Improving the Quality of Care PPACA has introduced several initiatives to improve patient’s quality of care. Such initiatives include the creation of Health Insurance Marketplace (HIM), establishing a Quality Rating System (QRS), and Consumer Experience Surveys. HIMs. HIMs had a rough start in the beginning of PPACA, but significant strides were taken to improve customer service in the marketplace. Marketplaces “help individuals and small employers shop for, select, and enroll in high quality, affordable private health plans (“Health Insurance,” 2016). While the marketplace can be an overwhelming experience for some users, PPACA “creates several new entities to advise and help consumers make health insurance purchase decisions. These entities include Navigators, Assisters, Certified Application Counselors, and Web brokers” (Meulemans, 2013). QRS. QRS is a rating system used in the Marketplace. The U.S. Department of Health & Human Services (HHS) collects and compiles data for healthcare providers and combines public reporting of quality rating information to formulate a rating for consumers to see in the
PPACA CASE STUDY 4 Marketplace (“Health Insurance,” 2016). This information can be used to find the best possible care for each individual’s unique needs. Consumer Experience Surveys. Consumer Experience Surveys are just as the name states. The surveys provide a means for patients to report their provider experience to HHS (“Health Insurance,” 2016). The information will be offered in the Marketplace to provide further users the ability to compare Quality Healthcare Providers (QHP). Social Perspectives Social perspective refers to society’s views or attitudes. In the case of PPACA social acceptance has not always been good. Per the Kaiser Family Foundation (KFF) Health Tracking Poll (see Figure 1), after the initial legislation passed in 2010 the approval rating of PPACA was 46% favorable and 40% unfavorable. As of March 2016 the approval rating is 41% favorable and 47% unfavorable (Kaiser Health Tracking Poll,” 2016). The favorability rating has had its ups and downs but has spent the majority of time in the unfavorable majority. Rescinded Coverage One way in which PPACA helps insureds is by “prohibiting individual and group health plans from placing lifetime limits on the dollar value of coverage and prohibit insurers from rescinding coverage except in cases of fraud” (“Summary,” 2013). In the past, insurance companies were well-known for locating loopholes in which they could rescind coverage and not have to pay on claims. After the establishment of the PPACA, insurance companies agreed to eliminate this practice (“Key Features, 2015). Pre-existing Conditions The pre-existing conditions rule “imposes the same insurance market regulations relating to guarantee issue, premium rating, and prohibitions on pre-existing condition exclusions in the individual market, in the Exchange, and in the small group market” (“Summary,” 2013).
PPACA CASE STUDY 5 Basically this rule stipulates that those with pre-existing conditions will receive the same treatment as those without pre-existing conditions.
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