Articles

The Patient-Centered Medical Home: The Healthcare Delivery Model for the Future?

One result of the Patient Protection and Affordable Care Act (PPACA) of 2010 has been a renewed conversation about the broken U.S. healthcare system. A wide range of proactive, strategic ideas and action steps have been suggested: alteration of the reimbursement mechanism, systemic efficiency improvements, emphasis on health and wellness promotion, programs that focus on improved outcomes, and methods to enhance adherence within the healthcare system. One potential method that received substantial attention in the PPACA is the organizational concept of the Patient-Centered Medical Home (PCMH), a transformational idea designed to improve quality of care while increasing systemic efficiency and reducing healthcare costs.

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Earthquake Deductibles and Deductible Buy Downs: Do You Know Your Liability in the Event of a Loss?

Earthquake coverage for property assets in high hazard areas is often subject to a percentage deductible rather than a specific flat dollar amount. The deductible will typically range from 2% to 5% based on several factors, including age of the building, type of construction (i.e., frame, masonry or steel), and soil conditions.

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Entity-Employed Physicians and Medical Malpractice Coverage Issues

Physician employment by hospitals and medical facilities continues. The change from independent to employed physician status has been rapid and all indications suggest that the trend will continue. As noted in a recent Wall Street Journal article, 70% of doctors had independent practices in 2006; now, less than 50% do. The majority of today’s doctors work in offices owned and operated by hospitals and, if this continues as expected, private practices will be a rarity within the next few years.

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Data Liability: Challenges Facing Employers

In a recent article titled Hack Attack published in Time Magazine, the author, Bill Saporito, provides a glimpse into the world of hackers and outlines the motivations of LulzSec, the group responsible for the much publicized Sony breach. In the article he points out that "Hackers have discovered that small and medium-size businesses are far more vulnerable than major corporations."

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Have You Outgrown Your Homeowner’s Insurance?

Several years ago I met with a potential client who had an extraordinarily beautiful Seattle home. As I reviewed the couple’s current insurance policy, I was shocked to discover that the home was insured for $3 million, only half of the $6 million replacement cost. When I questioned this, the couple told me their carrier could only provide a maximum $3 million limit on a homeowner’s policy. Their insurance agent had assured them that there was no reason to worry; he had sold them a $3 million umbrella liability policy to make up the difference.

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The Health Reform Individual Mandate is Ruled Unconstitutional – or was it?

In the last 45 days, two separate federal appeals courts have come to opposite decisions regarding the constitutionality of the individual mandate contained in the Affordable Care Act (ACA). Beginning in 2014, the individual mandate requires most Americans to purchase minimum health insurance coverage or face financial penalties.

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Preventive Services for Women

On August 1, 2011, the Department of Health and Human Services (HHS) adopted guidelines that will require non-grandfathered health plans to provide women’s preventive services with no cost sharing for participants. The new guidelines will apply to group health plans for plan years beginning on or after August 1st, 2012.

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Healthcare Reform: FAQs

HHS Releases Health Insurance Exchange Regulations

On Monday July 11, 2011, the U.S. Department of Health and Human Services (HHS) published two Notices of Proposed Rulemaking (NPRM). The first proposed rule outlines a framework to assist states in setting up state-based health insurance exchanges created by the Affordable Care Act (ACA). The second NPRM addresses underwriting standards related to reinsurance, risk corridors, and risk adjustment rules.

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Claims Appeals and External Review Requirements Amended

On Friday June 24th, The Internal Revenue Service (IRS), Department of Labor (DOL) and Department of Health and Human Services (HHS) (the Departments) jointly published an amendment to interim final rules related to the Internal Claims and Appeals and External Review Processes requirements contained in the Patient Protection and Affordable Care Act (PPACA). The Departments also released additional guidance in Technical Release 2011-02.

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Privacy by Design: A Key Concern for VCs and Start-Ups

The privacy landscape appears to be shifting toward a model that promotes greater consumer awareness of and control over data. Reflecting its consumer protection mission, the FTC’s Protecting Consumer Privacy in an Era of Rapid Change issued December 1, 2010 urges companies to adopt a “privacy by design” approach.

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2011 Budget Compromise Eliminates Free Choice Vouchers

On Friday April 15th President Obama signed the 2011 budget compromise worked out by Congress. Officially called the Department of Defense and Full-Year Continuing Appropriations Act of 2011 (H.R. 1473), but commonly called the continuing resolution (CR), the compromise makes a number of changes to provisions contained in the Patient Protection and Affordable Care Act (ACA).

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