The Crystal Ball of the Health Care Reform
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The Crystal Ball of the Health Care Reform



Presentation made by Dr. Carolyn A. (Cindy) Watts on the 5th of November, 2012 during the live webinar hosted by VCU Department of Gerontology (discussion moderated by Dr E. Ayn Welleford) - review ...

Presentation made by Dr. Carolyn A. (Cindy) Watts on the 5th of November, 2012 during the live webinar hosted by VCU Department of Gerontology (discussion moderated by Dr E. Ayn Welleford) - review recording of webinar at



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The Crystal Ball of the Health Care Reform The Crystal Ball of the Health Care Reform Presentation Transcript

  • Looking into theCrystal Ball of Health Care Reform:Patient Protection and Affordable Care Act (PPACA) and the Allied Health Professions Carolyn Watts, Ph.D. Professor and Chair Department of Health Administration, Virginia Commonwealth University
  • Poll:Knowledge and Attitudes
  • Primary Question:Is Health Care a “Social Good”? YES for elderly, certain YES for most low income Americans NO individuals, disabled 1965 2014
  • Financing Context $8300/person Mixed public/private 50% 17% of GDP (in 2009)Medicare Medicaid Employers Uninsured 15% 20% 67% 18%of population of population of non-elderly of population Up to 2/3 of all births
  • Delivery System Context Volume- based payment Illness – not health – based care Decades of profession al control
  • Proposed by 6 presidentsCrowd-out of Rising un-other public programs employment Pressure for Reform Rising Increasing enrollment inexpenditures public programs Fragile state of delivery system
  • Cost as % of income at all Global time high business • 12.6% in 1996 disadvantage • 23.2% in 2010Approaching Changingnational debt demographics cliff More Pressures
  • Still More PressuresRise of chronic illness/obesity More evidence/information New technology
  • What Did We Expect?
  • Health Care Reform: PPACA Individual Employer mandates responsibility• Subsidies • Tax credits• Fines • Fines
  • PPACA • Limits on underwriting and exclusions • Older dependent children coverageInsurance rules • 2018: tax on first dollar coverage • “Expedia” for private insuranceExchanges • States or federal government (default)
  • PPACA • Eliminate categories; 133% FPL • Federal government pays 100% for 3 Medicaid years expansion • “Donut Hole” • Preventive services Medicare • Provider payment reductions payment cuts;benefit increases • Increases in Medicare payroll tax
  • PPACA • Accountable Care Organizations Delivery and • Bundled payment paymentdemonstrations • Innovation Center • Incentives for employers Wellness • Mandated coverage of prevention
  • PPACA: Myths All Americans must have coverage Exemptions for: • Very low income • Insurance costs > 8% of income • Religious beliefs, incarceration, Native Americans
  • PPACA: MythsEveryone must have thesame coverage• Essential benefit package as floor• Choices through employer/exchange
  • PPACA: More Myths All businesses must provide coverage • Small businesses (< 50 employees) exempt • = 96% of 6M businesses • 96% of other businesses already do • 10,000 businesses (.2%) will be affected
  • …and More Myths Government will take over insurance • MUST contract with at least 2 private insurance companies in every US market
  • …and More Myths Medicare benefits will be drastically cut • Increases for traditional Medicare • Drug coverage • Preventive services • Reduced payments for Medicare HMOs
  • …Still More Myths “Death Panels” will limit care provided • Funding of new evidence base, but CMS prohibited from using it • Pres. G.W. Bush-era legislation allows coverage of integrated advance planning • Independent coverage of advance planning taken out of PPACA
  • So Far….54M Saved $3.7B on 3M Young adults $321M Insurance rebates to small 54M People got newly drugsseniors new dependent businesses (more to big free preventive coverage business) services
  • Evolving government roleEvolving employer role Future Evolving insurance markets Evolving delivery systemEvolving consumer role Evolving technology
  • Future Evolving government roleImpact of States and Medicareelections Medicaid payment/rules
  • Future Evolving employer role Insurance What if they Wellness coverage and drop coverage? programsbenefit changes Harvard study: $3.72 HC Value-based insurance So savings, $2.73 absenteeism design what? savings from $1 wellness program
  • Future Evolving insurance markets Provider Integration Impact ofConsolidation payment with providers exchanges changes
  • Future Evolving delivery systemConsolidation Physician Scope of Retail and Transparency employment practice medicine integration
  • FutureEvolving consumer roleResponsibility Responsibility for health & for financing metrics
  • Future Evolving technologyGenetic New Robotics Telemedicine E-medicinemedicine pharmaceuticals
  • What are the Opportunities for Allied Health? Greater demand Different Expanding payment Medicaid (?) models OPPORTUNITIES for ALLIED HEALTH More Evolving consumer scope of engagement practice Team-based medicine
  • What are the Challenges for Allied Health? Different Lower payment payment rates models More concentrated Shrinking interests Medicaid (?)(payers, syste ms) CHALLENGES