Health insurance is an insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over a large number of persons. By estimating the overall risk of health care and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.
Partners HealthCare is a Boston-based non-profit hospital and physicians network that includes Brigham and Women's Hospital (BWH) and Massachusetts General Hospital (MGH), two of the nation's most prestigious teaching institutions. It was founded in 1994 with H. Richard Nesson, MD, former president of Brigham and Women's Hospital as CEO of Partners HealthCare and Samuel O. Thier, MD, formerly president of Massachusetts General Hospital as president. According to The Boston Globe, by 2008, Partners became Massachusetts' "largest private employer and its biggest healthcare provider, treating more than a third of hospital patients in the Boston metropolitan area".
Vertex Pharmaceuticals, Inc. is an American biopharmaceutical company based in Boston, Massachusetts.
Highmark is a non-profit healthcare company and Integrated Delivery Network based in Pittsburgh, Pennsylvania, United States. It is a large individual not-for-profit health insurer in the United States, which operates several for-profit subsidiaries.
Blue Cross Blue Shield Association (BCBSA) is a federation of 36 separate United States health insurance organizations and companies, providing health insurance in the United States to more than 106 million people. Blue Cross was founded in 1929 and became the Blue Cross Association in 1960, while Blue Shield emerged in 1939 and the Blue Shield Association was created in 1948. The two organizations merged in 1982.
The Commonwealth of Massachusetts passed a health care reform law in 2006 with the aim of providing health insurance to nearly all of its residents. The law mandated that nearly every resident of Massachusetts obtain a minimum level of insurance coverage, provided free and subsidized health care insurance for residents earning less than 150% and 300%, respectively, of the federal poverty level (FPL) and mandated employers with more than 10 full-time employees provide healthcare insurance. The law was amended significantly in 2008 and twice in 2010 to make it consistent with the federal Affordable Care Act. Major revisions related to health care industry price controls were passed in August 2012, and the employer mandate was repealed in 2013 in favor of the federal mandate. Because Mitt Romney was the governor of Massachusetts at the time, the law has colloquially been called Romneycare, a reference to the nicknaming of the Patient Protection and Affordable Care Act as "Obamacare".
Samuel Osiah Thier is professor of Medicine and Health Care Policy at Harvard University.
HealthMarkets, Inc. is a holding company, formerly known as UICI, with its headquarters in North Richland Hills, Texas. HealthMarkets, Inc. is owned by affiliates of a group of private equity investors, current and former members of management, and its independent sales agents through the company's stock plan. HealthMarkets owns SureBridge, the consumer brand for products underwritten by The Chesapeake Life Insurance Company, Mid-West National Life Insurance Company of Tennessee, and HealthMarkets Insurance Agency, Inc., formerly known as Insphere Insurance Solutions, Inc., which is licensed as an insurance agency in all 50 states. The company offers individual policies as well as life insurance, supplemental insurance, Medicare, and long-term plans from national and regional carriers.
Health insurance in the United States is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance "is used to describe any form of insurance providing protection against the costs of medical services. This usage includes private insurance and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.
In the United States, health insurance marketplaces, also called health exchanges, are organizations in each state through which people can purchase health insurance. People can purchase health insurance that complies with the Patient Protection and Affordable Care Act at ACA health exchanges, where they can choose from a range of government-regulated and standardized health care plans offered by the insurers participating in the exchange.
Cost-shifting is either an economic situation where one individual, group, or government underpays for a service, resulting another individual, group or government overpaying for a service. It can occur where one group pays a smaller share of costs than before, resulting in another group paying a larger share of costs than before. Some commentators on health policy in the United States believe the former currently happens in Medicare and Medicaid as they underpay for services resulting in private insurers overpaying. In 1995, Health Affairs started a study testing the “cost-shifting” theory using a unique new data set that combines MarketScan private claims data with Medicare hospital cost reports, the study ran from 1995-2009. In May 2013 when the findings were released, the study found that a 10 percent reduction in Medicare payment rates led to an estimated reduction in private payment rates of 3 percent or 8 percent, depending on the statistical model used. These payment rate spillovers may reflect an effort by hospitals to rein in their operating costs in the face of lower Medicare payment rates.
There were a number of different health care reforms proposed during the Obama administration. Key reforms address cost and coverage and include obesity, prevention and treatment of chronic conditions, defensive medicine or tort reform, incentives that reward more care instead of better care, redundant payment systems, tax policy, rationing, a shortage of doctors and nurses, intervention vs. hospice, fraud, and use of imaging technology, among others.
The Patient Protection and Affordable Care Act (PPACA), often shortened to the Affordable Care Act (ACA) or nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965.
Bundled payment, also known as episode-based payment, episode payment, episode-of-care payment, case rate, evidence-based case rate, global bundled payment, global payment, package pricing, or packaged pricing, is defined as the reimbursement of health care providers "on the basis of expected costs for clinically-defined episodes of care." It has been described as "a middle ground" between fee-for-service reimbursement and capitation, given that risk is shared between payer and provider. Bundled payments have been proposed in the health care reform debate in the United States as a strategy for reducing health care costs, especially during the Obama administration (2009–2016). Commercial payers have shown interest in bundled payments in order to reduce costs. In 2012, it was estimated that approximately one-third of the United States healthcare reimbursement used bundled methodology.
The Caitlin Raymond International Registry (CRIR) was a bone marrow registry that was a subsidiary of the UMass Memorial Health Ventures Inc in Worcester, Massachusetts.
Anthem, Inc. is an American health insurance company founded in the 1940s, prior to 2014 known as WellPoint, Inc. It is the largest for-profit managed health care company in the Blue Cross and Blue Shield Association. It was formed when Anthem Insurance Company acquired WellPoint Health Networks, Inc., with the combined company adopting the name WellPoint, Inc.; trading on the NYSE for the combined company began under the WLP symbol on December 1, 2004. On December 3, 2014, WellPoint changed its corporate name to Anthem Inc., and its NYSE ticker changed from WLP to ANTM.
Dr. Gene Lindsey is former President and CEO Emeritus of Atrius Health and Harvard Vanguard Medical Associates and a resident of Wellesley, Massachusetts. As head of an organization with more than 40 years experience as an Accountable Care Organization (ACO), Dr. Lindsey has been a leading voice in Massachusetts on healthcare reform and has led several initiatives at Atrius Health, including signing Blue Cross Blue Shield of Massachusetts' Alternative Quality Contract (AQC) and a Toyota Lean Transformation. Dr. Lindsey has been featured in numerous news articles and speaks around the United States on healthcare reform and ACOs.
Steward Health Care is the largest physician-led, private, tax-paying health care network in the U.S. — annually caring for 2.2 million people during more than 12 million physician and hospital visits. Headquartered in Dallas, Steward’s integrated health care model employs 40,000 people at 36 hospitals and hundreds of urgent care, skilled nursing, and primary and specialty care medical practice locations across 11 states and the country of Malta. Steward Health Care is led by CEO Ralph de la Torre, MD, a Cuban-American physician, engineer and cardiac surgeon.
Tufts Health Plan is a Massachusetts-based health insurance company under Tufts Associated Health Plans, Inc. with headquarters in Watertown.
