Publications

Publications

The ACA and essential health benefits: Overview of new coverage standards in individual and small group markets

Beginning in January 2014, the Affordable Care Act (ACA) introduced a series of health insurance reforms, particularly for consumers purchasing coverage through the individual market or covered through employment at a small firm. One of the most prominent of these reforms is the requirement that all health plan products in certain market segments must cover an established set of essential …

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Effects of the ACA on insurance affordability for the uninsured in Michigan

January 1, 2014, marked the beginning of new health insurance affordability programs made available through the Patient Protection and Affordable Care Act (ACA). These programs include tax credits to lower premium costs, assistance to reduce out-of-pocket expenses, and an optional state expansion of Medicaid eligibility. This analysis examines the effects of the ACA’s premium tax credits and cost-sharing reductions on …

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ACA Health Insurance Marketplace: Michigan overview and operations

On March 31, 2014, the Affordable Care Act’s (ACA) Health Insurance Marketplace officially closed for most people until open enrollment begins for 2015 health plans on November 15, 2014. By the end of the first open enrollment period, 272,539 Michigan residents had signed up for a plan through the ACA marketplace. Assuming that many of these residents complete the enrollment …

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Pain-Related Care and the Affordable Care Act: Summary of Common Practices

This paper provides a brief overview of key findings in the Institute of Medicine (IOM) 2011 report on pain, how public and commercial insurers approach pain management, and the pain-related provisions in the 2010 Patient Protection and Affordable Care Act (ACA). The IOM released a report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, summarizing findings …

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An in-depth look at six cost containment programs in the Affordable Care Act

This paper describes six cost-containment policies or initiatives included in the Affordable Care Act (ACA) that target how health care is delivered and the growth of health care costs. A summary of the implementation occurring in Michigan is also provided. The policies or initiatives explored in depth here are: Accountable Care Organizations Hospital-Acquired Conditions Value-Based Purchasing Hospital Readmission Reductions Program …

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Cost containment in the Affordable Care Act: An overview of policies and savings

While there has been considerable media coverage about the insurance impacts of the Affordable Care Act (ACA), there has been less discussion of the law’s changes to provider reimbursement policy, reforms to the delivery system, and investments in programs to improve the quality of care and constrain long-run growth in health care expenditures. And yet, the elements included in the …

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Best Practices in Care Management for Senior Populations

Care Management is a service designed to help patients and their caregivers manage medical conditions more effectively, in order to improve health and reduce the need for hospitalizations and emergency department visits. The concept arose in the past decade from disease management programs of the 1990s, which focused on individual diseases rather than more comprehensive consideration of patients’ needs. Care …

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Premium cost changes attributable to the Affordable Care Act

The Affordable Care Act (ACA) expands health insurance coverage to millions of uninsured Americans and introduces several reforms to the health insurance market, particularly for people who purchase coverage on their own or receive it through employment at a small business. These reforms standardize benefits, limit insurance rating practices, prohibit coverage denials, limit out-of-pocket costs, and levy new taxes on …

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Medicaid and Medicare Disproportionate Share Hospital programs

Congress created the Disproportionate Share Hospital (DSH) program in the early 1980s to help hospitals offset the costs of providing care to low-income individuals. Medicaid and Medicare each have a distinct DSH program, with a unique structure and financing mechanism. In addition to giving a brief overview of the Medicaid and Medicare Disproportionate Share Hospital programs, this document will: Discuss …

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Care transitions: Best practices and evidence-based programs

Poorly coordinated care transitions from the hospital to other care settings cost an estimated $12 billion to $44 billion per year. Poor transitions also often result in poor health outcomes. The most common adverse effects associated with poor transitions are injuries due to medication errors, complications from procedures, infections, and falls. Providers are focused on improving transitions, due in part …

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