Stan Dorn's Health Care Reform Rundown

Health reform passed —now what? Some overlooked stories National Health Journalism Fellowships July 12, 2010 Stan Dorn The Urban Institute [email_address] 202.261.5561

Overview
Little-known aspects of health reform legislation
Health policy outside the new law
Implementation issues

Part I Little known aspects of the reform law

Introduction
Patient Protection and Affordable Care Act (PPACA or ACA)
Some “early deliverables”
Main provisions effective in 2014
Subsidies
Exchange
Shared responsibility
Insurance reforms

Conservative provisions

Guns
Ban on compelled disclosure of gun ownership
Ban on health plan discrimination based on gun ownership
History

Health insurance exchange
Consumer-driven choice
Diverse offerings
AV standard
Multiple AV levels
Extensive consumer information to guide choice
Both plan and provider

Other conservative provisions
$500 million in funding for abstinence-only education
Limited Medicaid benefits for newly eligible adults
History

New models of health care delivery

Theories of cost control
Traditional argument
From the right, demand-side management
From the left, supply-side management
Common assumption: health care is a fixed widget
Third way: what if we change the widget?
Intuition: we’re paying for things we don’t need
The incentives are wrong
Examples of success: Geisinger, Mayo

But how do we move from TO

CMS Center for Medicare and Medicaid Innovation
$10 billion through 2019
$5 million in planning money for FY 2010
Similar funding thereafter
Broad mandate - test and expand many models
Substantively open-ended

Models specified in law
Patient-centered medical home (PCMH)
Move from FFS to comprehensive or salary-based payment
Care coordination for chronically ill elders
Preventing hospitalization of high-risk patients through disease registry, care coordination, home telehealth
Patient decision-making tools
Fully integrating care and funds for Medicaid/Medicaid dual eligibles
All-payer payment reform
Outpatient care where non-physicians determine
Pharmacist-based medication management

Key concepts of the Patient-Centered Medical Home
Care coordination
Integrated into medical practice
Manage care transitions
Patient education
24/7 availability
Aided by HIT

More nudges towards a new health care approach
Quality standards in the exchange
Care coordination, including PCMH
Effort to prevent hospital readmission
Medicaid PCMH option
Community health teams
Primary care extension centers
Medicare reimbursement reforms
Value-based payments for hospitals and doctors
Penalties for hospitals with high rates of readmission, hospital acquired infection
ACOs
Conflict-of-interest disclosures

Covering the low-income uninsured

21 st -century enrollment
Traditional public benefits
PPACA streamlining
One form, one eligibility determination process for all programs
Data warehouse
Potential for eliminating traditional application forms
Key question: will Medicaid come along?

Medicaid revolution
Shift from categorical to income-based eligibility
Radical simplification
Hints at reimbursement equity

Part II Health policy outside PPACA

Waiting for 2014
Why the delay?
Cost
Implementation
Bad news in the meantime
Economic downturn causes cuts to need-based health programs
Health costs continue to rise
Employer-sponsored insurance (ESI) continues to fray
Health insurers continue to discriminate
Politics: who gets the blame when things go wrong?
Some potentially good news: HIT investments

Part III Implementation of national health reform

“Early deliverables” that have gone largely uncovered
Coverage and access
Small employer tax credits
Reinsurance for early retirees
Community health center expansion
Health consumer assistance programs
Insurance reforms
Preexisting condition exclusions for children
Rescissions
Lifetime and annual limits
Premium review
Delivery system changes do not wait for 2014

Preparing for 2014
States
Extraordinary chance to reform health care
Daunting duties to expand health coverage
Great money-saving opportunities
Very limited administrative capacity
Specific question: the exchange
State or federal operation?
What basic philosophy towards insurers?
Federal administrative capacity

Conclusion
Huge changes under way
Enormous potential
How much of the potential will be realized?

Stan Dorn's Health Care Reform Rundown

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Stan Dorn’s Health Care Reform Rundown Presentation Transcript