Your Care Connection: Fill & Download for Free

In a lot of ways, the short term future of major pieces of the American healthcare system will be determined by the election on Tuesday. But I’ll set those specifics aside and tell you what I think will happen to US healthcare in the next 10 or so years. As I mentioned in other answers, getting direct accountability between insurers and consumers and providers is absolutely critical in moving this whole system in the right direction (getting costs under control, providing a better member experience, and forcing some correlation between cost and quality that is totally absent right now).So how will that happen? First off, I think that adjustments to the ACA (mentioned elsewhere) will really put that market on strong foundations and we’ll see that continue to grow to a much larger individually-insured population across the country. Second, I think we will absolutely see a trend of employers getting out of the way of managing their employees’ healthcare options. You saw this in the 20th century with retirement plans: most employers used to provide pension plans where you would expect to receive a certain amount for your retirement, and the employer/pension fund was responsible for making sure that happened. The risk there is that, if market dynamics change, pensions can find themselves underfunded--they don’t have enough money to make good on the promises they made to their employees. So what happened? Basically everyone is on a 401k now, where the employee owns their own retirement account, and the employer can make a contribution to it each month. That obviously makes a lot more sense, because the people who manage a supermarket chain or video game design company aren’t expert investors, so they shouldn’t be making promises they don’t necessarily understand or know that they will be able to deliver on.The same thing will happen to health insurance: your employer will probably still help you pay for your monthly premiums (maybe up to a certain amount), but you’ll decide which insurance company you go with, and you can take that insurance with you from job to job. So the employer can get out of the way of making decisions it doesn’t understand, and the healthcare system will finally be economically incentivized to give you great service. Now instead of just the ACA market, you’ll have insurers directly accountable to their customers across the much bigger employer insurance market, and that will be a good thing for healthcare consumers (aka all of us).We’re already seeing a lot of pressure and movement to change how we pay healthcare providers (doctors and hospitals) for delivering care. Right now most doctors get paid more for doing more tests on you, surgeons get paid for doing surgery, and hospitals get paid for how long they keep you in the hospital. That doesn’t make any sense and it’s why the system is good at getting people better when they’re sick, but really pretty bad at keeping people healthy - the incentives aren’t structured to optimize for that.So what you’re seeing the beginning of (and one thing Oscar is doing a lot of) is agreements between insurers and providers where we ‘share risk’ - so your doctor and the hospital in your neighborhood makes more money if you don’t get sick than if you do. Over time, making healthcare providers feel the pain of rising costs (instead of just passing it on to insurers and, via insurers, the rest of us) will force some major restructuring in how healthcare is delivered. But beyond sharing risk, there are other creative things that insurers and providers can do to help modernize how we deliver healthcare.For instance, in New York, we get a notification every time one of our members enters the emergency room, and we used this data to try a pilot this past summer: every time a member entered the emergency room, an automated tool would scrape our internal claims data (basically very structured bills we get from doctors for what they did to a particular member, so that they can get paid) and found out whether that member had a history with a primary care provider in our network. If they did, another automated system would create a fax (yes, most doctors offices still use fax machines) that would tell Dr. Smith that his patient Jane Doe was just in the ER. It would give them a number to call and a PIN to enter into our phone system when they called, and that PIN would trigger a call on the member’s phone - in other words, they’d call us and we’d route them to the member, live. And if they actually talked to the member (which we could measure, because it’s our own internal system), we’d pay them $25. That’s just a little mechanism we can create to incentivize the system to behave the way it should: your doctor should know you just had an emergency and should follow up with you to make sure everything is OK. (This actually was an easy system to build for us, but notice all the pieces we needed to have in place to pull this off: our internal comms systems, the real-time data infrastructure, the connectivity to the State of New York’s health information network, various layers of authorizations, and the claims and payment infrastructure to introduce these new kinds of transactions ourselves.)But we need to (and are, at Oscar) do even bigger things. You should be able to text your doctor (securely, through a trusted system) instead of being forced to go to her office just to answer a simple question. You should have a “health quarterback” that can help you make sure you’re staying on top of your care protocols and managing your illness if you’re sick, or reminding you about checkups and routine tests you should be getting if you’re healthy. They should also be a trusted source to answer questions in this incredibly confusing system. We have that in Oscar Concierge (members have a team of 3 member services reps and a registered nurse that can help them manage their health and answer even clinical questions they might have), but nothing like that exists to the extent it needs to in US healthcare.To distill this into some simple keywords, today’s system is:Uncoordinated - you don’t know what to do nextUncontrolled - you end up doing too muchUncompetitive - there isn’t any competitive pressure among participants to provide value for moneyIntransparent - data and knowledge doesn’t flow between providersUnmeasured - there aren’t any good quality metrics because nobody watches the entire systemUnobserved - nobody proactively tells you what to do next and what to watch out forDisincentivized - doctors, insurers, brokers have the wrong incentivesAnd it needs to go towards a system that is:Coordinated - clear clinical pathways, algorithmic, systematic, testedControlled - the right utilization for the right issue (tele-visits instead of ER)Competitive - providers, insurers, everyone competing on value for moneyTransparent - your data is free and available to your providersMeasured - which doctor works for which condition and situationObserved - someone watching over you and helping you outIncentivized - everyone pulling in the direction of better health & getting paid to do so

