professor emeritus, psychiatry chair, ucfw issues in health care joel e dimsdale, m.d. 3/31/15
TRANSCRIPT
P R O F E S S O R E M E R I T U S , P S Y C H I A T R YC H A I R , U C F W
ISSUES IN HEALTH CAREJOEL E DIMSDALE, M.D.
3/31/15
UC CARE GOALS
• Self-funded platform-- UC has many others such as disability & malpractice• 2014 earnings were 76.68% for HN
(43.47% Aetna)* • Can we have some of that and invest it in other
things?• Self-funded means we assume financial risk
• Increased efficiency w common purchasing etc. = decreased costs• Improve platform for care delivery
*Zacks Equity Research 3/23/15
UC CARE PROGRESS
• 23,000 employee subscribers• Year 1: rocky start;
major access issues (not so much in San Diego)• How much fault is UC
Care vs Blue Shield as 3rd Party Administrator?
• Year 2: less confusion; slightly improved access
WHO IS THE ENEMY?
• Health care is costly• Limited competition in
certain practice environments = high costs (e.g. Sutter, Santa Barbara)• Conflicts of interest:• Patient• Med Center• Doctor • Insurance company• Employer
2016 AND BEYOND
• Continue UC Care PPO• Self-insure HMO?• Savings?• Who will be 3rd party
administrator?• 2016- unlikely• 2017- maybe
• No plans for absorbing Kaiser
CHALLENGES I: HEP C
• HCV 1% prevalence; • New drugs curative
after 3-6 months but cost $100,000; currently covered for use in those w fibrotic liver changes; • Current cost
$5/member/month• If all were treated, cost
$35/member/month
CHALLENGES II: CADILLAC TAX
• Cadillac tax- 2018• Goal: decrease
costs by having employees share in costs (e.g. curtail utilization)• 40% tax on plans
costing >$10,200/y for individual (>$27,500 for family)
CHALLENGES III: MENTAL HEALTH
• Nationwide, mental health problems account for ~25% of all hospitalizations & are in the top 5 most costly conditions*
• Currently “carved out” to Optum• How well is it working?
• How do we coordinate care across mental health and other health? (e.g. depression in diabetes)
*Agency Healthcare Research and Quality 09-P011, 2009
CHALLENGES IV: PAY BANDS
• Progressive increase in insurance rates; higher earners subsidize lower earners• Employee cost (monthly) for family
coverage UC Care, 2015• <$51,000 $335• $51,101 – 101,000 $446• $101,001- 152,000 $550• >$152,001 $657
• Should there be a 5th pay band? (?>$200K)
CHALLENGES V: RETIREE HEALTH
• Currently pay as you go charge of 2.65% covered comp payroll• Not guaranteed• Governor suggesting pre-
funding as a vested right• VERY costly (normal cost
+ amortization of accrued costs) means more costs on payroll beyond pension costs
• BS High option not as “high” as you may think
CHALLENGES VI: IT’S MORE THAN THE PREMIUM
• Premium•Deductible• Co-pay•Network
QUESTIONS?
•Don’t kill the messenger