ObamaCare: Why Should You Care?

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Did you have time to read the 1,990 page healthcare bill that was recently passed through Congress? Have you since wondered about the impact that massive bill will have on the average American, health insurance providers, business owners and YOU? If yes, then join the Young Professionals of Chicago as we host a panel of diverse health care professionals that will be discussing current healthcare reform and taking questions on the impact of the United States' new healthcare policy. The distinguished panelists will also provide some insight and clarity into what this massive bill means for individuals like you. There will also be an opportunity for open networking with other young professionals before and after the discussion.

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ObamaCare: Why Should You Care?

  1. 1. Obamacare:Why Should You Care?<br />Presenters:<br />Jermaine Paul / Danyale Ellis <br />Art Estler / Anwer Kahn<br />
  2. 2. State of Healthcare<br />Increasing Uninsured Population<br /><ul><li>Estimated 45 million individuals lack health insurance
  3. 3. Non-elderly adults make up the largest percentage of the uninsured
  4. 4. 80% of uninsured are comprised of individuals from working families</li></ul>Unsustainable Rising Cost<br /><ul><li>Total health expenditures reached $2.3 trillion in 2008
  5. 5. 16.2% of the Gross Domestic Product (GDP)
  6. 6. Aging population
  7. 7. Overutilization of services
  8. 8. Medical bills are the #1 cause of bankruptcy
  9. 9. Increasing number of medical errors</li></ul>Underinvestment in prevention and public health<br /><ul><li>Lack of access to preventative services
  10. 10. Poor personal choices</li></li></ul><li>The Solution<br /> Health Care and Education Affordability Reconciliation Act of 2010 & Patient Protection and Affordable Care ActExpand health insurance coverage to 32 million individuals<br />Expansion of Medicaid eligibility<br />Requires states to expand Medicaid to include childless adults<br />Expanded to 133 percent of the federal poverty level<br />Individual Mandate<br />In 2014, everyone must purchase health insurance or face an annual fine of a flat dollar amount or percent of income<br />Employer Mandate<br />In 2014, employers with more than 50 employees must provide health insurance or pay a fine of $2000 per worker each year if any worker receives federal subsidies to purchase health insurance<br />Preventative care<br />Plan will be required to provide free preventative care<br />Not subject to deductible or co-payment<br />
  11. 11. The Solution Cont.<br />Health Insurance Exchanges<br /><ul><li> Uninsured and self employed can purchase insurance through state-based exchanges</li></ul>Subsidies available for families between 100% -400% of the federal poverty level<br />Separate exchanges for small businesses<br />Tax credits will be made available to companies<br />Insurance Companies<br /><ul><li>Insurers will be prohibited from denying coverage for pre-existing conditions
  12. 12. Insurers required to provide coverage for non-dependent children up to age 26 under their parents’ plan
  13. 13. Bans annual caps and lifetime maximums on coverage</li></ul>Electronic Health Information Technology Investment<br /><ul><li>Electronic Medical Records</li></li></ul><li>Cost of Health Care Reform<br />Congressional Budget Office (CBO) score<br /><ul><li>The plan will cost $940 billion over the next 10 years
  14. 14. Cuts the deficit by $143 billion in the first 10 years
  15. 15. Cuts the deficit by $1.2 trillion in the second 10 years
  16. 16. Reduces annual growth in Medicare expenditures by 1.4 percentage</li></ul> points per year<br />
  17. 17. Financing<br />Medicare Payroll Tax<br /><ul><li>Beginning in 2012, the Medicare Payroll Tax will be expanded to include unearned income. That will be a 3.8% tax on investment income for families making more than $250,000 per year ($200,000 for individuals)</li></ul>Excise Tax <br /><ul><li>Beginning in 2018, insurance companies will pay a 40% excise tax on "Cadillac" high-end insurance plans worth over $27,500 for families ($10,200 for individuals)
  18. 18. 10% excise tax on indoor tanning services
  19. 19. Beginning in 2013, medical device manufacturers will pay a 2.9% excise tax on the sale of any product</li></li></ul><li>Financing Cont.<br />Medicare Advantage Plans<br /><ul><li>Government payments will be reduced by $132 billion over the next 10 years</li></ul>New “Fees”<br /><ul><li>In 2011, new fees will be imposed for brand-name drug makers based on market share in 2011
