the crystal ball of the health care reform
Post on 21-Oct-2014
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DESCRIPTION
Presentation made by Dr. Carolyn A. (Cindy) Watts on the 5th of November, 2012 during the live webinar hosted by VCU Department of Gerontology (discussion moderated by Dr E. Ayn Welleford) - review recording of webinar at http://www.alzpossible.org/wordpress-3.1.4/wordpress/alliedhealth/TRANSCRIPT
Carolyn Watts, Ph.D.Professor and Chair
Department of Health Administration, Virginia Commonwealth University
Looking into the Crystal Ball of Health Care Reform:
Patient Protection and Affordable Care Act (PPACA)
and the Allied Health Professions
Poll: Knowledge and Attitudes
Primary Question: Is Health Care a “Social Good”?
1965
NO
2014
YES for elderly, certain low income individuals, disabled
YES for most Americans
Financing Context
67%of non-elderly
20%of population
15%of population
50%
Medicare Medicaid Employers
18%of population
Mixed public/private
of GDP (in 2009)
17%
$8300/person
Uninsured
Up to 2/3 of all births
Delivery System Context
Volume-based
payment
Illness
– not health –
based care
Decades of
professional control
Pressure for
Reform
Proposed by 6
presidents
Rising un-employment
Rising enrollment in
public programs
Fragile state of delivery
system
Increasing expenditures
Crowd-out of other public programs
More Pressures
Approaching national debt
cliff
Cost as % of income at all time high• 12.6% in 1996• 23.2% in 2010
Global business
disadvantage
Changing demographics
Still More Pressures
Rise of chronic illness/obesity
More evidence/information
New technology
What Did We Expect?
Health Care Reform: PPACA
Individual mandates
• Subsidies• Fines
Employer responsibility
• Tax credits• Fines
PPACA
Insuranc
e rule
s
• Limits on underwriting and exclusions• Older dependent children coverage• 2018: tax on first dollar coverage
Exchanges
• “Expedia” for private insurance• States or federal government (default)
PPACA
Medicaid
expansion
• Eliminate categories; 133% FPL• Federal government pays 100% for 3
years
Medicare
payment cuts; benefit increas
es
• “Donut Hole”• Preventive services• Provider payment reductions• Increases in Medicare payroll tax
PPACA
Delivery and
payment
demonstratio
ns
• Accountable Care Organizations• Bundled payment• Innovation Center
Wellness
• Incentives for employers• Mandated coverage of prevention
PPACA: Myths
All Americans must have coverage
Exemptions for:• Very low income• Insurance costs > 8% of income• Religious beliefs, incarceration,
Native Americans
PPACA: Myths
Everyone must have the same coverage
• Essential benefit package as floor• Choices through
employer/exchange
All businesses must provide coverage
• Small businesses (< 50 employees) exempt• = 96% of 6M businesses• 96% of other businesses already do• 10,000 businesses (.2%) will be affected
PPACA: More Myths
Government will take over insurance• MUST contract with at least 2
private insurance companies in every US market
…and More Myths
…and More Myths
Medicare benefits will be drastically cut
• Increases for traditional Medicare • Drug coverage• Preventive services
• Reduced payments for Medicare HMOs
…Still More Myths
“Death Panels” will limit care provided
• Funding of new evidence base, but CMS prohibited from using it
• Pres. G.W. Bush-era legislation allows coverage of integrated advance planning
• Independent coverage of advance planning taken out of PPACA
So Far….
54M seniors
Saved $3.7B on drugs Young adults
new dependent coverage
3MInsurance rebates to small businesses (more to big business)
$321MPeople got newly free preventive services
54M
Futu
re
Evolving government role
Evolving employer role
Evolving insurance markets
Evolving delivery system
Evolving consumer role
Evolving technology
Future
Evolving government role
Impact of elections
States and Medicaid
Medicare payment/rules
Future
Evolving employer role
Insurance coverage and
benefit changes
What if they drop coverage?
Wellness programs
Value-based insurance design
So
what?
Harvard study: $3.72 HC savings, $2.73 absenteeism
savings from $1 wellness program
Future
Evolving insurance markets
Consolidation Integration with providers
Impact of exchanges
Provider payment changes
Future
Evolving delivery system
Consolidation and
integration
Physician employment
Scope of practice Transparency Retail
medicine
Future
Evolving consumer role
Responsibility for health &
metrics
Responsibility for financing
Future
Evolving technology
Genetic medicine
New pharmaceuticals Robotics Telemedicine E-medicine
What are the Opportunities for Allied Health?
OPPORTUNITIES for ALLIED
HEALTH
Greater demand
Expanding Medicaid (?)
Evolving scope of practice
Team-based medicine
More consumer
engagement
Different payment models
What are the Challenges for Allied Health?
CHALLENGES
More concentrated
interests (payers, systems)
Lower payment rates
Different payment models
Shrinking Medicaid (?)
Health Care
2020