared to their larger counterparts for offering health insurance to their employees. With the implementation of healthcare reforms, it is expected that small businesses will be greatly benefited.

Healthcare reforms will slow the growth rate of costs and expand health insurance coverage improving living standards of families. Unsustainable increase in the budget deficit will be checked and efficiency of the labor market will be enhanced…

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Ever wondered where the health insurance companies spend the money that you pay to avail the health coverage? Of course, there is no single recipient who receives all the money. If you have bought health insurance and ever paid heed to the words of advisors or experts, you might have understood that there are various components of health insurance coverage. For example:

  1. Doctor visit
  2. Hospitalization
  3. Prescription drugs

The premium that you pay for your health insurance policy covers the costs for all these segments. The importance of understanding these terms lies in the fact that you can choose to opt out what type of coverage you might not need, which helps in reducing the premium costs. Let’s suppose you enjoy good health status and do not need to see a doctor too often. You can opt out of the coverage provided for doctor visit because it helps in lowering the premium; actually you will find it lower than paying the full amount out of your own pocket.
It is clear that understanding the distribution of coverage type and costs involved in every segment of a health insurance policy does help the consumers…

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Benefits to Virginians through the Affordable Care Act
Healthcare reforms are one of the most debated topics in the insurance industry right now. There are lots of articles, blogs and debates going on throughout all types of media: print, online, mobile, etc. In the similar vein, we are here to discuss some benefits that the residents of Virginia will have with the implementation of this Act.

  • Around 109,000 small businesses in Virginia could be helped by a new small business tax credit. In return, these businesses will have to provide coverage to their workers
  • A roughly calculated figure of 91,500 Medicare beneficiaries in Virginia hit the donut hole, or gap in Medicare Part D drug coverage. However, these Medicare beneficiaries received no extra help to defray the cost of their prescription drugs. With the implementation of this Act, Medicare beneficiaries in Virginia who hit the gap this year will automatically be mailed a one-time $250 rebate check.
  • Some help for early retirees also as an estimated 82,100 people from Virginia retired before they were eligible for Medicare and have health coverage through their former employers. From June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize these early retirees to get reinsurance.
  • To provide coverage for insurance and consumers with pre-existing conditions, $113 million federal dollars are available to Virginia starting July 1 to provide coverage. This will be functional till the state-run exchanges become functional.
  • 146 Community Health Centres will be benefitted at the beginning October 1, 2010, with increased funding. This will help nearly double the number of patients seen by these centers over the next five years.
  • National Health Service Corps would be funded with $1.5 bn over five years to provide scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. With this funding, around 9% of Virginia’s population who live in an underserved area would be helped.
  • With the new Act, Virginia enjoys the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status, for the very first time…

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