  20. 20. In 2014, new fees will be imposed on health insurance companies based on market share</li></ul>Enhance Fraud Abuse Checks<br /><ul><li>New screening procedures will be implemented to help eliminate fraud and waste</li></li></ul><li>Healthcare Reform: Federally Qualified Healthcare Facilities<br />Presented By:<br />Danyale Ellis<br />
  21. 21. FQHCs Role in ObamaCare<br />You may be asking yourself, “How does FQHC’s relate to the Healthcare bill?” The current healthcare system does not have the capacity to serve the anticipated millions of individuals who will transition from uninsured to insured once the law goes into effect. Thus, President Obama has and will invest in community health centers to take on a large percentage of the care.<br />
  22. 22. Federally Qualified Health Centers<br /><ul><li>Created under federal law over 40 years ago
  23. 23. Receive Federal Grant: Section 330 of the Public Health Service Act
  24. 24. Administrated by Health Resources and Services Administration (HRSA)
  25. 25. 1,200 centers nation-wide
  26. 26. Serve over 18 million patients
  27. 27. Over a dozen located in Cook County</li></li></ul><li>Federally Qualified Health Centers<br /><ul><li>They provide a variety of services:
  28. 28. Primary Care
  29. 29. Case Management
  30. 30. Transportation
  31. 31. Dental Care
  32. 32. Mental Health
  33. 33. Pharmacy</li></li></ul><li>Current Reform Bill Impacts<br />The current healthcare system does not have the capacity to care for the millions of Americans who will transition from uninsured to insured. Thus, President Obama has and will invest in community health centers to take on a large percentage of the care.<br />
  34. 34. Federal Stimulus Money<br /><ul><li>What has happened?
  35. 35. Through Federal Stimulus Dollars in 2009, community health centers:
  36. 36. Opened new health centers;
  37. 37. Purchased Electronic Health Records Systems;
  38. 38. Took on growing number of uninsured; and
  39. 39. Renovated or built new facilities</li></li></ul><li>Healthcare Reform<br />What will happen?<br /> Through the healthcare reform bill, community health care centers will receive $11.9 billion over the next five years in order to expand their operational capacity to serve nearly 20 million new patients.<br />
  40. 40. Federally Qualified Health Centers<br /> Currently serves over 18 million patients, after the implementation of the healthcare bill, they will nearly double the number of patients served. Due to the funding received through the healthcare reform act, federally qualified health centers will continue to provide quality and affordable health care services to serve those in need<br />
  41. 41. Health Care Reform: Prevention<br />Presented By:Arthur Elster, MD, MJ<br />
  42. 42. Leading Causes of Death: 30-40 yrs<br />Causes Female (%) Male (%)<br /> Cancer 21% 8%<br /> Unintentional Injury 21% 30.5%<br /> Ht Dis. 10% 12%<br /> Suicide 6% 12.5%<br /> Homicide 4% 8%<br /> HIV Dis. 4% 4%<br /> Stroke 3% 2%<br /> Diabetes Mellitus 2.5% 2%<br /> Liver Dis. 2% 2%<br />
  43. 43. Preventable Causes of Death<br />Tobacco (18%)<br />Poor Diet and Physical Activity (16.5%)<br />Alcohol Consumption (3.5%)<br />Microbial Agents (3%)<br />Toxic Agents (2.5%)<br />Motor Vehicle (2%)<br />Firearms (1%)<br />Sexual Behavior…including HIV (1%) <br />Illicit Drug Use (1%)<br /> Non-preventable ….around 50%<br />
  44. 44. Current Issues<br />US health care and insurance industries center on acute care, not prevention (exception….non-for-profit HMO)<br />The greatest advances in health over the past several decades have come from public health and preventive medicine<br />Wellness is often presumed to reside in the personal domain<br />But… an ounce of prevention (may be) worth a pound of cure<br />
  45. 45. What are Preventive Services?<br />Screening, counseling, and immunizations services aimed at “otherwise well populations” delivered in an office setting<br />
  46. 46. Health Care Reform and Preventive Services<br /> "A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for evidence-based items or services that have in effect a rating of `A' or `B' in the current recommendations of the United States Preventive Services Task Force."<br />
  47. 47. Us Preventive Services Task Force:Sample of Recommendations<br />Screening for: <br /><ul><li>HIV
  48. 48. STD
  49. 49. High Blood Pressure,
  50. 50. Type II Diabetes (in people with marginally high B.P.)
