CMSA Today - Issue 1, 2014 - (Page 20)

Implications for Case Managers in Managed Care Settings An Integrated Approach The impact of health care reform from a managed care perspective By Mary Beth Newman, MSN, RN-BC, CCP, CCM, Tina Kowlsen, RN, BS, CCM, and Virginia Beckworth, PhD, RN T he Patient Protection and Affordable Care Act of 2010 (ACA) has created many hopes, concerns, and questions for both the health care consumer as well as for health care providers and payers regarding how health care reform is actively changing and impacting the health care system in America. One of the key impacts with which most health care professionals are familiar is the individual coverage mandate and the implementation of the health insurance marketplace or "exchanges." However, there are also a number of other key insurance reforms and quality of care provisions within the ACA that have a considerable impact on health plans. It is important to be aware of the depth, breadth, and variety of health care reform mandates and initiatives when considering 20 CMSA TODAY the influence of health care reform on the managed care industry. This article will highlight what these mandates and initiatives are and why they are significant from a managed care perspective. HEALTH INSURANCE MARKETPLACE OR "EXCHANGES" Considerable movement is underway to implement the health insurance exchange marketplace. From a managed care perspective, many people have been Issue 1 * 2014 * DIGITAL waiting to see what plans will be offered, what benefits will be included in these health plans, and what the costs for health insurance coverage will be - whether accessing health insurance through the public and/or private insurance exchanges or other health insurance programs. Currently, there are 26 states that set up state public exchange programs classified as "Conditionally Approved State Partnership Marketplaces" (CMS CCIIO, 2013a). The remaining states offer their residents health plans through the federal exchange program at www.healthcare.gov. According to the U.S. Census Bureau (2012), there were 49 million Americans who lacked health insurance in 2011. http://www.healthcare.gov

Table of Contents for the Digital Edition of CMSA Today - Issue 1, 2014

President’s Letter
CMSA Corporate Partners
Association News
The Opportunity to Lead Change
An Integrated Approach
Health Care Reform in the Military
Innovation as Necessity
Opioid Abuse Crisis
Index of Advertisers

CMSA Today - Issue 1, 2014

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