Softheon’s Top 10 Stories of 2018

Softheon’s Top 10 Stories of 2018

Last year unveiled advancements in healthcare technology, newly proposed regulations to our healthcare system, and updates from the Centers of Medicare & Medicaid Services (CMS). As we welcome the new year, take a look at our top 10 stories of 2018.

February: 

The department of Health and Human Services (HHS) published a proposed rule to expand the availability of short-term, limited-duration health insurance plans to increase affordable coverage options for Americans. The proposed rule was released in response to the October 12thExecutive Order, signed by President Trump, which directed federal agencies to propose ways to expand access to short-term plans. 

March: 

A proposed rule from the US. Department of Labor (DOL) could lead to a significant increase in the number of members enrolled in Association Health Plans (AHPs) and, in turn, decrease membership and increase premiums for individual and small group markets. 

April: 

In June 2018, the Federally-Facilitated-Marketplace (FFM) is expected to launch new technology known as Enhanced Direct Enrollment (EDE) – which will allow consumers and agent/brokers to shop, enroll, and manage policy changes to Marketplace health products, without ever having to create an application on Healthcare.gov or contact Marketplace Customer Service. 

July: 

On June 25, 2018, the Centers for Medicare and Medicaid Services (CMS) released its 2018 Enrollment Manual. The manual offers 15 key highlights relating to several processes including auto reenrollment and non-renewal, reports such as the Batch Auto-Reenrollment (BAR) Progress Report, as well as updates on Enhanced Direct Enrollment (EDE), Marketplace premiums, and Medicaid.

September:  

 A Texas lawsuit will be heard determining pivotal laws and regulations concerning the Affordable Care Act. Republican attorney generals, led by Texas’ Attorney General Ken Paxton, will go against the Democratic party, led by California’s Attorney General Xavier Becerra, to debate the fate of the ACA. U.S District Judge Reed O’Connor will hear both sides and determine whether the health law should be put on hold while the case is being contested. GOP Plaintiffs are looking for a “preliminary injunction” on the law. 

The Affordable Care Act (ACA) opened the door to an improved Medicaid Managed Care system. 

Kentucky implemented traditional Medicaid Expansion in 2014 under the ACA, which led to a substantial increase in Medicaid enrollment. According to the state, subsequent to this: additional Federal funding was allocated to federally qualified health centers; Medicaid reimbursement for primary care was increased; and major policy changes that were aimed at expanding the supply of behavioral health services were executed. 

A bipartisan group of senators unveiled a draft bill targeting surprise medical bills in an effort to protect patients from unexpected and exorbitant charges. If approved, the bill will establish several measures intended to warn patients about additional costs at out-of-network facilities and prevent out-of-network health care providers from charging additional costs for emergency services.

October:  

Enrollment in Medicaid and Managed Care Organization (MCO) plans in the United States has reached an all-time high of 74 million recipients. According to Health Affairs, “an estimated 71 percent of Medicaid recipients are receiving their care via private health plans, both investor-owned and nonprofit.” In 2016, research behind the shift showed that managed care plans can provide services that state Medicaid agencies cannot fulfill. For example, network contracting, information technology, and use of management systems to display low-value care can vastly improve the health of beneficiaries. 

Social determinants of health (SDoH) are conditions in the environments in which people are born, live, learn, work, play, and age that impacts a wide range of health, functioning, and quality of life trajectories. Individual and community behaviors can influence health costs and outcomes regardless of being outside the control of the health system. Understanding social determinants of health is imperative for strengthening health and minimizing longstanding disparities in healthcare. 

December:  

U.S. District Judge Reed O’Connor of Texas ruled the Affordable Care Act (ACA) unconstitutional. Congress stated that the Supreme Court supported the ACA in 2012 because it contained the individual mandate or a tax penalty for Americans who didn’t purchase a health insurance plan. Once Congress revoked the Individual Mandate in 2017, O’Connor concluded the rest of the law fell apart. “In sum, the Individual Mandate is so interwoven with [the ACA’s] regulations that they cannot be separated. None of them can stand,” O’Connor wrote. He made this decision after 18 Republican state attorney general and 2 GOP governors stated their case. 

What’s next for healthcare in 2019?

Digital transformation in healthcare technology is top-of-mind. We expect to see reinvention & reuse of Artificial Intelligence, Insurtech, population health management, predictive analytic tools, & connected clouds. 

The digitalization of the healthcare industry involves a slow and tedious implementation but, with the intention of improving traditional business models. These upcoming technology trends will focus on measurable outcomes and ultimately transform patients’ lives and the well-being of Americans. Read more in our blog ‘Top 5 Technology Trends to Reshape Healthcare in 2019.’

The views and opinions expressed by the authors on this blog website and those providing comments are theirs alone, and do not reflect the opinions of Softheon. Please direct any questions or comments to research@softheon.com. 

Amanda Wolfer

Amanda is the Senior Digital Strategist at Softheon. She works closely with the Marketing team to develop and maintain Softheon’s blog and social media presence. She received her bachelor’s degree in English Language & Literature and Organizational Communication from SUNY New Paltz in New Paltz, New York.

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