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Innovation

The next hidden benefits of health reform

The end of mammograms co-pays and the establishment of an institute to run comparative effectiveness research kick off this year.
Written by Dana Blankenhorn, Inactive

Whatever you think of the Affordable Care Act (views are subject to change) it's the law.

Its provisions will be phased in over many years. Some that are already kicking in, like keeping kids on parents' policies until age 26 and an end to "lifetime coverage caps," are well-known.

(Conservatives are right to note that many taxes included in the bill will come in before important benefits like health insurance exchanges, by the way.)

The folks at Kaiser Health News are out with seven provisions, coming into effect this year, you may not know about but which may offer major benefits:

No co-pays on preventive tests -- This comes into effect with plans that start after September 23.  It means such things as annual mammograms or blood tests for those on statins (like me) will be completely free. Companies selling diagnostic tests and vaccines are already lobbying to have their stuff called "preventive" so it will fall under this provision.

Comparative Effectiveness -- A non-profit set up by the Government Accountability Office will soon start digging through data to find what works and costs less, which will eventually filter down into "best practices" like those Intermountain Healthcare is putting into GE's Qualibria software. Critics called this "rationing."

Early retirees will now have some of their extraordinary medical costs reimbursed through a $5 billion fund meant as a bridge between the current system and health exchanges due to be set up in 2014. This reduces the burden on companies who cover retirees still ineligible for Medicare.

Justifications of rate increases to state insurance commissioners are due to start coming in, making that process more transparent.

States may now, if they choose, expand their Medicaid programs to cover those 33% above the poverty line. Federal aid will be available to do this. Connecticut has already filed for it, and says it will save $53 million moving 45,000 people to the new program.

Care coordination will soon come to about 8.8 million elderly poor who are eligible under both Medicaid and Medicare. This will save states money and deliver one set of rules for so-called "dual eligibles."

The FDA will now have the power to approve "biosimilars" -- drugs similar to patented treatments for things like cancer and multiple schlerosis -- after just 12 years of exclusivity. This should dramatically cut the cost of follow-on treatments for these patients.

In some cases, Kaiser notes, there are still regulations to be written and hoops to be jumped through. In some cases, states may choose to ignore the benefits. States like Virginia, for instance, which will learn if their suit to overturn the whole law has a chance this month, may choose to ignore the new opportunities until the case is decided.

Bonus benefit -- A new government Web site called Hospital Compare lets you see how aggressively different facilities in your area order radiation-heavy tests like CT scans and MRIs. This could not only save money, but reduce the radiation load (and risks) patients endure while being diagnosed. Current data is from 2008.

But the opportunities are going to be there and, if they are publicized, they could increase public support for the law.

This post was originally published on Smartplanet.com

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