1 executive roadmap: examining the impact of healthcare reform, stimulus funding and hit regulations...

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Executive Roadmap: Examining the Impact of HealthcareReform, Stimulus Funding and HIT Regulations

Miriam Paramore, SVP Clinical and Government ServicesAAHAM Conference, Laughlin, NV

April 15, 2010

Stakes Are Very High

Medicare Trust Fund Reserves to be exhausted by 2017 (2009 Annual Report, Social Security and Medicare Board of Trustees)

41 states face budget shortfalls adding up to $35 Billion (Kaiser Commission on Medicaid and the Uninsured, February 2010)

March 21, 2010

YEA219

NAY212

House Passes Healthcare Reform in Historic Sunday Night Vote

H.R. 3590, Patient Protection and Affordable Health Care Act (previously passed by Senate)

+H.R. 4872, Health Care & Education Affordability Reconciliation Act of 2010

Fiscal Impact•Costs $938 billion over a decade•Cuts the deficit by $143 billion in the first ten years (2010- 2019)•Cuts the deficit by $1.2 trillion in the second ten years•Expands health insurance coverage to 32 million Americans (or 94%)

Basic Provisions H.R. 3590 + H.R. 4872:Insurance Reforms

• Prohibits insurance companies from denying coverage to individuals with preexisting conditions (effective immediately for children and applies to all individuals beginning in 2014)

• Closes the “doughnut hole” gap in Medicare prescription drug coverage

• Prohibits insurance companies from placing lifetime caps on coverage

• Requires health plans to allow young adults up to age 26 to remain on their parents’ insurance policy

• Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program

• Individual health insurance mandate for most US residents; penalties for individuals who do not obtain insurance

• Penalties for employers that do not offer health insurance • Expands Medicaid to cover individuals with income less

than 133 percent of the federal poverty level• Increases funding for Community Health Centers• Establishes 50 health insurance exchanges, administered

by states, through which small businesses and individuals can buy coverage

• Subsidies for premiums and cost sharing through the new insurance exchanges

• Tax credits to small businesses to make employee coverage more affordable

Basic Provisions H.R. 3590 + H.R. 4872:Access to Coverage

Beyond the Headlines:Administrative Simplification Provisions

• Accelerates HHS adoption of uniform standards and operating rules for electronic transactions governed under the Health Insurance Portability and Accountability Act (HIPAA)

• Expands HIPAA transactions and requires uniform standards and operating rules for the following:• Eligibility verification• Claims status • Claims remittance • Claims attachments• Referral certification and authorization • Electronic funds transfer (EFT) payments

• Requires health plans to certify compliance or face financial penalties

85% 15%

Cost of Care = $2 T Admin Costs = $360 B

Total U.S. Healthcare Spend = $2.4 Trillion

4% on Prevention

4% on Prevention

Where does the money go?

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Practical Savings Today: Measuring Progress Through the US Healthcare Efficiency Index™

ushealthcareindex.com

Independent Advisory Council

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Index Development and Implementation

• Phase 1: Industry data

• 5 basic transactions

• Phase 2: Primary data collection

• “National Progress Report on

Healthcare Efficiency” (April 2010)

• Phase 3: Expansion: Pharmacy

Adherence and Safety Index

• With Vanderbilt Center for Better

Health

• Phase 4: Expansion: Dental Index

National Progress Report on Healthcare Efficiency: 2010

Key Learnings

1.Transparency on costs is vital to the nation’s

economy; healthcare is murky at best

2.Lines are blurring between manual and

electronic processing

3.Costs must be removed at the system level to

avoid perpetual cost shifts

4.Efficiency is a journey, not a destination:

continue to drive transaction value

ushealthcareindex.com

Don’t Throw it Away!

Stopping paper checks in healthcare

would save $11 billion a year

To Get There, Start From Where You Are

A

B

what would u dow/ $30 B?

ushealthcareindex.com

But It’s Not Just About Healthcare Reform…

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HITECH: February 17, 2009

ARRA and HITECH ACT: Unprecedented Investment in Health IT

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HIPAA Simplified: Practical Tools

19Simplified Gap Analysis Full Gap Analysis

One-Stop Shop

Seventy-one percent of U.S. health care executives surveyed said that electronic health record systems are likely to get attention and budget approval in their hospitals in 2010, according to a recent StatCom survey.

Meanwhile, 53% of U.S. health care executives surveyed said that computerized physician order entry systems are likely to receive attention and budget approval in their hospitals in 2010, the survey found.

Thirty-one percent of survey respondents predicted that patient flow and logistics technology would receive attention and hospital budget approval in 2010.

Results are based on a November 2009 survey of 440 U.S. health care executives.

What Technologies Are Likely To Get Attention /Budget Approval in 2010?

Meaningful Use:RCM + EMR + HIE = MU

Meaningful Use is Easy!

*Certification in process pending the final rules from the federal government

1. Eligible healthcare providers want to meet Meaningful Use requirements in order to qualify for stimulus funds

2. To do so, they need to be able to connect payers and to other providers for exchange of administrative, financial, and clinical data

3. Emdeon’s Meaningful Use Portal integrates Emdeon Office and Emdeon Clinician EMR Lite* to deliver one solution to EPs

Navigating HIT Over the Next 5 Years: 5010/ICD-10 + HITECH/Meaningful Use

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+ Healthcare Reform

Questions?

Miriam ParamoreSVP Clinical and Government Servicesmparamore@emdeon.com