Hc Reform June 2011 Ppaca

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Presentation on Health Care Reform given to CEO groups and consultants for "C" level execs.

Presentation on Health Care Reform given to CEO groups and consultants for "C" level execs.

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  • 1. HealthCare Reform – Patient Protection and Affordable Care Act
    • Changing the Supply and Demand Curve regarding Health Care
    • The Players
    • Why now instead of under Clinton?
    • What Models were under consideration?
    • What will be the impact on Employers and Employees?
    • What can you do now to control costs?
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 2.
    • Imagine the HC Reform train roaring down the tracks with “Cost Control” brake broken off in the engineers hand!
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 3. 04/18/11 Prepared by Chuck Kiskaden 949-636-3601 bbbbbbbbbb bbbbb Instructions on implementing Health Care Reform Legislation
  • 4. 04/18/11 Prepared by Chuck Kiskaden 949-636-3601 OUT OF Contro l H C Insurance Cost Control Emergency Brake Handle Broken OFF
  • 5. Supply and Demand Curve 04/18/11 Prepared by Chuck Kiskaden 949-636-3601 What happens when you change the demand, hold the cost and no change in Supply?
  • 6. The Players
    • Employers
    • Employees
    • Unemployed
    • Retired
    • Organized Medicine (Docs, Hospitals, HMOs, ancillary Providers, Pharma, etc.)
    • For Profit Insurance Companies & HMO’s
    • States
    • Federal Government
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 7. Employers
    • Wins Loses
    • No companies Denied Pay or Play
    • $0 Copay on Prev. Children to 26
    • Carrier MLR restrictions Increased $
    • Health Exchanges 2014 Health Exchanges
    • Tax Credits Vouchers in 2014
    • W2 changes
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 8. Individuals
    • Wins Loses
    • No Pre-X exclus. Inc in Med Tax Ded
    • Children to 26 Increased $
    • $0 Copay on Prev. Mandated Coverage
    • Vouchers in 2014
    • Reduced Donut Hole
    • Mini-Meds eliminated
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 9. Individuals
    • Wins Loses
    • High Risk Pools
    • Expanded M’Cal
    • Premium Subsidies
    • No Lifetime Limits
    • Prohibition on Recision
    • Max waiting period 90 days
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 10. 04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 11. Why Now?
    • Between 2002 and 2009, premiums more than doubled, increasing 117.5%, while California's overall inflation rate increased 23.1%.
    • 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???
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 12. Plan Design Trends 04/18/11 Prepared by Chuck Kiskaden 949-636-3601
            • 2007 2009
            • PPO HMO PPO HMO KP
    • Co – Pays $10 $20 $ 20 $20/$30 EOA $15
    • Inpatient Hosp $250/$750 $250 per day $0
    • Deductible Avg. $364/842 $250 $ 500 - 1000 250 -1000 $?
    • Out of Pocket Max
    • In-Network $2178 $1973 $2000 $1500/$4500 1500/3000
    • Out of Network $5187 NA $6000 NA NA
    • Co-Insurance
    • In-Network 80% 100% 80% 100% 100%
    • Out of Network 60 -70% 0% 70% 0% 0%
  • 13. National Rx Benefit Trends 04/18/11 Prepared by Chuck Kiskaden 949-636-3601
            • 2005 2007 2009
    • Prescriptions (3 Tier)
    • Generic $ 10 $ 10 $ 10 to $20
    • Brand $ 23 $ 24 $ 30 (after ded)
    • Non-Formulary $ 40 $ 50 $ 50 (after ded)
    Data Source – National Survey of Employer Sponsored Health Plans
  • 14. Macro Cost Shifting 04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 15. Macro Cost Shifting 04/18/11 Prepared by Chuck Kiskaden 949-636-3601 Pay Full Retail Medical paid at $.60 on the dollar Best Risks and Underinsured Poor Risks, Can’t afford Insurance, etc.
  • 16. What Models were under Consideration?
    • Universal Health Care
    • Single Payor System
    • Medicare for All
    • Health Insurance Reform
      • 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?
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 17.
    • Health Reform – What happens next and when?
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 18. Patient Protection and Affordable Care Act
    • Cost – $940 billion over next 10 years
    • Deficit Impact –
      • Saves $143 Billion over next 10 years
      • Saves $1.2 Trillion over second 10 years
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 19. Patient Protection and Affordable Care Act
    • 32 Million uninsured now covered
    • Mandated coverage starting 2014
      • Fine if not insured - $95 or 1% of income in first year (whichever is greater) and finally reaching $695 or 2% of income.
