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Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
Health Care Reform 2010
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Health Care Reform 2010

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  • 1. Employer’s Forum Discussion on HealthCare Reform - 2009
    • Changing the Supply and Demand Curve regarding Health Care
    • The Players
    • Why now instead of under Clinton?
    • Which Model will prevail?
    • What will be the impact on Employers and Employees?
    • What can you do now to control costs?
  • 2.  
  • 3. Supply and Demand Curve
  • 4. Supply and Demand Curve What happens when you change the demand, hold the cost and no change in Supply?
  • 5. Employer’s Forum Discussion on HealthCare Reform - 2009
    • Question – How many children in California are un-insured for basic health care?
  • 6. Employer’s Forum Discussion on HealthCare Reform - 2009
    • Question – How many children in California are un-insured for basic health care?
    • 683,000
  • 7. Employer’s Forum Discussion on HealthCare Reform - 2009
  • 8. Employer’s Forum Discussion on HealthCare Reform - 2009
  • 9. Employer’s Forum Discussion on HealthCare Reform - 2009
  • 10. Paying for Health Care Reform
    • Source Health Care Reserve Fund
    • ($ in billions)
    • 10 years
    • FY 2010 Budget   $635
    • - Medicare and Medicaid Savings $309
    • - Revenues $ $326
    • Additional Medicare and Medicaid Savings -  $313
    • - Incorporate productivity adjustments into
      • Medicare payment updates $110
      • Reduce hospital subsidies for treating the uninsured as  coverage increases $106
      • Pay better prices for Medicare Part D drugs $75
      • Other $22
    • Total $948
  • 11. The Players
    • Employers
    • Employees
    • Unemployed
    • Retired
    • Organized Medicine (Docs, Hospitals, HMOs, ancillary Providers, Pharma, etc.)
    • For Profit Insurance Companies & HMO’s
    • States
    • Federal Government
  • 12.  
  • 13. 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???
  • 14. Plan Design Trends
            • 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%
  • 15. National Rx Benefit Trends
            • 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
  • 16. Macro Cost Shifting
  • 17. Macro Cost Shifting Pay Full Retail
  • 18. Macro Cost Shifting Pay Full Retail Best Risks and Underinsured
  • 19. Macro Cost Shifting Pay Full Retail Best Risks and Underinsured Poor Risks, Can’t afford Insurance, etc.
  • 20. Macro Cost Shifting Pay Full Retail Medical paid at $.60 on the dollar Best Risks and Underinsured Poor Risks, Can’t afford Insurance, etc.
  • 21. Why Now?
    • Health Care costs have doubled in last 8 years
    • 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!
  • 22. What Cost Control Options do Employers currently have? 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.
  • 23. Which Model will Prevail?
    • Single Payor System
    • Universal Health Care
      • 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?
  • 24. Current Bills
    • HR 3962 Americas Affordable Health For America Act
    • Proposed Senate Bill “America’s Health Future Act” - HR 3590
  • 25. HR 3962 Americas Affordable Health Choices Act
      • Public Option
      • Pay or Play for employers
      • Guaranteed Coverage (no cherry picking)
      • Minimum benefit level established
      • Federal and State subsidies
        • Probably at 400% of Federal Poverty Level
      • Minimum ER contribution levels set (like SF city regs)
  • 26. HR 3962 Americas Affordable Health Choices Act
    • Immediate Reforms
      • High Risk Pool
      • Ins. Carriers subject to 85% loss ratio max
      • Dependent coverage up to age 27
      • Limits on Pre-existing conditions exclusions
      • Protection for retiree health
    • Health Insurance Exchange in 2013
  • 27. HR 3962 Americas Affordable Health Choices Act
    • Health Insurance Exchange in 2013
      • Small employers
      • Groups with 100 employees after three years
      • Individuals
      • Contracts negotiated with Providers
      • Includes Ins. Plans and Public Option
  • 28. HR 3962 Americas Affordable Health Choices Act
    • Health Insurance Exchange in 2013
      • No Lifetime or annual limits on coverage
      • No exclusions for pre-existing conditions
      • Age rated products allowed, however with Ins. Premium ratio limit of 1 to 2 from youngest to oldest.
