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Health Insurance

‘Narrow’ networks are the exchange norm here

Georgia had the highest percentage of “narrow’’ insurance networks in the 2014 health exchanges, a new report says.

Healthcare CostFive of six Georgia “Silver” exchange plans last year had medical provider networks with a limited choice of doctors, the report said.

The 83 percent of Georgia plans having narrow networks surpassed that of all other states, according to University of Pennsylvania researchers.

The report, released Monday, said health insurers are using narrow networks to keep premiums down as consumers shop for coverage on the exchanges, created under the Affordable Care Act. full story

Pediatricians, facing new realities, form network

More than 1,100 Georgia pediatricians have joined a new physician-led network that aims to improve quality of care and eventually contract for payments from insurers.

The sign-ups so far represent roughly one-third of the total number of pediatricians practicing in the state.

Dr. Bob Wiskind

Dr. Robert Wiskind

Children’s Healthcare of Atlanta helped create the nonprofit entity, called the Children’s Care Network.

Dr. Robert Wiskind, an Atlanta pediatrician who is the network’s board chairman, told GHN recently that members will share  national “best practices’’ of medical care, such as identifying which children with concussions need to get a CT scan.

The doctors, who practice in the Atlanta region, will also share data on how the care they each give to kids compares with the care given by their peers.

The creation of the Children’s Care Network comes at a time of dramatic change in the way medical providers are paid for their services. full story

‘Special’ exchange enrollment surpasses 55,000

More than 55,000 Georgians signed up for health insurance exchange coverage during a “special” four-month period through the end of June.

This period came after regular open enrollment ended in February.

healthcaregovThe signups during the special period included people who lost job-based coverage, got married or had a baby since late February.

Overall, more than 940,000 Americans took advantage of these changes in circumstances to obtain coverage in 37 states that use the federal exchange, part of the Affordable Care Act.

Georgia’s enrollment of 55,581 was the third highest total in these states, after those of Florida and Texas.   full story

SHBP members get good news on prices

Most schoolteachers and state employees will see lower premiums for health care under their 2016 benefits plan unveiled Thursday.

Clyde Reese

Clyde Reese

Only people with a high-deductible plan from UnitedHealthcare will have an average increase next year, said Department of Community Health officials at an agency board meeting Thursday.

The health plan options will remain the same, as will employee co-pays, Community Health officials said.  This current year’s deductibles generally will be retained as well.

“We are going to focus on continuity and stability,’’ said Commissioner Clyde Reese, the head of the department. “Our members have had a lot of disruption.” full story

Surprising facts behind Ga.’s kidney transplant rate

The Southeast has the lowest rates of kidney transplantation by region, and Georgia is at the bottom among states.

That dismal ranking led a group of researchers to study how often kidney dialysis patients in Georgia are referred to transplant centers.

Rachel Patzer

Rachel Patzer

Their study, published Tuesday in the Journal of the American Medical Association, found that just 28 percent of Georgia patients are referred to transplant facilities within the first year of dialysis treatment.

The low number of referrals came even though a transplant is considered the best treatment for most patients with end-stage renal disease (ESRD), which occurs when the kidneys stop working well enough for a person to live without dialysis or a transplant.

The study also found a big variation in the percentage of referrals among Georgia dialysis facilities – from zero to 75 percent. full story

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