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Affordable Care Act Actuarial Premise

aca resized 600Open enrollment for the Affordable Care Act (Obama Care) will close at the end of March 2014. The original goal of 6 million enrollees will be tough to achieve. According to the Department of Health and Human Services there were four million enrollees through Feb. 25, 2014.
The actuarial science that accompanied the introduction of the new healthcare act is a complicated set of metrics that ultimately determined how much to charge to capture the costs associated with reimbursing medical expenses (less deductibles and co-pays). There are several revenue sources attached to the legislation that fall outside direct premium payment, but two expense factors associated with coverage will soon provide a clearer picture of the true cost of the program.
The first and most dramatic expense is the inclusion of applicants with serious pre-existing conditions. It is not uncommon for mounting medical bills to force a family into bankruptcy. The private markets have typically excluded applicants that had specific pre-existing medical conditions to limit the insurer's financial exposure. Part of the offsetting premiums to cover such catastrophic illness through the Affordable Care Act would be premiums from a large population of younger, healthier adults that would rarely need significant medical services.
According to initial objectives, the plan needed around 38 percent of the new enrollees to be under the age of 35. Both state exchanges and federal enrollment have hovered between 30 and 31 percent. This less than expected enrollment of younger adults breaks with preliminary actuaries and will lead to increased costs.
A secondary cost associated with expected enrollment involves subsidies for applicants below certain income thresholds. Currently, 83 percent of the applicants have qualified for federal subsidies. It is difficult to ascertain the government's expected levels of assistance, but early figures indicate this may be a larger expense than originally anticipated. Some of these costs are to be offset by higher taxes on higher wage earners and savings from Medicare.
The bottom line is that the cost of the plan will likely not conform to the original modeling provided, and additional revenue (taxes) will be needed in the future. Despite the continued debate, this plan may be modified in the future, but repealing it would be as likely as repealing Medicare.

The Future of ObamaCare

describe the imageIt all started with  the tension of the waiting game when the ultimate fate of the Affordable Care Act would be determined by the Supreme Court Justices. This hurdle was overcome by proclaiming part of the legislation as a "tax" instead of a mandate, and the voluntary participation by the states in the expansion of Medicaid. The next hurdle was the proclamation by some in Congress that this legislation would be repealed. When that didn't occur, word was the Act would never get the funding necessary to be executed nationally.
These bumps in the road are now in our rearview mirror, and thousands, or millions, depending on your source, are now enrolled in some form of the coverage presented via the Affordable Care Act.
Despite the current status of the plan, there are still significant rumblings about how to change course and derail the legislation. Early signs in the enrollment do not foretell a good trend for the economics of the plan. The hoped for young adults have not enrolled in the numbers expected, and the older, sicker demographics by far are the largest group of enrollees.
Will this trend create an economic burden on the U.S. Absolutely. Will this economic burden cause sufficient backlash to repeal the Affordable Care Act? Absolutely not! This horse has left the barn. The second after the first enrollee became insured through the ACA, the nature and future of the nation's health insurance industry was changed forever. Industry leaders that still resist, and hold out for a reversal of the current status do so at their own peril.
The current legislation will be amended and parts of the plan will be "tweaked" over time, but the overriding theme of the Act will not go away. Any economic realities that will surely come to the forefront as the plan grows will not be sufficient ammunition for legislators to "take back" the coverage that has now been provided to a distinct population of Americans.
In summary, from a strategic standpoint, best to move forward with the assumption that ObamaCare is here to stay, rather than "hope for change."

Affordable Care Act: From the Street

describe the imageDespite the derisive debates surrounding ObamaCare, there are some good changes that have been mandated for those seeking health insurance on their own. In 2014, all new plans offered are required to cover a set of "essential health benefits," some at no cost to the enrollee.
These "essential health benefits" include the following:
·      Outpatient care
·      Emergency care
·      Hospitalization
·      Maternity and newborn care
·      Mental-health services and addiction treatment
·      Prescription drugs
·      Rehabilitative services and devices
·      Laboratory
·      Preventive healthcare
·      Pediatric services
One of the major changes noted is the mandatory coverage for pregnancy, labor, and delivery. An individual plan purchased prior to 2014 would typically exclude such coverage. Mental health and/or substance abuse coverage will be an added benefit for anyone enrolling in any of the approved plans in 2014.
Preventive care benefits include flu shots, colonoscopy screenings and polyp removal, mammograms, autism screening and vision testing for children, a host of contraceptive methods, breast pumps and lactation support for nursing mothers and over-the-counter products that are prescribed by a health-care provider.
One cannot be sure how "affordable" these additional benefits will be, but it does establish a framework for expected minimum standards.

