Published in NJBIZ
by Beth Fitzgerald
These are times of constant upheaval in health care: Hospitals are merging, the Affordable Care Act is expanding health coverage (and coverage issues) and employers are simply struggling to find health plans that they and their workers can afford.
So what will the future hold?
To find out, we asked a cross section of experts — from hospitals, physician groups, payers, think tanks, the law, business advocacy and academia — for their 2015 predictions.
Here’s what they had to say:
Linda Schwimmer, vice president, New Jersey Health Care Quality Institute
“The ACA is under tremendous threat if the Supreme Court decides that subsidies can only be used in state run marketplaces. New Jersey has a federally run marketplace and over 82 percent of the plans purchased on it are paid with a subsidy. If the subsidy goes away — the marketplace and the law will have to be revamped.
“The continued expansion of Medicaid and making sure that there is enough access to care is an important issue for us. The expansion of Medicaid in New Jersey has meant that 400,000 more people are now insured — which is good for their long-term health, but we need to make sure that there are enough willing providers to care for people with Medicaid coverage. This challenge requires taking a hard look at how we reimburse for Medicaid and why is it so much lower than Medicare and commercial rates.
“The ‘out of network’ issue continues to harm consumers and needlessly add cost to the health care system. We expect the legislature and executive branch to finally address this issue with serious reform which will create more transparency around actual costs to consumers, control costs for the state-funded health benefits plans, and resolve an issue that has been brewing for the last eight years.
“Finally, we expect to see more public reporting of quality measures as we move away from a ‘fee for service’ focused health care system. The Leapfrog Group will be reporting C-section and episiotomy rates by hospital this year. There will be reporting on surgery quality as well to support new payment models called ‘reference-based pricing.'”
Read all of the experts’ health care predictions for 2015 in the original article here.