Health Reform: Local Safety Net Implications

Karen J. Minyard, Ph.D., Executive Director,Georgia Health Policy Center, Georgia State University

Sources of Coverage in North Carolina:Before and After Full Implementation of Health Reform

Note: This shows the non-elderly and is a preliminary estimate, subject to revision. “Other” is comprised of the following: Medicare (disabled or end-stage

renal patients), Champus, CHAMPVA (coverage for armed forces and veterans families) and Indian Health Services. Estimates are based on 2008 numbers.

Remaining Uninsured

• Approximately 1/4 to 1/3 will be non-citizens• Those with incomes between 100% and 250%

have income volatility that results in transitions in and out of Medicaid eligibility and insurance subsidy categories

• Those who are uninsured are likely to be younger and healthier than those currently uninsured and those who become insured

Medicaid Insurance Subsidies

Approximately $1 Trillion

Fees, Penalties, Medicare & Taxes Savings

Funding & Spending

Sources of Revenue

Federal Expenditures

• Changes in Public Coverage

• Changes in Private Coverage

• Improving Health Care Quality

• Improving Health

Major Components of Change

BEHAVIORAL HEALTH

CHRONIC DISEASE MANAGEMENT

DIAGNOSTIC

SERVICES

Rx MEDS

EMERGENCY

& TRAUMA

CARE

SOCIAL SERVICES

ORAL

HEALTH

PUBLIC HEALTH DEPARTMENTS

COMMUNITY SERVICE BOARDS

FQHCsHOSPITALS

NON-PROFIT CLINICS

PRIVATELY INSURED PATIENTS

STATE FUNDS

CHARITABLE

CONTRIBUTIONS

PATIENT FEES

DRUG

COMPANIES

COUNTY FUNDS

FEDERAL

FUNDS

NEEDS OF THE UNINSURED

PRIVATE

OFFICES

PRIMARY CARE

SAFETY NET PROVIDERS

FINANCING SOURCES

DURABLE MEDICAL EQUIPMENT

Rx DRUG PROGRAMS

COORDINATION

OF CARE

IN-PATIENT

CARESPECIALTY CARE

Current Health Care Safety Net: The Puzzle Pieces

NEEDS OF THE UNINSURED

SAFETY NET PROVIDERS

FINANCING SOURCES

Health Reform: Starting to Align the Pieces

An Example of the Impact of Health Reform on the Healthcare Workforce in Georgia

• Approximately 1.2 million Georgians will gain health coverage through Medicaid and Health Insurance Exchanges

• Rough estimates indicate that this coverage will generate 1.2 – 2 million additional physician visits per year in Georgia*

• This translates into an additional shortfall of 300-400 physicians in Georgia*

• The elimination of copays, deductibles, and coinsurance for many preventive services may also increase the demand for primary care providers • *Dr. Patricia Ketsche, Associate

Professor, Institute of Health Administration, J. Mack Robinson College of Business, Georgia State University

Health Reform Provisions to Increase Primary Care Workforce

• $11 billion to increase/expand Federally Qualified Health Centers (FQHCs).

• Reallocation of unused medical residency sites with preference to high need states

• State workforce planning grants• Loan repayment and scholarship programs• Primary Care Extension Program• Increases in Medicare and Medicaid payments for primary

care providers

8 Critical Activities

• Provide Access to Affordable Prescriptions

• Culturally & Linguistically Competent Medical Homes

• Manage Chronic Diseases• Assure Access to Specialty &

Hospital Care• Coordinate Care Continuum

• Connect to Prevention & Wellness Services

• Outreach & Enroll into Eligible Programs

• Develop Strategies to Provide Access/Cover Low-Wage Workers

Grant OpportunitiesPrevention and Wellness

• Community Transformation Grants

• Grants to Promote Positive Health Behaviors and Outcomes

• Incentives for Preventing Chronic Disease in the Medicaid Population• Maternal, Infant, and Early

Childhood Home Visiting Programs

• National Diabetes Prevention Program

• Small Employer Workplace Wellness Grants

Coordination

• Navigators- Health Insurance Exchange- Patient• Community-Based Care

Transitions Program

• Community Health Teams• Community-Based

Collaborative Care Network Program

• Community Benefit

Quality Care

• Medication Management Services in Treatment of Chronic Diseases

• Primary Care Extension Program

• Health Professions Training and Continuing Education

• National Centers of Excellence for Depression

ReflectionFrom the perspectives of Care Share and thelocal networks:

– What will be the key needs and outcomes related to health reform that the program and the local networks should focus on?

– What do you see as the “levers” of highest value?

– How is this different during transition and after full implementation?

ReflectionDuring Transition

Needs/Outcomes

High Value Levers

Program Level

Local Networks

After Full Implementation

Needs/ Outcomes

High Value Levers

Program Level

Local Networks