Currently, several PPO shifts are occurring in the marketplace when it comes to total care and the Affordable Care Act. To date, the current open enrollment period that has recently begun is the third since the induction of the Affordable Care Act. Apparently, this enrollment period is now allowing people unlimited options when it comes to choosing their health care; however, even health insurance companies are finding this option to be a bit questionable. As a result, most companies are now offering a very select few choices when it comes to PPO plans.
Based on information being received about the PPO shifts in marketplace for total care, the companies that provide insurance to individuals are quickly discovering that the component of such plans that cover “out-of-network” is becoming extremely problematic. This is mostly because of the fact that the health insurance companies are losing a tremendous amount of money. In fact, all but one third of the companies that provided PPO plans in the year 2014 on the exchange associated with the Affordable Care Act have experienced some sort of reduction within the plan or have quit offering PPO plans completely.
Prior to the announcement of the 2016 changes in total care, approximately half of all of the insurance companies started to restrict the care for out-of-network services. The only exception involved cases where a true medical emergency existed or a pre-approved formal-based petition was present. The main reason why insurance companies are using the network design in order to control the costs is because of the fact that they are offered only a limited ability to increase premiums. Customers, frankly, do not have the financial means to spend a lot. Insurance companies do not have the ability to give a lot. As a result, the companies are attempting to lower usage and drastically limit the outstanding costs associated with out-of-network total care.
As a result of these limitations, it is believed that consumers will request out-of-network care less often than they currently inquire about it. Unfortunately, as a physical therapy provider, you may find that your profits start to decrease in 2016 as a result of this model. When seeing your patients, it is imperative that you continue to focus on providing value-driven care instead of volume-driven care. If you place a special emphasis on value-driven care, you will not experience too much of a profit fluctuation. For more information on total care, insurance, and value-driven healthcare, click HERE today.