Daily Pay a "Taxing" Issue

describe the imageCompanies often claim that their employees are their greatest assets. In the world of temporary staffing, aside from existing contracts and operations, nothing could be closer to the truth. Human capital is the currency of staffing firms, and needs are constantly changing to provide the best possible experience for the temp worker.

One of the debates in the staffing world is the flexibility of pay periods provided to the workforce. One aspect of this debate is the cost-to-benefit analysis of providing daily pay for temporary workers. The question that is most frequently heard, is, "will the fact that I am not offering daily pay adversely affect my recruiting efforts, and if so, will it do so to an extent that surpasses the additional costs associated with implementation?" An early assumption of this question was the notion that as socio-economic demographics move downward (i.e. pay scale), payroll cycles must increase from bi-weekly, to weekly, and then to daily. Companies that have elected not to offer daily pay options due to their higher-paid temp workers are potentially making a recruiting error. In an era when debit cards, EFTs, ACHs and direct deposits have become the norm, daily pay can become an expected benefit for the temp worker.

If in fact daily pay is determined to be a market differentiator, the obstacle has historically been the back-office consequences of attempting to process pay in 24-hour increments. The largest obstacle in daily pay typically begins and ends with the onerous calculation and accounting for taxes in anything less than a one-week pay period. Most of the larger payroll processing companies are not designed to facilitate daily payrolls. From a sheer processing standpoint, this makes perfect sense. Imagine the scope of multiplying the pay and tax calculations for every client up to five times each week with the corresponding tracking and calculations for overtime for cumulative tax deposits!

Fortunately today, through technology, there are low-cost methods available to manage daily payroll without causing havoc with the existing payroll provider. Low-cost subscriptions are available that will calculate taxes on a day-to-day basis and then push that accumulated data directly into the weekly or bi-weekly payroll format. These subscriptions not only integrate with existing payroll systems, but are granular enough to provide exact tax rates to the geo-coded employee residence or workplace.

Another benefit to such functionality is the ability to directly populate "cash cards" or other deposit mechanisms for the best possible candidate experience. If your firm has been hesitant to offer daily pay due to operational concerns, check out the newer low-cost benefits of daily pay technology.

Introducing ... BlueSky Lite!


describe the imageAre you tired of using paper for credentialing? Would you like a seamless transition to an electronic system? Is your agency perilously close to outgrowing the use of spreadsheets in credentialing?

If you answered YES to any of these questions, then BlueSky Medical Staffing Software has been reading your mind, because we are here to announce a solution!

Introducing … BlueSky LiteWe will present this new product to the industry for the first time during the 2013 Healthcare Staffing Summit in Chicago.

Our top-notch credentialing system will assist with the following:

  • Storage for Multiple Electronic Files

  • Creation and Generatation of Caregiver Profiles

  • Automation of Notification Emails for Expiring Documents and Credentials

  • Credentialing Reports

BlueSky Lite offers additional support with these features:

  • Orientation Tracking

  • DNR Tracking with DNR Report for Joint Commission

  • HR Notes

  • Reminders

Want to learn more about the other exciting features BlueSky Lite has to offer? Contact our team today at to schedule a no-obligation demo, or call 615-349-1985. Your life as you know it, is about to change!

Don't forget to visit us at the 2013 Healthcare Staffing Summit!

You can find us in Booth No. 101!!

New BlueSky Updates!


describe the imageAt BlueSky, we have more enhancements to announce that will save our clients time and increase their productivity. They will also help to further establish BlueSky MSS as THE source for cutting-edge technology in the medical staffing software sphere.

One exciting update we want to feature is a change we made to the Pay overtime calculation.

This stemmed from an issue agencies faced when they had a contract with a facility -- particularly those in California concerned with daily overtime -- but oftentimes were faced with the problem of pay and bill weeks that did not coincide. Our developers recognized this discrepency and wanted to make things easier for our clients.

