A New Landscape for Health Care

Boulder County Business Report
PULSE: What’s Next? Health Care Reform in the Boulder Vall...
Since the passage of the Affordable Care Act (ACA), America has been on a trajectory that will
result in significant chang...
Objectives

Name key components of the national health care reform that have some basis in
current United States health ca...
Health Care in America:
Perfect storm or perfect opportunity?

 Since March 2010 the United States has been on a path to ...
Economic Status
United States economy

 Unemployment: 7.2% (Colorado 7.0%)
 Living in Poverty: 46.5 million people
(15% of US population...
7
8
9
10
Health Insurance Coverage, by type, 2010

11
http://www.kff.org/insurance/snapshot/Employer-Health-Insurance-Costs-and-Worker-Compensation.cfm

12
Health Status
Adult Obesity

14
Childhood Obesity

15
Diabetes

16
Heart Disease Deaths

17
Health Care Costs
Health Care Costs: Contributors
 Aging of the population
 Changes in third party payment
 Personal income growth

 Hea...
Payment Reform Activity
Insurance reforms help, changing care delivery cures!

 Whether through insurance reforms, increa...
Payment Reform Activity
Payment Reform
 Fee for service problems
 Modified arrangements
 Risk sharing arrangements and gain
sharing arrangement...
So, where are we headed?
The Future of Health Care in America
Some Likely Scenarios

 In this section, we will explore some likely outcomes that w...
Looking Ahead
Medicaid
 Limit coverage and
benefits
 More managed care
 Accountable Care
Organizations

Medicare

Insur...
Looking Ahead
Delivery System

Providers

 Coordination of
care, venue
management, integratio
n

 Larger multispecialty
...
Looking Ahead
Patients
 Self-efficacy
 Self-care
 Consumerism
 Higher out of pocket
expenses

27

Hospitals
 Quality ...
Looking Ahead
Brokers/Consultants

PPACA

 Will play increasing
role in the individual
market

 More delays in
implement...
Looking Ahead
Federal and State Government

 Financing health care coverage
challenges will continue
 New rules establis...
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,
...
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 tod...
Thank you!

32
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Pulse - Allen Davis

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  • 2009United States 180.11Alabama231.5Alaska156.9Arizona144.6Arkansas218.8California165.6Colorado136.5Connecticut164.8Delaware177.8District of Columbia219.1Florida154.4Georgia192.5Guam230.52Hawaii145.0Idaho154.6Illinois183.2Indiana195.0Iowa175.9Kansas163.1Kentucky210.2Louisiana223.8Maine157.4Maryland195.0Massachusetts156.3Michigan207.0Minnesota121.9Mississippi244.9Missouri202.5Montana154.0Nebraska153.9Nevada191.8New Hampshire150.1New Jersey180.4New Mexico149.5New York211.0North Carolina178.4North Dakota166.2Ohio189.7Oklahoma226.9Oregon142.6Pennsylvania192.1Rhode Island176.3South Carolina182.1South Dakota168.2Tennessee210.9Texas178.6Utah135.9Vermont156.0Virgin Islands160.32Virginia171.7Washington154.4West Virginia218.1Wisconsin164.7Wyoming173.0Puerto Rico122.02
  • Pulse - Allen Davis

    1. 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. 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. 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 3
    4. 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. 4
    5. 5. Economic Status
    6. 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) 6
    7. 7. 7
    8. 8. 8
    9. 9. 9
    10. 10. 10
    11. 11. Health Insurance Coverage, by type, 2010 11
    12. 12. http://www.kff.org/insurance/snapshot/Employer-Health-Insurance-Costs-and-Worker-Compensation.cfm 12
    13. 13. Health Status
    14. 14. Adult Obesity 14
    15. 15. Childhood Obesity 15
    16. 16. Diabetes 16
    17. 17. Heart Disease Deaths 17
    18. 18. Health Care Costs
    19. 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 19
    20. 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. 20
    21. 21. Payment Reform Activity
    22. 22. Payment Reform  Fee for service problems  Modified arrangements  Risk sharing arrangements and gain sharing arrangements  Global caps  Bundled payments  Quality bonuses 22
    23. 23. So, where are we headed?
    24. 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. 24
    25. 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 25  Creative benefit designs  Explosion in individual coverage  Health Insurance Marketplaces (Exchanges): the bet
    26. 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 26  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. 27. Looking Ahead Patients  Self-efficacy  Self-care  Consumerism  Higher out of pocket expenses 27 Hospitals  Quality improvement activity  Physician-owned practices Employers  Self-funding  Less Employer Sponsored Insurance  Focus on wellness  Productivity measurement will take hold
    28. 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 28 States  Continue to be learning labs  Exchanges will look more similar over time
    29. 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 29
    30. 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'. 30
    31. 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'. 31
    32. 32. Thank you! 32
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