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Health care reform: we’re ready!

Since the Affordable Care Act (ACA) was passed in 2010, major changes have been occurring in the country’s health care systems. Even more changes are coming Jan. 1, when key provisions of the ACA take effect. Jan. 1 is when nearly everyone will be required to have health insurance and can no longer be denied coverage because of a pre-existing condition. Coverage limits on most covered benefits become a thing of the past then too.

Through all of these changes, Centegra has remained committed to providing excellent patient care. That’s always going to be the case. In fact, our goal has been to be proactive rather than reactive when faced with change. “Centegra has been ahead of the curve for some time with respect to the overall health care delivery system and what’s needed to survive and thrive in the new world,” says Jeff Schmidt, senior vice president of clinical integration and payer strategies.

Our preparations for the changes brought about by the ACA are apparent in the Centegra Health and Wellness Network. This is an association of Centegra Health System and hundreds of physicians who joined forces to help area residents better manage their health. The network fills a vital role for the people of McHenry County by focusing on its members’ well-being. It offers a full range of services, from preventive care to advanced treatments.

Wellness and preventive care are areas of emphasis under the ACA. Also, many preventive services will now be covered by health plans. The idea is that stopping problems before they start helps everyone save money. “Preventive care has proven to control costs much better than anything else,” says Schmidt.

Moving forward, hospitals will be reimbursed, to a great extent, based on patient outcomes and the quality of services the hospital provides rather than simply the quantity of services. This means officials will look to factors such as preventable hospital readmissions, immunization rates and blood sugar levels of people with diabetes to determine how well people are being cared for. The Centegra Health and Wellness Network (CHWN) provides the framework for everyone involved with health care in our area to collaborate and address issues such as these. It helps ensure that area residents get the high-quality health care they deserve. At the same time, it moves us away from a fee-for-service model to a value-based model. “We’ve already laid the foundation for a migration to that type of reimbursement platform,” says Schmidt. You can also rest assured that Centegra will continue to be a health care leader. “We try to stay one step ahead of the trends and anticipate what we need to do to be better,” says Schmidt. “We’ll remain steadfast in our mission.”

To help people who don’t have health insurance get it by Jan. 1, Illinois and other states have established marketplaces. There, you can see what’s available and compare your coverage options. Open enrollment for the marketplace began on Oct. 1, with coverage available as early as Jan. 1, 2014. CHWN is a participating provider with the Blue Cross and Blue Shield HMO plan options available on the marketplace.

To learn more about plans on the Illinois marketplace, visit and click on “How Can I Be Covered?”