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This is the first of a 2-part discussion that explores the role Healthcare Analytics can play in the era of Health Reforms.  Here, we discuss the contemporary realm of Analytics and the challenges to its usage.

Pharmaceutical companies are perhaps the most seasoned users of Analytics in the healthcare market since detailed analysis is central to their efforts in drug research and clinical trials. Other healthcare entities like payers, provider organizations and government agencies haven’t adopted Analytics as enthusiastically. However, this scenario might change rather soon. With State Exchanges set to redefine the health insurance marketplace, most healthcare organizations have understood that they can either adapt to the reforms or perish. As 2013 progresses, healthcare businesses are realizing that they need to squeeze more out of every dollar spent, limit wastage of resources and eliminate fraudulent practices to achieve profitability-cum-compliance. This translates into many operational and administrative changes. Healthcare Analytics can make this transformation less challenging.

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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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