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So we found a solution to match those pay and bill periods allowing for overtime.

What this means:

  • Agencies no longer have to manually override overtime payroll and invoicing.
  • There will be no discrepencies in overtime calculations if a facility has a different bill week than pay week.
  • OT calculations for the contract will match the facility contract.

Previously, either the agency or the caregiver might have received the short end of the stick. With this new tool, reconciliations are much easier for payroll and invoicing teams. Now, the pay and bill will add up. Keep in mind, however, that is update pertains to contract work only and does not apply to per diem shifts.

Other new upgrades include:

  • Gross Margin has been added to the candidate search.
  • A vendor contact is now available in Vendor Notes and in the Note grid.
  • Facility- and Unit-required documents have been added to Placement.
  • Radius Search for caregiver and facility
  • Revamped Email Template Editor!
  • And much, much more!

Thank you again for your feedback. Our upgrades are the direct result from the feedback of our clients! As always, if you have any questions please forward them to We are here to help!

Ready to experience positive change with BlueSky Medical Staffing Software? Our goal is to save you time and money by housing all of your credentialing, scheduling and caregiver documentation in one easy-to-access location. You can count on our experts to provide answers to all of your burning questions. Call us at 615-349-1985 to schedule a demo, or email us at

BlueSky's SMS Solution


Ever had a job to fill but wondered what the best way was to get the message out quickly to your candidates?

describe the imageShort Message Service (SMS) text messaging is one of the fastest and most effective ways to reach your caregivers, and it yields a very high "read rate," meaning you are literally "getting the message out" to the candidates you want to place.

SMS allows your agency to reach its selected caregivers with new shifts instantly, and you can connect with them at any time of day.

Once you receive a response confirming a shift it comes directly to your email address, enabling you to make on-the-spot decisions about which caregiver to place for an open job. All of this is typically executed in a brief amount of time without either party ever having to pick up the phone and make a call.

The way it works in BlueSky:
In BlueSky, you can designate a company user to manage your SMS messages (both outgoing and incoming). Be sure the caregivers you are texting have a cell phone in your system records. Keep in mind that our system will not send a message to a home telephone number. From here, just type in your message with all relevant details, and fire it off to the group of caregivers you want to include. It's that easy!

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Each caregiver will receive all of the information you enter, along with a special code and simple instructions on how to respond to the opening.

You can even go back into each caregiver's record, and a note will appear reminding you that the message was sent along with the date, time and any other relevant information.

Ready to experience positive change with BlueSky Medical Staffing Software? Our goal is to save you time and money by housing all of your credentialing, scheduling and caregiver documentation in one easy-to-access location. You can count on our experts to provide answers to all of your burning questions. Call us at 615-349-1985 to schedule a demo, or email us at

BlueSky's Global Cash Card Integration


GCCThese are exciting times here at BlueSky. At this year's Healthcare Staffing Summit in Chicago we will unveil a long-awaited feature: an integration with Global Cash Card! Be sure to stop by and visit us in Booth No. 101 for a live demo! We are thrilled to share this seamless enhancement with our loyal customers.

What is Global Cash Card?
Global Cash Card is a paycard program designed to make payroll and invoicing much more convenient for your company and employees. It essentially takes the place of a paper check.

Global Cash Card is ideal for daily pay, because it loads funds electronically onto the card, effectively bypassing paperwork and paper checks as well as their costs. It also works great for travel assignments, because the caregiver will no longer have to visit his or her branch office to pick up a check.

Find out more here:

How will it work?
The employee will have his or her compensation loaded onto a paycard, which looks like a standard credit, debit or gift card. Equipped with top-notch security, the card funds are FDIC insured and 100 percent paperless. The card will get funded after you run payroll, and the caregiver's net pay will load.

When will it be ready?
BlueSky will unveil this feature at the 2013 Healthcare Staffing Summit in Chicago. If you haven't signed up yet be sure to do so here. You don't want to miss this!