  • 29. Affordable Health Care for America (House bill from Pelosi)
    • Health Insurance Exchange in 2013
      • Minimum standard benefit package for all
        • Preventive care with no cost sharing by member
        • Mental Health benefits
        • Oral health and Vision for children
        • Caps on annual Out of Pocket costs ($5K/$10K)
      • Creates CLASS – Voluntary LTC plan
  • 30. Affordable Health Care for America (House bill from Pelosi)
    • Sliding Scale Affordability Credits
      • Up to 400% of FPL ($43k and $88K)
    • Expands M’Caid (Cal) to 150% FPL
    • Improves M’Care
      • Removes donut hole
      • No cost sharing for preventive services
      • Low income subsidies
      • Improved access to providers
  • 31. HR 3962 Americas Affordable Health Choices Act
    • Individuals not buying med. Insurance will pay penalty of up to 2.5% of annual taxable income
    • Play or Pay for employers based on taxable payroll
    • Incentives for more medical students and ancillary medical personnel
  • 32. Business Case for Investing in HC Reform
    • Expanding Access
    • Lowering Health Care Administrative Costs Through a Public-Private Approach to Health Reform
    • The United States leads all industrialized countries in the share of national health care expenditures devoted to insurance administration.
    • Estimated administrative costs would fall from 12.7 percent of claims to an average of 9.4 percent. Savings—as much as $265 billion over 2010–2020—would be realized through less marketing and underwriting, reduced costs of claims administration, less time spent negotiating provider payment rates, and fewer or standardized commissions to insurance brokers.
  • 33.
    • 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
  • 34. NOW – Silos of Payment Doctors HMO’s Hospitals Nursing Homes and ECF’s $$$ $$$ $$$ $$$ $$$ $$$ $$$
  • 35. NOW – Silos of Payment Doctors HMO’s Hospitals Nursing Homes and ECF’s $$$ $$$ $$$ $$$ $$$ $$$ $$$
  • 36. FUTURE? Bundled payment Doctors HMO’s Hospitals Nursing Homes and ECF’s $$$
  • 37.  
  • 38. Proposed Senate Bill America’s Health Future Act – HR 3590
    • $849 billion in cost (over 10 years)
    • $127 Billion decrease in National Debt over next 10 years and $600 billion in following decade
  • 39. Proposed Senate Bill America’s Health Future Act – HR 3590
    • Mandates that everyone buy HC Insurance (like auto in CA) with financial penalty for failure to do so
    • Insurance Exchanges established to provide selected individuals and families with subsidies (100 to 400% of FPL)
      • Start up funds to create CO-Ops
    • Significantly expand M’Caid eligibility (up to 133% of FPL)
      • Expands state liabilities by $33B
    • Reduce growth of M’Care reimbursement to providers and eliminate subsidies for Medicare Advantage HMO plans
  • 40. Proposed Senate Bill “America’s Health Future Act” – HR 3590
    • Impose exise tax on Ins “Cadillac” Plans with high premiums
      • 40% on excess of $8000 (single) and $21000 (family) per year
    • Tax credits for small employers to cover employees
    • Other changes to M’Care, M’Caid and the tax code
    • Affects employers with 50+ employees.
      • Penalty for not providing insurance coverage ($750)
      • Penalty if employees have to pay more than 10% of their salary for insurance
    • Increase in M’Care payroll tax (=.5%) to 1.95%
  • 41.
    • What can you do today to manage health care costs?
    Ideas on how to lower HC Costs
  • 42.
    • Improving employees Lives
    • Improving Work/Life Cycle
    • Being a catalyst for Wellness
    • Employee/dependents Health Care education
    Seeking Synergy in Managing Employee Benefits!!!
  • 43.
    • Employee Benefits Cost Control
    • Plan Design
    • Utilization Management
    • Risk Management Data Reports
    Seeking Synergy in Managing Employee Benefits!!!
  • 44.
    • Employers “In Control”
    • Improving Work/Life Cycle
    • Plan Design
    • Being a catalyst for Wellness
    • Utilization Management
    • Employee/dependents Health Care education
    • Risk Management Data Reports
    Seeking Synergy in Managing Employee Benefits!!!
  • 45.  
  • 46. Information and Data Sources
  • 47. 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
  • 48.
    • 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
    Health Care Reform Web Sites
  • 49. Health Care Web Sites
  • 50. 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
  • 51. 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
  • 52. 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 .
  • 53. 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/
  • 54. 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
  • 55. 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
  • 56. 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
  • 57.  

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