health reform: an environmental overview

Health Reform: An Environmental Overview

Jon Fishpaw, VP, Advocacy & Government Relations Catholic Health PartnersMay 18, 2011

An Important First Step

While not perfect, the legislation represents an important first stepin helping ensure Americans have access to quality healthcare, and we are encouraged by the inclusion of numerous global provisions in the legislation that:

• Covers 32 million uninsured and prohibits denials for pre-existing conditions;

• Provides funding for workforce development and related job training;

• Implements a series of insurance and delivery system reforms; and

• Provides incentives for health and wellness.

More Work Needed for Systemic Reform

CHP believes much work remains to be done on reforming the reimbursement model in order to incentivize hospitals and others that are consistently providing high quality care at the greatest value to payers. We are also disappointed that lawmakers didn't seize this historic opportunity to align payment incentives, and we'll continue to lead by example and advocate for aligned incentives so that we can control the growing costs of healthcare.

Implementation and Changes Over Time States Attorneys General have filed suit against federal government onConstitutionality, and potential Supreme Court decision.

Added fiscal pressures due to one-half of newly insured on Medicaid & 133% of FPL new floor for Medicaid eligibility.

Federal BureaucracyHHS Secretary is central actor to rule-making and regulatory oversightnew federal legislation to follow.

Elections 2012, 2014 mid-terms, and 2016 Presidential elections.

Healthcare Reform Implementation Timeline

Healthcare Reform Implementation Timeline

Healthcare Reform Implementation Timeline

Healthcare Reform Implementation Timeline

Healthcare Reform Implementation Timeline

Barriers to Overcome

• Numerous sections of ACA are authorized, but not appropriated.

• CBO projects 22M+ Americans will remain without coverage by 2019.

• Beginning in 2014, 16 of 32 million newly insured to be covered by Medicaid, placing further constraints on state budgets.

• Systemic program payment reform, including physician payment.

In addition to new rule-making authority and regulatory oversight for providers and employers, there are issues that remain unaddressed …

Opportunities & Challenges

OpportunitiesExpanded coverage to 32 million uninsuredLinking payment to qualityGreater physician alignment & integrationPilot Programs & innovative care solutionsLimitations on specialty hospitals

ChallengesCuts before CoveragePlanningCost containmentEmployer health insurance provisionsIncreased regulation

The Road Ahead

An incremental, collaborative approach will help address provider,

employer and community provisions…

Title I. Quality, Affordable Health Care for All Americans

Title II. Role of Public ProgramsTitle III. Improving the Quality and Efficiency of HealthcareTitle IV. Chronic Disease Prevention / Improving Public

Health Title V. Health Care Work ForceTitle VI. Transparency and Program IntegrityTitle VII. Improving Access to Innovative Medical TherapiesTitle VIII. Community Living Assistance Services and SupportsTitle IX. Revenue Provisions

Four Steps to Considering the Elements

PreparationEstablishment of clear stakeholder groups to understand

timing andimpact of provisions.

Pilot / Demonstrations / Grant FundingIdentifying the universe of opportunities.

Rule MakingShifting external federal focus to executive branch of

government.

StrategyLinking reform provisions to current and tangible initiatives.

Integrating Reform with Top Priorities

1. Ambulatory Transformation:• ACOs• Medical Homes• Physician Employment and Alignment

2. Inpatient Transformation:• Increase Quality • Lower Cost• Full Transparency

3. Clinical Information Transformation:• Epic (EMR)• Health Information Exchanges

Medical Home: One Example of Reform Integration

Source: Advisory Board

Questions?

Jon FishpawVP, Advocacy & Government RelationsCatholic Health Partnersjpfishpaw@health-partners.org513.639.0136