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 20. Tax Implications
    • Individual tax starting in 2014 if you are not insured
    • Pay or Play for large employers - $2000 per year
    • Cadilac Plan tax – 40% excise tax
    • Medicare Tax increase on investment income from 2.9 to 3.8 in 2013
    • Brand name Rx excise tax of 2.5 B rising to 4.2 B in 2018
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 21. Tax Implications
    • Excise tax on medical device manufacturers – 2.9% starting 2012
    • Health Carriers – 8 B starting in 2014, 11.3 B in 2015 -2017, 14.3 B in 2018 assessed based on market share
    • Tax on itemized deductions threshhold increased from 7.5% to 10%
    • Excise tax on indoor tanning – 10%
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 22. Patient Protection and Affordable Care Act
    • September 2010
      • Tax Credits for Small Businesses
      • Drug Cost help for Seniors ($250 rebate checks in 2010 toward donut hole costs and in 2011 50% discount of Generic drug cost as the donut hole slowly closes)
      • Coverage for Pre-existing conditions through high risk pools - $5 billion
        • High risk pools set up 90 days after signature
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 23. Tax Credits for small groups
    • For the next four years, until the Exchanges are set up,
      • businesses with 10 or fewer full-time-equivalent employees earning less than $25,000 a year on average will be eligible for a tax credit of 35% of health insurance costs.
      • Companies with between 11 and 25 workers and an average wage of up to $50,000 are eligible for partial credits.
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 24. Tax Credits for small groups
    • The tax credit will remain in place, increasing to 50% of costs, for the first two years a company buys insurance through its state exchange.
    • The Congressional Budget Office predicts that the tax credit will affect about 12% of individuals covered via the small-group insurance market, lowering their cost of insurance by between 8% and 11%.
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 25. Patient Protection and Affordable Care Act
    • September 2010
      • Reinsurance for early retirees (55 to 64). The program reimburses participating employment-based plans for 80 percent of the cost of benefits provided per enrollee in excess of $15,000 and below $90,000
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 26. Patient Protection and Affordable Care Act
    • September 2010
      • All Kids get covered even with pre-existing conditions
      • Prohibition on Rescission - No insurance carrier can cancel your insurance if you have a major medical condition
      • No more lifetime limits
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 27. Patient Protection and Affordable Care Act
    • September 2010
      • Unmarried Children can stay on parents plan until age 26
      • Development and utilization of uniform explanation of coverage documents and standardized definitions.
      • Office of women’s health
      • Reasonable break time for nursing mothers
        • Amends Fair Labor Stds Act (100+ employers)
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 28. Patient Protection and Affordable Care Act As of January 1, 2011
    • Insurance premium MLR payment reform
      • Claims to Premium ratio can not be less than 80% for small employers
      • Claims to Premium ration can not be less than 85% for all other employers (100+)
      • Non-Profit Blue Plans must meet 85% ratio
      • Rebates for all amounts where administrative costs exceeding these ratios
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 29. Patient Protection and Affordable Care Act As of January 1, 2011
    • Funding for reducing childhood obesity demonstration project
    • Every hospital operating within the United States shall publish a list of standard charges for items and services provided by the hospital.
