1. A New Landscape for Health Care
Boulder County Business Report
PULSE: What’s Next? Health Care Reform in the Boulder Valley
November 12, 2013
Jandel T. Allen-Davis, MD
Vice President, Government and External Relations
Kaiser Permanente, Colorado Region

2. Since the passage of the Affordable Care Act (ACA), America has been on a trajectory that will
result in significant changes in how health care in America is delivered, experienced and
financed. Even if none, some or all of the landmark legislation is changed or delayed in
implementation, we will not retreat to the health care system of old.
In this discussion, after reviewing many of the changes that have taken place in United States
with the passage of the ACA, we will take a speculative look into the future, based on the current
status of health care in the US and in Colorado.

3. Objectives
Name key components of the national health care reform that have some basis in
current United States health care reform initiatives.
Identify 4 key strategies to control costs in the US health care system.
Articulate one potential scenario, should the public policy debate regarding health care
reform change.
Fifth Agenda
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4. Health Care in America:
Perfect storm or perfect opportunity?
 Since March 2010 the United States has been on a path to enact
the Affordable Care Act. In this section, we will lay out the
current status of health care in America: the cost, the coverage
and the outcomes.
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5. Economic Status

6. United States economy
 Unemployment: 7.2% (Colorado 7.0%)
 Living in Poverty: 46.5 million people
(15% of US population)
 Uninsured: 14.8% (National Health
Interview Survey Jan.-March 2013)
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11. Health Insurance Coverage, by type, 2010
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12. http://www.kff.org/insurance/snapshot/Employer-Health-Insurance-Costs-and-Worker-Compensation.cfm
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13. Health Status

14. Adult Obesity
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15. Childhood Obesity
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16. Diabetes
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17. Heart Disease Deaths
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18. Health Care Costs

19. Health Care Costs: Contributors
 Aging of the population
 Changes in third party payment
 Personal income growth
 Health sector prices
 Administrative costs
 Defensive medicine and supplierinduced demand
 Technology related changes in medical
practice
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20. Payment Reform Activity
Insurance reforms help, changing care delivery cures!
 Whether through insurance reforms, increasing access to
coverage, or changing how care is delivered and by whom, many
feel that the pace of increase in the cost of health care will not
decelerate until we change how the system is organized and
how providers are paid.
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21. Payment Reform Activity

22. Payment Reform
 Fee for service problems
 Modified arrangements
 Risk sharing arrangements and gain
sharing arrangements
 Global caps
 Bundled payments
 Quality bonuses
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23. So, where are we headed?

24. The Future of Health Care in America
Some Likely Scenarios
 In this section, we will explore some likely outcomes that will
define how care and coverage will play out in the coming
decades. We will cover topics such as
Medicaid, Medicare, Health Insurance Exchanges, health
insurance benefit design, health care status of
Americans, delivery systems of the future and the role of
information technology.
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25. Looking Ahead
Medicaid
 Limit coverage and
benefits
 More managed care
 Accountable Care
Organizations
Medicare
Insurance Market
 Means testing: higher
income people will
have less access
 Fewer small players:
mergers, acquisitions
 Set the standards for
care across the
nation
 Financial pressures
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 Creative benefit
designs
 Explosion in
individual coverage
 Health Insurance
Marketplaces
(Exchanges): the bet

26. Looking Ahead
Delivery System
Providers
 Coordination of
care, venue
management, integratio
n
 Larger multispecialty
groups, fewer
physician owned
practices
 Proliferation of
electronic health
records
 More interoperability
and transparency
 Value equation: quality
and efficiency
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 Shift back to primary
care as payment
reform takes hold
 Pay for value
Communities
 Health status will
continue to decline
 Focus on community
health
 Built
environment, dispariti
es, “place matters”

27. Looking Ahead
Patients
 Self-efficacy
 Self-care
 Consumerism
 Higher out of pocket
expenses
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Hospitals
 Quality improvement
activity
 Physician-owned
practices
Employers
 Self-funding
 Less Employer
Sponsored Insurance
 Focus on wellness
 Productivity
measurement will
take hold

28. Looking Ahead
Brokers/Consultants
PPACA
 Will play increasing
role in the individual
market
 More delays in
implementation
possible
 Consolidation among
the players
 “The end of the
beginning of health
care reform.”
 Navigators, Assisters
, Health Coverage
Guides
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States
 Continue to be
learning labs
 Exchanges will look
more similar over
time

29. Looking Ahead
Federal and State Government
 Financing health care coverage
challenges will continue
 New rules establish incentives to get
most of the US population into the risk
pool, standardize benefit design and
pricing
 State and federal regulators better
positioned as referees over a leveled
playing field
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30. We are at the beginning…
The Road goes ever on and on
Down from the door where it began,
Now far ahead the Road has gone,
And I must follow if I can,
Pursuing it with eager feet,
Until it joins some larger way
Where many path and errands meet.
And whither then? I cannot say.
— The Lord of the Rings
The Old Walking Song sung by Bilbo Baggins, Chapter 'A
Long-Expected Party'.
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31. We are at the beginning…
Still round the corner there may wait
A new road or a secret gate,
And though we pass them by today,
Tomorrow we may come this way
And take the hidden paths that run
Towards the Moon or to the Sun.
— The Lord of the Rings
A Walking Song sung by Frodo, Sam and Pippin, as they
set off for Buckland, Chapter 'Three is Company'.
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32. Thank you!
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