health care reform 2009 w medicare info

8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180

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Quaker Gardens Discussion on HealthCare Reform - 2009

$400 Billion Impact on MediCare The Players Why now instead of under Clinton? Which Model will prevail? What will be the impact on

Employers and Employees?


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Impact on MediCare?

Any Changes in Benefits? What will happen to the medical

delivery system? What happens when MediCare is

cut by $400+ Billion over 10 Years?

Myths in HC Reform?


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Possible Changes in M’Care Benefits?

Get the “Hole” out of the Donut for MediCare Part D

Better programs on transition of care from Hospital to other levels of care


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HR 3962 Proposal Improved financial assistance Eliminate Part D cost sharing Eliminate barriers to enrollment Improve communications to eligibles Extended coverage of

immunosuppressive drugs Voluntary advance care planning

services


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HR 3962 Proposal Improvements in calculating income

for calculating part B premiums Create Accountable Care

Organizations to reward medical providers for improvements in Quality of Care

Funding of MediCare graduate medical education

MediCare Rural access protections


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HR 3962 Proposal Nursing Home Transparency Incentivize use of Electronic Medical Records Bundled payments for post-acute care

services Address geographic inequities in provider

payment No Mid-year drug formulary changes allowed Free Generic drugs (Jan 2011)


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HR 3962 Proposal

Medical Home Pilot Coverage and waiver of cost

sharing for preventive medical services

Waiver of deductible for colorectal screening services

Expanding access to vaccines


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HR 3962 Proposal Independence at Home medical pilot

(A) reducing preventable hospitalizations; (B) preventing hospital readmissions; (C) reducing emergency room visits; (D) improving health outcomes commensurate

with the beneficiaries’ stage of chronic illness; (E) improving the efficiency of care, such as by

reducing duplicative diagnostic and laboratory tests;

(F) reducing the cost of health care services covered under this title; and(G) achieving beneficiary and family care giver satisfaction.


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What will happen to the M’Care Health Care Delivery System?

Basic laws of Supply and Demand … Well, if you decrease the payment and keep the

demand the same, there could be less providers accepting MediCare’s allowed charges! OUCH!


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Where will the $400+ billion in cuts in M’Care

come from?

the savings comes from cutting billions of dollars in overpayments to insurance companies and eliminating waste, fraud, and abuse


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Myths in HC Reform? Cuts in Benefits? Rationing with Older Citizens being

the last to get needed health care? Bureacratic Health Care Panels that

say NO? Forced Euthanasia?

HC Reform will Bankrupt America? Illegal Immigrants will be covered?


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Paying for Health Care ReformSource Health Care Reserve

Fund ($ in billions) 10 years

FY 2010 Budget $635 - Medicare and Medicaid Savings $309 - Revenues$ $326

Additional Medicare and Medicaid Savings- $313 - Incorporate productivity adjustments into

Medicare payment updates $110- Reduce hospital subsidies for treating

the uninsured as coverage increases$106

- Pay better prices for Medicare Part D drugs $75- Other $22

Total $948


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The Players Employers Employees Unemployed Retired Organized Medicine (Docs, Hospitals,

HMOs, ancillary Providers, Pharma, etc.) For Profit Insurance Companies & HMO’s States Federal Government


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Why Now?

Health Care costs have doubled in last 8 years

Cost shifting has reached tipping point to trigger federal & state intervention Tipping points are "the levels at which the

momentum for change becomes unstoppable."

$800,000,000,000 in potential savings!


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Macro Cost Shifting


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Pay Full Retail

Macro Cost Shifting


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Pay Full Retail

Best Risks and Underinsured

Macro Cost Shifting


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Pay Full Retail


Poor Risks, Can’t afford Insurance, etc.

Macro Cost Shifting


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Pay Full Retail

Medical paid at $.60 on the dollar


Poor Risks, Can’t afford Insurance, etc.

Macro Cost Shifting


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Which Model will Prevail? Single Payor System Universal Health Care

With Health Care Exchange that includes a Public Plan or Health Care Co-operative

At State Level? (A program like the HIPC?) At Federal Level?