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 30. Patient Protection and Affordable Care Act As of January 1, 2011
    • State health care workforce development grants
    • Federally supported student loan funds
    • Nursing student loan program
    • Health care workforce loan repayment programs
    • Nurse-managed health clinics
    • Training in family medicine, general internal medicine, general pediatrics, and physician assistantship
    • Centers of Excellence program, which develops a minority applicant pool
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 31. Patient Protection and Affordable Care Act As of January 1, 2011
    • Expanding access to primary care services and general surgery services
    • Spending for Federally Qualified Health Centers (FQHCs)
    • Transparency reports and reporting of physician ownership or investment interests
    • Medicare self-referral disclosure protocol (Whistle Blowers) Jan 2011
    • CLASS - a new, voluntary, self-funded public long term care insurance program
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 32. Patient Protection and Affordable Care Act As of January 1, 2011
    • Inclusion of cost of employer-sponsored health coverage on W-2 (Delayed to 2012)
    • Increase in additional tax on distributions from HSAs and Archer MSAs not used for qualified medical expenses to 20%
    • Eliminates tax deduction for retiree expenses allocable to Medicare Part D
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 33. Patient Protection and Affordable Care Act As of January 1, 2011
    • Increases gross income threshold for itemized deduction for medical expenses from 7.5 percent to 10 percent
    • Additional hospital insurance tax on high-income taxpayers
      • single taxpayers with income in excess of $200,000 and couples filing jointly with incomes in excess of $250,000 increases from 0.5 % 0.9 %
    • Requires that non-profit BCBS organizations have a medical loss ratio of 85 percent or higher
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 34. Patient Protection and Affordable Care Act As of January 1, 2011
    • Establishes Simple Cafeteria Plans that ease participation restrictions so that small businesses can provide tax-free benefits to their employees. Under this provision, self-employed individuals are included as qualified employees
    • Support for Pregnant and Parenting Teens and Women
    • Grants for small businesses to provide comprehensive workplace wellness programs
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 35. Patient Protection and Affordable Care Act As of January 1, 2011
    • Requires all plans to cover preventive services and immunizations recommended by the U.S. Preventive Services Task Force and the CDC, certain child preventive services recommended by the Health Resources and Services Administration (HRSA), and women’s preventive care and screening recommended by HRSA, without any cost-sharing .
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 36. Patient Protection and Affordable Care Act
      • As of 2013
        • Limits the amount of contributions to health FSAs to $2,500 per year
        • Medicare Tax increase on investment income from 2.9 to 3.8
        • Exchanges begin being marketed and employees are made aware
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 37. Patient Protection and Affordable Care Act
      • As of 2014
        • Total Ban on Pre-existing condition denials
        • Health insurance exchanges open
        • End to annual benefit maximums
        • Fair health insurance premiums (individuals and small groups age rates limited to 1 to 3 ratio)
          • Small Groups 1 to 100 ees (state can set at 1 to 50 until 2016)
        • Guaranteed availability of coverage
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 38. Patient Protection and Affordable Care Act
      • As of 2014
        • Prohibits discrimination against individual participants and beneficiaries based on health status
          • No Discrimination based on medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability – including acts of domestic violence or disability
          • Permits employers to vary insurance premiums by as much as 30 percent for employee participation in certain health promotion and disease prevention programs
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 39. Patient Protection and Affordable Care Act
      • As of 2014
        • Comprehensive health insurance coverage minimum package defined
          • For all plans in all markets, prohibits out-of-pocket limits that are greater than the limits for Health Savings Accounts. For the small group market, prohibits deductibles that are greater than $2,000 for individuals and $4,000 for families.
        • Prohibition on excessive waiting periods that exceed 90 days
        • Risk Assessment Risk Adjustment with 3% corridor
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 40. Patient Protection and Affordable Care Act
    • As of 2014 - Free choice vouchers
      • Requires employers that offer coverage and make a contribution to provide free choice vouchers to qualified employees for the purchase of qualified health plans through Exchanges.
      • Employees qualify if their required contribution under the employer’s plan would be between 8 and 9.8 percent of their income.
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 41. Patient Protection and Affordable Care Act
      • Insurance Exchanges
        • Available to employees who lose their job, quit or decide to start up their own business
        • Catastrophic plan available to people under the age of 30
        • Catastrophic plan also available to anyone of any age making a salary of less than 8% of the lowest premium plan available.
        • Employees in group plans where the employer does not cover at least 60% of the premium
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 42. Patient Protection and Affordable Care Act
      • Insurance Exchanges
        • Premium subsidies in the exchanges for anyone from 133% to 400% of FPL
        • Free coverage if the cheapest policy exceeds 8% of your income.
        • Expanded Medicaid to 133% of FPL
          • $29,327 for family of four
        • Premiums capped at a percentage of income
          • From 3% to as much as 9.5%
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 43. Patient Protection and Affordable Care Act
      • As of 2018
        • Employer excess premium tax of 40% for plans with premiums exceeding $10,200 for singles and $27,500 for family coverage
          • Retirees and employees in high risk professions like fire fighters would have the excess premium tax kick in at premiums exceeding $11,850 for singles and $30,950 for family coverage
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 44. MediCare
    • Hospital value-based purchasing program – FY 2013
      • payment would be tied to hospital performance on quality measures related to common and high-cost conditions, such as cardiac, surgical and pneumonia care
    • Payment adjustment for conditions acquired in hospitals
      • hospitals in the top 25th percentile of rates of hospital acquired conditions
    • Medicare shared savings program. Rewards Accountable Care Organizations (ACOs)
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 45. MediCare
    • National pilot program on payment bundling
    • Independence at home demonstration program
    • Permitting physician assistants to order post-hospital extended care services
    • Medicare coverage gap discount program
      • Requires drug manufacturers to provide a 50 percent discount to Part D beneficiaries for brand-name drugs and biologics purchased during the coverage gap beginning July 1, 2010
    • Office of women’s health
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 46.
