Individuals who have health insurance coverage thanks to the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) have a higher prevalence of certain diseases, a greater propensity to use medical services, and are more costly to cover according to an investigation of claims between 2014 and 2015. A Blue Cross Blue Shield (BCBS) report revealed these trends after comparing the health status, use of medical services, and corresponding costs of those enrolled in individual coverage before and after the implementation of the ACA. BCBS also compared this data to that of individuals with employer-based coverage.
Use of services. The data collected by BCBS highlighted the facts those individuals who enrolled in BCBS plans in 2014 and 2015 utilized medical services, on average, more than those who had coverage prior to 2014. Comparing these groups, the data revealed that those with coverage post-ACA implementation had inpatient admissions that were 84 percent higher, outpatient visits that increased by 48 percent, and medical professional services that grew by 26 percent. When comparing newly enrolled individuals use of medical services with individuals who received coverage through their employer, inpatient, outpatient, and medical professional services increased by 38 percent, 10 percent, and 10 percent, respectively.
Prevalence of disease. BCBS analyzed data collected in the first nine months of 2015, which showed that the newly enrolled BCBS beneficiaries experienced higher rates of hypertension, diabetes, coronary artery disease, and depression. BCBS predicted that if it were able to collect data for the full year, the higher prevalence among the new enrollees would be even more pronounced. Further, the study found that the newly enrolled also had a higher prevalence of HIV and Hepatitis C. Specifically, the new enrollees had rates of HIV at 41 and Hepatitis C at 24 per 10,000. Individuals enrolled pre-ACA implementation had HIV at 12 and Hepatitis C at 10 per 10,000; individuals with employer-sponsored coverage had rates of 11 per 10,000 for both diseases.
Medical costs. BCBS identified an increase of 12 percent, or a jump from $501 to $559, when it came to the average monthly medical costs of individuals who were enrolled in BCBS plans after the ACA took effect. While the report noted that this could be a result of several factors including increases in medical services, underlying medical cost inflation also played a role. In that same time, medical costs for those with employer coverage increased by 8 percent, from $422 to $457.
Going forward. In the conclusion of the study, BCBS called the analysis “the first comprehensive, in-depth look at the medical needs and costs of caring for individuals enrolled in health insurance coverage with the expanded access and broader benefits called for under the ACA.” Further, these findings indicated, according to BCBS, that health insurers, medical professionals, and consumers need to work in conjunction to determine how to best utilize health care services. BCBS also noted that it would be emphasizing the importance of primary care and medical adherence to consumers. The company also announced it would be “expanding patient-focused care programs that emphasize prevention, wellness, and coordinated care so that individuals can get healthy faster and stay healthy longer.”
Companies: Blue Cross Blue Shield
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