  51. 51. Cervical Cancer
  52. 52. Colorectal Cancer
  53. 53. Depression
  54. 54. Mammography (50-74 yrs)
  55. 55. Tobacco Cessation Counseling
  56. 56. Screening and Intensive Counseling for Obesity</li></ul> For the complete list, see www.ahrq.gov/clinic/cps3dix.htm<br />
  57. 57. The Changing Landscape of American Healthcare<br />Presented By:<br />Anwer Khan<br />23<br />
  58. 58. Discussion Points<br /><ul><li>Playing Ball
  59. 59. Managing Change
  60. 60. Making an Impact:
  61. 61. Data Integration
  62. 62. “Meaningful” Application</li></li></ul><li>Playing Ball – Broad & Complex Field<br />The healthcare landscape is becoming increasingly more broad and complex...<br />tomorrow's healthcare organization must be built on a platform of information-driven transparency; one that illustrates:<br />Compelling Cost Savings<br />Repeatable Outcomes <br />Plausible Innovation<br />Good<br />Bad<br /><ul><li>Cheaper catastrophic coverage
  63. 63. No Denials for Pre-existing Conditions or Lifetime Limits
  64. 64. More Access to Information – personal portals and electronic health records
  65. 65. Higher taxes and premiums for upper income earners
  66. 66. Overtime health care costs will rise – forcing the need to save a significant amount for your and potentially your parent’s future
  67. 67. Increased competition across insurers and care providers will require more due diligence from you</li></ul>For<br />You:<br />
  68. 68. Playing Ball– Principal Components of Healthcare Reform<br />The “ABCDE” of<br /> Today’s Healthcare:<br /><ul><li>Access
  69. 69. Best Quality
  70. 70. Cost
  71. 71. Disparities
  72. 72. Effectiveness</li></ul>President Obama’s FY 2010 Budget overview:<br /><ul><li>Reduce long-term growth of health care costs for businesses and government.
  73. 73. Protect families from bankruptcy or debt because of health care costs.
  74. 74. Guarantee choice of doctors and health plans.
  75. 75. Invest in prevention and wellness.
  76. 76. Improve patient safety and quality care.
  77. 77. Assure affordable, quality health coverage for all Americans.
  78. 78. Maintain coverage when you change or lose your job.
  79. 79. End barriers to coverage for people with pre-existing medical conditions.</li></li></ul><li>Playing Ball– Balancing Cost, Quality & Outcomes<br />Patient Education<br />Loss of Position<br />Care Delivery Equilibrium<br />Performance Incentives<br />Data Transparency<br />Delivery Costs<br />Quality of Outcomes<br />Privacy<br />Resource Mix<br />Competitive Position<br />Physician Education<br />Achieving equilibrium is the responsibility of every member of the Healthcare Ecosystem, including the Patient<br />
  80. 80. Managing Change– Good and Bad<br />
  81. 81. Managing Change–Individual and Collective Calls to Action<br />
  82. 82. Making an Impact: High Performance Medicine<br />Clinical Operations at the intersection of Business and Technology<br /><ul><li>Qualify for meaningful use incentive payments
  83. 83. Increase referral volume from community providers
  84. 84. Minimize redundant procedures
  85. 85. Reduce in-patient re-admits
  86. 86. Improve quality, safety, efficiency, and reduce health disparities
  87. 87. Engage patients and families
  88. 88. Improve care coordination
  89. 89. Improve population and public health
  90. 90. Enhance patient safety by reducing medication errors system-wide</li></ul>Streamline business processes:<br /><ul><li>Pre-registration
  91. 91. Provider Information request
  92. 92. Reimbursement information capture
  93. 93. Fulfillment of patient information requests
  94. 94. Ensure adequate privacy and security protections for personal health information
  95. 95. Patient Satisfaction</li></ul>Clinical Practice<br />Business Growth<br /><ul><li>Expand disease management programs by supporting activities for certain patients with chronic illnesses
  96. 96. Increase capture of ancillary services
  97. 97. Improve cost effectiveness through managing utilization trends and analysis of variance</li></ul>Information Technology<br />
  98. 98. Thank You!<br />31<br />
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