Pay or Play for employers Guaranteed Coverage (no exclusions for pre-existing

conditions and no cherry picking) Minimum benefit level established Federal and State subsidies

Probably at 400% of Federal Poverty Level Minimum ER contribution levels set (like SF city regs)


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Payment ReformHealth Care Payment Reform That Rewards Value, Not Volume

Bundling payments to cover care over a specified period, revising fees to increase compensation for primary care, and offering providers financial incentives to serve as patient-centered medical homes

Quality ImprovementHealth Information Technology Policy Evidence Based Medicine and a Business Case for Health

Information Technology

Business Case for Investing in HC Reform


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Ideas on how to lower HC Costs

Competitive Public Plan Change MediCare payment structure

Reduce annual increases to providers Reduce payments to M’Care Advantage

Plans (now 14% higher than FFS docs) Pharma discounts for Seniors Rx in the

Doughnut Hole


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Use Best Practices and Evidence Based Medicine Conduct Comparative Effectiveness

Research at new proposed “ Center for Quality Improvement”

Docs and Hospitals Create Incentives for delivering Quality

Medical Care Bundle Payments to Providers to encourage

“coordinated care” across provider spectrum


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NOW – Silos of Payment

Doctors HMO’s

Hospitals

Nursing Homes and ECF’s

$$$

$$$$$$

$$$$$$

$$$$$$


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NOW – Silos of Payment

Doctors HMO’s

Hospitals


$$$

$$$$$$

$$$$$$

$$$$$$


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FUTURE? Bundled payment

Doctors HMO’s

Hospitals


$$$


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Mandate that everyone be covered by all carriers with no pre-existing condition exclusions and no adverse selection rating.


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Information and Data Sources


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Health Care Reform Web Sites AARP.org commonwealthfund.org/ healthreform.gov/ mailmanschool.org/facultypubs/

womenshealthcarereform.pdf whitehouse.gov/assets/documents/

CEA_Health_Care_Report.pdf reuters.com/article/healthNews/

idUSTRE56K01720090721 hudson.org/files/documents/

20090612_JB_Kuttner_longterm_fiscal_impact_health_reform.pdf


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http://randcompare.org/http://randcompare.org/current/http://randcompare.org/options/http://randcompare.org/options/mechanism/refundable_tax_credit http://randcompare.org/options/mechanism/purchasing_pools

Massachusetts “Health Care Connector”http://randcompare.org/options/mechanism/employer_mandate

Pay or Play explainedMandates (Cal, Or, WA passed and subs

repealed)Hawaii 1974Mass 2006

Health Care Reform Web Sites


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Health Care Web Sites


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Medical Info/Research www.medem.com - modern medical library www.ncqa.com - Nat'l Committee on Qual.

Assurance www.doctorsolve.com/ - Info on drugs in Canada www.coverfingtheuninsured.org www.insureusa.org http://www.prevent.org/ - information on disease

prevention and health promotion policies and practices

www.cmwf.org/index.htm - Commonwealth Fund


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Employee Empowerment & Health Wellness

www.4women.gov - Nat'l Women’s Health site www.ivanhoe.com - Medical Breakthroughs http://vm.cfsan.fda.gov - US FDA Food Safety Ctr. www.healthyroads.com – ASHP wellness product www.new.chcf.org - Cal Health Care Fndn www.mrmib.ca.gov – MRMIB http://www.opa.ca.gov/report_card/. - Cal Office of Patient

Advocate www.healthcarecoach.com/ www.mayoclinic.com http://www.doclopedia.com- Use doclopedia to put your medical

history, prescriptions, and bills in one convenient space for FREE


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Employee Empowerment & Health Wellness

http://www.hhs.gov/transparency/ - The “Four” Value Driven Health Care Principles. Health care transparency provides consumers with the information necessary, and the incentive, to choose health care providers based on value.

www.netwellness.org – 100 health topics to find in-depth information on hundreds of diseases and wellness issues

http://www.insureuonline.org/ - The National Association of Insurance Commissioners (NAIC) has created the Insure U — Get Smart About Insurance program to help consumers make educated decisions.

www.organizedwisdom.com - OrganizedWisdom is a collaborative health information community, combining professional and user-generated health content with social networking technologies to help people make the most informed health decisions possible.


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Provider/Health Plan Report Cards www.healthscope.org www.lumetra.org - dedicated to measurably

improving the quality, safety, and integrity of healthcare.

www.aahp.org - Amer Assn of Health Plans www.chcf.org – California Health Care

Foundation www.healthcarecoverageguide.org – Cal

Health Care Foundation web site www.guiadecoberturadesalud.org – CHCF

hispanic site for small employers www. benefitscheckup.org/


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Government Web Sites www.cdc.gov - Center for Disease Control www.medlineplus.gov www.medicare.gov/ - info on Part D drug plans www.leginfo.ca.go - Cal ins code www.dmhc.ca.gov - Dept Managed Health

Care www.mrmib.org – High Risk Ins pools


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The end


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health care reform 2009 w medicare info

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