    • Payment Reform
    • Health 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 Improvement
    • Health Information Technology Policy
    • Evidence Based Medicine and a Business Case for Health Information Technology
    Business Case for Investing in HC Reform 04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 47. NOW – Silos of Payment 04/18/11 Prepared by Chuck Kiskaden 949-636-3601 Doctors HMO’s Hospitals Nursing Homes and ECF’s $$$ $$$ $$$ $$$ $$$ $$$ $$$
  • 48. NOW – Silos of Payment 04/18/11 Prepared by Chuck Kiskaden 949-636-3601 Doctors HMO’s Hospitals Nursing Homes and ECF’s $$$ $$$ $$$ $$$ $$$ $$$ $$$
  • 49. FUTURE? Accountable Care Organizations 04/18/11 Prepared by Chuck Kiskaden 949-636-3601 Doctors HMO’s Hospitals Nursing Homes and ECF’s $$$
  • 50.
    • A Financing and Data Integration Model
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 51. 04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 52.
    • What can you do today to manage health care costs?
    Ideas on how to lower HC Costs 04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 53. What Cost Control Options do Employers currently have? 04/18/11 Prepared by Chuck Kiskaden 949-636-3601 Unavoidable Costs Cost Sharing (5% to 10%) Coverage Elections (0% to 15%) Plan Selection (5% to 10%) Provider Selection (5% to 10%) Prescription Therapies (5% to 7.5%) Disease Management (5% to 10%) While no silver bullets will solve the health care crisis, aggressive strategies in two to four areas will have a dramatic impact.
  • 54. 04/18/11 Prepared by Chuck Kiskaden 949-636-3601
    • Improving employees Lives
    • Improving Work/Life Cycle
    • Create a Corporate Wellness Culture
    • Employee/dependents Health Care education
    Seeking Synergy in Managing Employee Benefits!!!
  • 55. 04/18/11 Prepared by Chuck Kiskaden 949-636-3601
    • Employee Benefits Cost Control
    • Plan Design
    • Utilization Management
    • Risk Management Data Reports
    Seeking Synergy in Managing Employee Benefits!!!
  • 56. 04/18/11 Prepared by Chuck Kiskaden 949-636-3601
    • Employers “In Control”
    • Improving Work/Life Cycle
    • Plan Design
    • Create a CorporateWellness Culture
    • Utilization Management
    • Employee/dependents Health Care education
    • Risk Management Data Reports
    Seeking Synergy in Managing Employee Benefits!!!
  • 57. Information and Data Sources 04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 58. Health Care Reform Web Sites
    • 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
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 59.
    • 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 explained
    • Mandates (Cal, Or, WA passed and subs repealed)
    • Hawaii 1974
    • Mass 2006
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601 Health Care Reform Web Sites
  • 60. Health Care Web Sites 04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 61. 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
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 62. 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
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 63. 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 .
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 64. 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/
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 65. 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
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 66. Insurance / Employer Purchasing
    • www.pbgh.org - Pacific Business Group on Health
    • www.calchoice.com – Small employer purchasing pool
    • www.ibenefits.com
    • www.bizjournals.com
    • www.definedcare.com - Defined Care Website
    • www.egroupbenefits.com
    • http://www.healthsmart.org/ - Practical health care information brought to you as a service from the National Business Coalition on Health .
    • http://www.nbch.org/members/members.cfm - List of Business Coalitions by state
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601
  • 67. Info for HR Specialists
    • www.smartbrief.com - AAHP Smartbrief
    • www.benefitsalert.com - ER benefits legal news
    • www.mcol.com
    • [email_address] - Email newsletter
    • http://www.lifemasters.com/ - An internet site to help employers access disease management information
    • www.ncqucalculator.com
    • www.healthleaders.com - stock site
    • www.allbusiness.com - small bus resources
    04/18/11 Prepared by Chuck Kiskaden 949-636-3601