Journal of Urgent Care Medicine

‘Relationship-Based Primary Care’ Experiment Closes Up Shop

UnitedHealth Group thought it was a great idea at the time: offer no-cost primary and behavioral care, in the hope that the company would bring in enough money through claims, while also building a loyal customer base. Detractors may say it was a nonstarter, or that the notion had merit but was poorly designed; some may even point the finger at the Affordable Care Act (ACA, or Obamacare). Either way, the company is shutting down …

Aetna Plans 2018 Exit from All ACA Exchanges

Aetna has apparently had enough of trying in vain to make participation in Affordable Care Act (ACA, or “Obamacare) exchanges profitable, and will exit all ACA exchanges for the 2018 coverage year. They follow a long line of insurers who already checked out, complaining that the ACA program simply made it impossible to conduct business, economically. Aetna announced their plans right after revealing that they’d drastically reduce their exchange business for the 2017 coverage year, …

Legislators May Face Healthcare Protests and Angry Voters Over Recess

A lot of Republicans are angry that their elected officials have failed, thus far, to replace the Affordable Care Act (ACA, or “Obamacare”) with something more to their liking. There may be an equal number of Democrats railing about the prospect of Congress doing exactly that. Senators and Congresspersons can expect to get an earful from both over the 2-week spring recess. Healthcare providers are likely to make their wishes known, too. Some legislators have …

Aetna–Humana Merger is Dead in the Water

Aetna Inc. and Humana Inc. have opted not to fight the decision a judge laid down to block their proposed merger based on the presumption that the $34 billion deal would violate antitrust laws. The two companies will continue to operate as separate entities, though the door is still open for either or both to seek other partners. Had the deal gone through, Aetna would have become a kingpin in Medicare Advantage. The implications for …

Direct Care Supports Scaled Down Operations

As you’ve read here, the spectrum of business models accessible to urgent care operators is constantly expanding. “Direct care,” in which patients pay a monthly fee for a range of basic services, is one that may appeal to operators and clinicians desiring a less-structured approach to running their business—such as getting insurance companies “out of the room,” as explained by Linnea Meyer, MD in an article published in The Wall Street Journal recently. Patients pay …

What’s Next for the Affordable Care Act?

The Affordable Care Act (ACA, or “Obamacare”) has given millions of citizens access to healthcare they didn’t have before, driving up volume in some urgent care centers and emergency rooms. It’s also put sometimes unbearable pressure on insurers to find a way to stay profitable in the state-run exchanges; most that originally participated have bowed out because they were losing too much money, in fact. With the election of Donald Trump as our next president, …

High Cost of Care Elsewhere May Be Nudging ACA Patients to Urgent Care

Patients whose health is insured under marketplaces created via the Affordable Care Act (ACA, aka “Obamacare”) have become acutely cost conscious when it comes to their own care—to the extent that they may not be getting the care they need, according to a new survey. While that paints a picture of a dysfunctional system, urgent care may be reaping some rewards as patients seek out quality care that won’t cost them as much as a …

Affordable Care Act Giveth to—and Taketh Away from—Urgent Care Centers

William Rodney, MD couldn’t jump fast enough when he found out the Affordable Care Act (ACA, or “Obamacare”) would be raising Medicaid primary care payments to Medicare levels. His urgent care practice (featured here previously; see One Year In, Latino-focused Clinic Doubles in Size) took in enough additional fees to create an outreach clinic for bilingual uninsured patients and to provide x-rays, ultrasound, and other services for underserved communities in Tennessee. Now he’s worried about …

Advantage, Urgent Care? Plans Are Already Passing ACA Losses Off on Members

Urgent care operators may have new leverage when negotiating reimbursements or appealing to cash-paying patients in North Carolina. Blue Cross and Blue Shield of North Carolina (BCBSNC) says it has lost $280 million by covering residents under the Affordable Care Act (ACA, or “Obamacare”)—and in response, it’s filing for a 2017 rate increase of 18.8%. BCBSNC says higher-than-expected ED visits and orthopedic treatments (the cost of which could be greatly diminished if appropriate patients visited …

With Less Competition, ACA Insurers Plan Major Price Increases

With many health insurers already scaling back—or vacating—state exchanges under the Affordable Care Act (ACA, or “Obamacare”), companies that plan on continuing to offer coverage may start charging members more for the “privilege” of being insured soon. Insurance industry projections show that many states could see jumps of 20% or so, while plan members in Pennsylvania and Georgia could see premiums go up by more than a third next year. Initially, 23 health insurance co-ops …

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