America's Healthcare Challenge

Since the COVID-19 pandemic, the healthcare industry has experienced significant transformations that have reshaped how care is delivered, accessed, and managed. These changes, driven by the need to adapt to the crisis, have led to lasting trends that continue to influence healthcare today. This segments looks at some of the top healthcare trends that have emerged since the pandemic and issues that need further attention. It concludes with some tips on how to jumpstart your upcoming new years resolutions by creating small habits now.

Each year insurance companies who participate in the ACA marketplace are required to post their proposed rate increases or their block of business in each state they operate in. These rates have been shown to vary widely depending on the year, however, they have stabilized for the most part recently. This segment breaks down the rate increases, informs you of how the companies determine these numbers and what you should do if you are in a situation where you are facing an undesirable rate increase.

Two heavyweights will be duking it out in the court system over problems with access to claim information as Kraft Heinz is suing Aetna over lack of access to critical data. Most large companies often self-insure their health plan. This means that they are responsible for paying claims up to a certain amount before separate insurance often kicks in called stop-loss. Since most businesses are not in the business of insurance they often partner with what is called a Third Party Administrator (TPA) to process and pay claims. Large insurance companies often also offer TPA services since they have the infrastructure in place. In order for this relationship to be successful it has to have transparency on both sides. Employers who are concerned about their healthcare costs will want to look at their claims history to see if there are any areas where they can control costs. The problem is when they are unable to get this information there is nothing they can do. This seems to be the heart of the issue between these two companies as Kraft Heinz is alleging that Aetna is withholding this important data. You can read more here... https://www.jdsupra.com/legalnews/kraft-heinz-sues-aetna-raising-novel-8183158/ https://www.benefitspro.com/2023/07/05/kraft-heinz-accuses-aetna-of-fiduciary-breaches-412-150903/

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We have reported previously on the ensuing crisis we face with regard to looming healthcare worker shortages. The biggest driver for this is demographics in that the baby boomer generation was much larger than other generations and as they continue to retire there may not be enough new workers to replace them. The system has failed to train more and now more angst from healthcare workers after the pandemic could exacerbate this problem even worse. We discuss these factors in this segment. Here is a link to the previous segment with more on this topic: https://soundcloud.com/americascanary/healthcare-clinicians-are-burned-out Here is the link to the article referred to in this segment: https://www.healthcaredive.com/news/healthcare-labor-trends-2023/641352/ FOLLOW ME ON ALL SOCIAL MEDIA PLATFORMS FACEBOOK: www.facebook.com/AmericasCanary LINKEDIN: www.linkedin.com/company/edbellis/ INSTAGRAM: www.instagram.com/americascanary/