Health insurance is a contract between you and your insurance company. When you buy a plan, the company agrees to pay part of your medical costs when you get sick or hurt.There are other important benefits of health insurance. Plans available through the Connect For Health Colorado Marketplace (and most other plans) provide free preventive care, like vaccines, screenings, and check-ups. They also cover some costs for prescription drugs. Also, having health insurance can help you get access to a medical provider who can get to know you and your individual medical needs.Health Insurance Protects You From High, Unexpected CostsDid you know the average cost of a 3-day hospital stay is $30,000? Or that fixing a broken leg can cost up to $7,500? Having health coverage can help protect you from high, unexpected costs like these.How Health Insurance Coverage WorksWhen you have insurance, you pay some costs and your insurance plan pays some:Premium: A premium is a fixed amount you pay to your insurance plan, usually every month. You pay this even if you do not use medical care that month.Deductible: If you need medical care, a deductible is the amount you pay for care before the insurance company starts to pay its share. Once you meet your deductible, your insurance company begins to cover some costs of your care. Some plans have lower deductibles, like $250. Some have higher deductibles, like $2,000. Many plans provide preventive services, and sometimes other care, before you’ve met your deductible.Co-pay: A co-pay is a fixed amount you will pay for a medical service. For example, a visit to the doctor’s office might cost $150 if you didn’t have coverage. With health insurance, you may pay only $25 and the health plan would pay the rest.Co-insurance: Co-insurance is similar to co-pay, except it’s a percentage of costs you pay. For instance, you may pay 20% of the cost of a $200 medical bill. So you would pay $40 and the health plan would pay the rest.How Insurance Protects YouInsurance coverage protects you in two ways from high medical costs:Out-of-pocket maximum: This is the total amount you will have to pay if you get sick. For example, if your plan has a $3,000 out of pocket maximum, once you pay $3,000 in deductibles, coinsurance, and co-pays the plan will pay for any covered care above that amount for the rest of the year.No yearly or lifetime limits: Health plans in the Connect For Health Colorado Marketplace cannot put dollar limits on how much they will spend each year or over your lifetime to cover essential health benefits. After you’ve reached your out-of-pocket maximum, your insurance company must pay for all of your covered medical care with no limit.People without health coverage are exposed to these costs. This can sometimes lead people without coverage into deep debt or even into bankruptcy.

It is one of the important feature. It consists of various services-you can book appointments to doctors, consult online by any mode (email, chat, video, audio), connect with care providers @home, order medicines online, lab test @home, pamper yourself with best salons, spa, buy best health insurance for you and your family.It saves time and money both.