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Life Health > Health Insurance > Health Insurance

PPACA utilization reports trickle out

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Some of the uninsured getting insurance through the Patient Protection and Affordable Care Act might be unhealthy, but their claims are only just now to creeping onto the spreadsheets.

Watertown, Mass.-based athenahealth Inc. says it sees no evidence that the flood of newly insured are causing any noticeable effect on its clients’ billing.

The company has worked with the Robert Wood Johnson Foundation to set up ACAView, a window into physician practice performance.

The company looked at five categories of visits – for adult primary care physicians, pediatricians, gynecologists, surgeons and other providers – and found the proportion of visits related to new patients was slightly lower this year than last in every category but pediatrics.

Both new and established patients were slightly less likely to come in with a major indicator of poor health – diabetes.

About 6.4 percent of the new patients who appeared in the first quarter had diabetes, down from 6.6 percent of the new patients in the first quarter of last year.

The state of medical billing could change once these people understand their new coverage better.

Express Scripts, a major pharmacy benefits manager, compared private exchange plan PBM clients with other PBM clients earlier this month. The company found exchange plan enrollees were four times more likely to be taking HIV drugs than traditional commercial plan enrollees.

But the carriers and hospital companies that have released first-quarter earnings so far this month have not reported any actual, obvious, PPACA-related increases in use of care.

CVS Caremark, another pharmacy benefits manager, argues in a recent commentary on prescription cost trends that increased, well-managed use of pharmacy benefits could be helpful.

Even for patients getting the most expensive (specialty) drugs, spending typically accounts for just 40 percent of medical costs, the company says.

“Appropriate use of prescribed therapies helps control costs for these and other high-cost patients,” the company says. 

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