A Brief History of Health Care Reform

Healthcare Retrospect Part 3: Achieving The Triple Aim

John J. Dalton, FHFMASenior Advisor Emeritus

1990s

Here’s the real story of the 1990s – the rapid growth ofmanaged care. In New Jersey,it began with US Healthcare’sprimary care gatekeeper model in Burlington County and spread rapidly throughout the state.

1990s

The Institute of Medicine’s1999 report stating that asmany as 98,000 preventable deaths occurred in hospitalseach year was a much needed wake-up call to the industry. CLABSIs, CAUTIs and SSIs become part of the Board of Trustees dashboard.

The Third Millennium• 2003 – President George W. Bush signs the

Medicare Prescription Drug, Improvement, and Modernization Act (MMA), now Medicare Part D, sometimes described as the full employment act for insurors and Big Pharma. • While it provided prescription drug coverage

to seniors, it prohibited Medicare from negotiating discounts from drug companies.

The Third Millennium

Employer-sponsoredinsurance was in decline before PPACA.Many experts expectthe decline to continue although recent data show a leveling off.

The Third Millennium2008 Presidential Campaign• John McCain’s proposals included tax credits - $2,500

for individuals and $5,000 for families who do not subscribe to or do not have access to health care through their employer. To help those denied coverage by insurance companies due to pre-existing conditions, McCain proposed working with states to create what he called a "Guaranteed Access Plan."• Barrack Obama calls for creating a National Health

Insurance Exchange including private insurance plans and a Medicare-like government run option with coverage guaranteed regardless of health status; require parents to cover their children, but no requirement for adults to buy insurance.

2010 - PPACA

Modeled on Massachusett’s Romneycare, the Patient Protection and Affordable Care Act was signed into Law by President Obama on March 23, 2010.

2016 - PPACALove it or hate it, Obamacare is here to stay. Here’s why:1. 18.2% of Americans uninsured at enactment; 10.4% in 20142. Young adults remain on parents’ policy until age 26; more than 2

million have gained coverage3. No more coverage denials due to pre-existing conditions4. Coverage rescinded only for fraud or misrepresentation5. Health exchanges won’t be going away; Accenture projects that

by 2018 private exchange enrollment will hit 40 million6. Even with 22 states not participating, enrollment in Medicaid

and CHIP has grown 26% by nearly 11 million people 7. Hospitals with the highest rates of hospital-acquired conditions

now receive reduced payments8. Quality is up and infection rates are down. From 2008-2013,

CLABSIs are down 46% and SSIs are down 16%.

2016 – the Triple AimPPACA has bent the cost curve, but much remains to be done. The U.S. has the best-equipped hospitals and the most thoroughly trained physicians in the world, yet our outcomes trail other developed countries and the gap is growing.

We must go beyond our comfort zones to provide improved care for our patients and better health for the populations we serve. Only then can the per capita cost of care be reduced.

Contact Information

BESLER Consulting3 Independence Way, Suite 201Princeton, New Jersey 08540

Phone: 609.514.1400Toll Free: 877.4BESLERFax: 609.514.1410

www.besler.com