Health Insurance Industry Issues and Legislation

Integration of virtual care can significantly decrease healthcare system costs in 3 different ways according to a new study. First, savings come from the lower cost of virtual care versus in-person patient primary care and specialist visits. Second, patients who see virtual providers had 19% fewer emergency room or urgent care visits. Third, virtual urgent care visits can reduce duplication of care compared to other virtual primary care providers or specialists.

The NSA expands on the provisions in the Affordable Care Act by making external reviews available for any adverse determination that involves consideration of whether a plan or insurer complied with NSA provisions. For example; a patient can ask for a review if the plan determined a pre-stabilization emergency treatment in an out-of-network (oon) emergency room did not qualify as "emergency services". Also, a patient in a non-emergent inpatient setting can challenge whether they received an appropriate notice and gave informed consent to waive their protections under the NSA regarding services performed by an oon provider.

Projections are that increases in healthcare costs will exceed the rate of inflation again in 2022. Ever-increasing pharmacy costs, high-cost structures of maintaining large hospital systems, and private equity-owned healthcare service providers pushing to maximize stakeholder profits will again generate increases in healthcare costs above the anticipated rate of general inflation. Premiums for fully insured groups will continue to rise and they will recoup only 50% of unspent premiums as they did in 2021, making self-funding an attractive alternative for many plans.

The International Organization for Standardization has approved its application for ISO 9001:2015 certification. ISO 9001 is the international standard that specifies requirements for a quality management system (QMS).To achieve ISO 9001 certification a company must demonstrate its ability to consistently provide products and services that meet customer and applicable statutory and regulatory requirements. Additionally, it must prove its commitment to enhance customer satisfaction through the effective application of the system, including processes for improvement of the system and the assurance of conformity to customer and applicable statutory and regulatory requirements.