Ready to experience positive change with BlueSky Medical Staffing Software? Our goal is to save you time and money by housing all of your credentialing, scheduling and caregiver documentation in one easy-to-access location. You can count on our experts to provide answers to all of your burning questions. Call us at 615-349-1985 to schedule a demo, or email us at

BlueSky Healthcare Staffing Enhancements


BlueSky Medical Staffing SoftwareAt BlueSky, we are always searching for ways to enrich the user experience for our clients. We recognize that healthcare staffing is an ever-evolving industry, so our work is centered on helping staffing agencies save time and money.

With that in mind, we have two exciting new system enhancements to share.

Caregiver/Facility Radius Search

Are you an account manager or recruiter looking to match a facility contract with a caregiver in a certain range? Perhaps you are targeting a certain location for sales or prospecting jobs from facilities.

BlueSky's radius search will help you identify those caregivers and/or facilities within your defined areas. All you will need to do is enter a valid U.S. zip code and search away to find the information you seek within a given radius. This tool is great for both per diem and travel needs.

Caregiver Short Application Feature

Have you ever had caregivers on the phone while you were short on time but wanted to get them entered into your system quickly? Perhaps they had only a minute or two to spare before racing out the door. We understand your time is precious and often fleeting. Enter the BlueSky short application, where basic, yet important, information can get entered into your company's system in a snap.

The short application feature captures only the most relevant data: name, contact information, degree, specialty, recruiter and the ability to upload a resume. From there, one of your team members or the caregiver can go back in at a later date and update the full profile. Most importantly, the information is captured right away and will not get lost in a stack of papers.

Take a look at it below, and let us know what you think. Will this help your agency?

BlueSky Medical Staffing Software

BlueSky is committed to its customers and loves getting feedback!

Ready to experience positive change with BlueSky Medical Staffing Software? Our goal is to save you time and money by housing all of your credentialing, scheduling and caregiver documentation in one easy-to-access location. You can count on our experts to provide answers to all of your burning questions. Call us at 615-349-1985 to schedule a demonstration, or email us at

Solutions Sought for Looming Physician Deficit


describe the imageEarlier this year, the president of BlueSky, Tim Teague, asked the following question in this article: "Will your new doctor be a nurse?"

Well, the debate over the future role of nurse practitioners has continued in the medical community given the projections of a looming physician shortfall.

This New York Times article breaks down the growing resentment between primary care physicians and nurse practitioners as questions linger about the future of health care in America:

"Analyzing questionnaires completed by almost 1,000 physicians and nurse practitioners, researchers did find that almost all of the doctors and nurses believed that nurse practitioners should be able to practice to the full extent of their training and that their inclusion in primary care would improve the timeliness of and access to care.

But the agreement ended there. Nurse practitioners believed that they could lead primary care practices and admit patients to a hospital and that they deserved to earn the same amount as doctors for the same work. The physicians disagreed. Many of the doctors said that they provided higher-quality care than their nursing counterparts and that increasing the number of nurse practitioners in primary care would not necessarily improve safety, effectiveness, equity or quality.

A third of the doctors went so far as to state that nurse practitioners would have a detrimental effect on the safety and effectiveness of care."

Meanwhile, one state, Kentucky, is tackling the issue with a new phenomenon known as "telemedicine" according to a piece from the Associated Press that appeared in the Insurance Journal. Its emergence is expected to help with a lack of accessibility to care centers:

"Telemedicine is seen as a way to help deal with doctor shortages, especially in rural areas and especially with another 600,000 people in the state who are expected to join insurance rolls in health exchanges and or through expanded Medicaid coverage, according to a report by The (Louisville) Courier-Journal."

Elizabeth Hayes of the Business Journal reported on the state of Oregon's laws regarding the roles of NPs:

"Oregon is one of the most liberal states when it comes to nurse practitioner responsibilities and pay. Unlike many states, nurse practitioners in Oregon can write prescriptions and own their own business. They can also make diagnoses, order lab work and refer patients to specialists."

The issue of physician shortages has presented the healthcare industry with a unique problem, one that might take several different courses as leaders search for a solution.

Ready to experience positive change with BlueSky Medical Staffing Software? Our goal is to save you time and money by housing all of your credentialing, scheduling and caregiver documentation in one easy-to-access location. You can count on our experts to provide answers to all of your burning questions. Call us at 615-349-1985 to schedule a demonstration, or email us at

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