Health Care Reform has brought about significant changes in the healthcare market, arguably some good and some not-so-good. One major change is the transformation of how care is delivered. We are experiencing a change in the structure of paying providers for the number of services delivered, to paying for improved outcomes and cost efficiency through a variety of models called Accountable Care Organizations (ACO). These models use a combination of technology and data, along with financial incentives to help providers coordinate care and improve clinical outcomes. Medicare was an early adopter, and approximately 423 organizations are participating in the Medicare ACO program. Future Medicare ACO programs will allow Medicare beneficiaries to choose an ACO versus other care models, and may provide a financial incentive to the Medicare beneficiary to do so. Continue reading Everything You Need to Know About Accountable Care Organizations (ACOs)
We recently heard of The Big Five health insurers vying for takeovers. The most current is Anthem’s bid for Cigna. Frustrated by negotiation breakdowns, Anthem made the deal public in an effort to “convince” the Cigna management team and board of the potential positive outcomes for them and the shareholders. But what about the members served by those organizations and why is this all occurring now?
A recent Wall Street Journal article1 shed some light on the motivations behind the sudden merger mania. The article alluded to: credit being inexpensive, the fact that some entities looking to pair up have complementary businesses, Health Care Reform has somewhat leveled the playing field, and economies of scale will be accretive. Also noted in this report, is the number of hospitals and insurance providers that have merged in recent years, with more mergers to come in the future. Continue reading Merger Mania
The IRS has recently released Notice 2015-16 addressing regulatory compliance with the proposed 2018 Cadillac Tax, or excise tax. The Cadillac Tax is a 40% excise tax on certain employer sponsored coverage which exceeds a statutory dollar limit. The purpose of the tax is to help reduce health care costs and usage by having employers provide benefits plans that encourage cost sharing by employees.
The IRS notice addresses three major items:
- Coverages subject to the Cadillac Tax
- Determination of the cost of those applicable coverages
- The annual statutory dollar limit
The Affordable Care Act (ACA) has added employer reporting requirements to the IRS code for 2015. These reporting regulations are being imposed to assist the IRS with enforcing the Employer Shared Responsibility provisions of the ACA and the Individual Mandate, which requires everyone to have basic health insurance.
The IRS regulations fall under two sections of the Internal Revenue Service Code – sections 6055 and 6056. The breakdown of the requirements for each section of the code and the mandated timing for the reporting are as follows: Continue reading It’s Here! Employer Reporting as Mandated by the ACA is Now in Effect