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As a result of health overhaul, hospitals across the country are bracing for significantly lower reimbursement rates from the federal government for Medicare patients, a development that is forcing large health systems to reevaluate their care models and prompting a palpable shift toward more integrated care.

Employers, meanwhile, face a host of complex issues themselves. With state and federal health exchanges -- where both employer groups and individuals will be able to shop for what is hoped to be more affordable health coverage with government subsidies -- coming online in the next two years, will those same employers drop health coverage for employees? And if so, will those employees be able to obtain affordable, quality coverage?

“This is a primary question that most benefits broker lose sleep over,” said David Hodges, vice president at Vantreo Insurance Brokerage. “The over-burdensome administration of the ACA will lead some small employers with low profit margins and mid-sized employers with easily replaceable, non-highly skilled workers to cancel health insurance.”

Similarly, health plans are shifting quickly, often aligning themselves directly with providers to form accountable care organizations, better known as ACOs, or ACO-type structures to prevent costly duplication and more streamlined care.  The impact of such structures is not yet known, providers and health plans said, but it’s nevertheless a reality that is emerging on both a local and national level.

And new forms of technology -- such as the continued march toward electronic health records -- are impacting health care delivery across the country, but concerns center on patient privacy and a host of other issues.

Read more analysis of the health care law from Mr. Hodges and other major figures in North Bay health care and insurance in the Nov. 12 issue of the Business Journal.North Bay providers, insurers discuss impact of Affordable Care ActJohn Fradelizio, Wells Fargo Insurance ServicesRick Heron, Western Health AdvantageDavid Hodges, Vantreo Insurance BrokerageDennis Lum, Kaiser PermanenteVictor McKnight, EPIC Insurance BrokersMichael Parr, NorthWest Insurance AgencyMike Purvis, Sutter Medical Center of Santa RosaTodd Salnas, St. Joseph Health, Sonoma CountyJim Settles, Woodruff Saywer & Co.