The health care reform bills, HR 3590 and HR 4872 (the
Reconciliation Bill) were signed into law on March 23,
2010 by President Obama. Because of these laws, changes
have occurred to your Evidence of Coverage, which is the
formal document containing the details of our
contractual obligation to you as your HMO. These changes
are summarized in a two page “Amendment to Evidence of
Coverage” that is available upon request from member
services or may be
downloaded from our website under the members tab on the webpage available by clicking “evidence of coverage.”
In a general manner the bill encourages the following changes within the healthcare delivery system of this country. The bill sets a path of change in healthcare on three fronts. They are:
- Human services are to merge with health services.
- Integrated delivery systems are encouraged.
- Outcomes based payments will eventually replace volume based payments for all health services by healthcare providers.
These conceptual goals are encouraged in multiple references within the thousands of pages of the two bills. The first goal to merge a community’s human services with its health services may take many forms. This effort may take place within demonstration projects in communities. Exactly how these changes will be encouraged and occur could be highly variable locale to locale.
In Athens, Georgia the integration of a healthcare delivery system is well underway within the various companies of Athens Regional Health Services. ARHS is the parent organization and the owner of Health Plan Select. Physicians within the HPS add the physician directed activities essential to the integrated healthcare delivery system. It must also be noted that other hospitals within the HPS network are also working on the integration aspect of care.
Athens Regional Medical Center, as well as other hospitals within the HPS network, is working very hard to improve their systems to enhance clinical quality and safety. These efforts, to improved quality and safety, lead to improvements in your outcomes whenever your care is delivered within an integrated delivery system such as ARHS.
This sort of integrated delivery system functions at a high level and is ideally positioned to improve its level of care. Doing the hard work of increasing the clinical quality of care, the accompanying safety of that care, and how to finance all that activity is not an easy task.
Payment changes can be carried out with HPS. We are in the business of structuring benefit plans for our members and in the business of contracting for health services from our providers. Here at HPS we can create the incentives that reward the behaviors from both members and providers that will lead to better health outcomes. Thank you for your continued support of HPS and our services. Now go outside and enjoy your summer.
