Quaker Gardens Discussion on HealthCare Reform - 2009 <ul><li>$400 Billion Impact on MediCare  </li></ul><ul><li>The Playe...
 
Impact on MediCare? <ul><li>Any Changes in Benefits? </li></ul><ul><li>What will happen to the medical delivery system? </...
Possible Changes in M’Care Benefits? <ul><li>Get the “Hole” out of the Donut for MediCare Part D </li></ul><ul><li>Better ...
HR 3962 Proposal <ul><li>Improved financial assistance </li></ul><ul><li>Eliminate Part D cost sharing </li></ul><ul><li>E...
HR 3962 Proposal <ul><li>Improvements in calculating income for calculating part B premiums </li></ul><ul><li>Create Accou...
HR 3962 Proposal <ul><li>Nursing Home Transparency </li></ul><ul><li>Incentivize use of Electronic Medical Records </li></...
HR 3962 Proposal <ul><li>Medical Home Pilot </li></ul><ul><li>Coverage and waiver of cost sharing for preventive medical s...
HR 3962 Proposal <ul><li>Independence at Home medical pilot </li></ul><ul><li>(A) reducing preventable hospitalizations; <...
What will happen to the M’Care Health Care Delivery System? <ul><li>Basic laws of Supply and Demand … </li></ul><ul><ul><l...
Where will the $400+ billion in cuts in M’Care come from? <ul><li>the savings comes from cutting billions of dollars in ov...
Myths in HC Reform? <ul><li>Cuts in Benefits? </li></ul><ul><li>Rationing with Older Citizens being the last to get needed...
Paying for Health Care Reform <ul><li>Source Health Care Reserve Fund </li></ul><ul><li>  ($ in billions) </li></ul><ul><l...
The Players <ul><li>Employers </li></ul><ul><li>Employees </li></ul><ul><li>Unemployed </li></ul><ul><li>Retired </li></ul...
Why Now? <ul><li>Health Care costs have doubled in last 8 years  </li></ul><ul><li>Cost shifting has reached tipping point...
Macro Cost Shifting
Macro Cost Shifting Pay Full Retail
Macro Cost Shifting Pay Full Retail Best Risks and Underinsured
Macro Cost Shifting Pay Full Retail Best Risks and Underinsured Poor Risks, Can’t afford Insurance, etc.
Macro Cost Shifting Pay Full Retail Medical paid at $.60 on the dollar Best Risks and Underinsured Poor Risks, Can’t affor...
 
Which Model will Prevail? <ul><li>Single Payor System </li></ul><ul><li>Universal Health Care </li></ul><ul><ul><li>With H...
<ul><li>Payment Reform </li></ul><ul><li>Health Care Payment Reform That Rewards Value, Not Volume   </li></ul><ul><li>Bun...
 
Ideas on how to lower HC Costs <ul><li>Competitive Public Plan  </li></ul><ul><li>Change MediCare payment structure </li><...
Ideas on how to lower HC Costs <ul><li>Use Best Practices and Evidence Based Medicine </li></ul><ul><ul><li>Conduct Compar...
 
NOW – Silos of Payment Doctors  HMO’s Hospitals Nursing Homes and ECF’s $$$ $$$ $$$ $$$ $$$ $$$ $$$
NOW – Silos of Payment Doctors  HMO’s Hospitals Nursing Homes and ECF’s $$$ $$$ $$$ $$$ $$$ $$$ $$$
FUTURE? Bundled payment Doctors  HMO’s Hospitals Nursing Homes and ECF’s $$$
Ideas on how to lower HC Costs <ul><li>Mandate that everyone be covered by all carriers with no pre-existing condition exc...
Information and Data Sources
Health Care Reform Web Sites <ul><li>AARP.org  </li></ul><ul><li>commonwealthfund.org /   </li></ul><ul><li>healthreform.g...
<ul><li>http:// randcompare.org / </li></ul><ul><li>http:// randcompare.org /current/ </li></ul><ul><li>http:// randcompar...
Health Care Web Sites
Medical Info/Research <ul><li>www.medem.com  - modern medical library  </li></ul><ul><li>www.ncqa.com  - Nat'l Committee o...
Employee Empowerment & Health Wellness <ul><li>www.4women.gov  - Nat'l Women’s Health site </li></ul><ul><li>www.ivanhoe.c...
Employee Empowerment & Health Wellness <ul><li>http://www.hhs.gov/transparency/  -  The “Four” Value Driven Health Care Pr...
Provider/Health Plan Report Cards <ul><li>www.healthscope.org </li></ul><ul><li>www.lumetra.org  - dedicated to measurably...
Government Web Sites <ul><li>www.cdc.gov  - Center for Disease Control </li></ul><ul><li>www.medlineplus.gov </li></ul><ul...
The end Questions????
 
 
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Health Care Reform 2009 W Medicare Info

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A presentation on Health Care Reforms potential impact on Medicare given to a group of 100 retirees in a retirement community.

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Health Care Reform 2009 W Medicare Info

  1. 1. Quaker Gardens Discussion on HealthCare Reform - 2009 <ul><li>$400 Billion Impact on MediCare </li></ul><ul><li>The Players </li></ul><ul><li>Why now instead of under Clinton? </li></ul><ul><li>Which Model will prevail? </li></ul><ul><li>What will be the impact on Employers and Employees? </li></ul>
  2. 3. Impact on MediCare? <ul><li>Any Changes in Benefits? </li></ul><ul><li>What will happen to the medical delivery system? </li></ul><ul><li>What happens when MediCare is cut by $400+ Billion over 10 Years? </li></ul><ul><li>Myths in HC Reform? </li></ul>
  3. 4. Possible Changes in M’Care Benefits? <ul><li>Get the “Hole” out of the Donut for MediCare Part D </li></ul><ul><li>Better programs on transition of care from Hospital to other levels of care </li></ul>
  4. 5. HR 3962 Proposal <ul><li>Improved financial assistance </li></ul><ul><li>Eliminate Part D cost sharing </li></ul><ul><li>Eliminate barriers to enrollment </li></ul><ul><li>Improve communications to eligibles </li></ul><ul><li>Extended coverage of immunosuppressive drugs </li></ul><ul><li>Voluntary advance care planning services </li></ul>
  5. 6. HR 3962 Proposal <ul><li>Improvements in calculating income for calculating part B premiums </li></ul><ul><li>Create Accountable Care Organizations to reward medical providers for improvements in Quality of Care </li></ul><ul><li>Funding of MediCare graduate medical education </li></ul><ul><li>MediCare Rural access protections </li></ul>
  6. 7. HR 3962 Proposal <ul><li>Nursing Home Transparency </li></ul><ul><li>Incentivize use of Electronic Medical Records </li></ul><ul><li>Bundled payments for post-acute care services </li></ul><ul><li>Address geographic inequities in provider payment </li></ul><ul><li>No Mid-year drug formulary changes allowed </li></ul><ul><li>Free Generic drugs (Jan 2011) </li></ul>
  7. 8. HR 3962 Proposal <ul><li>Medical Home Pilot </li></ul><ul><li>Coverage and waiver of cost sharing for preventive medical services </li></ul><ul><li>Waiver of deductible for colorectal screening services </li></ul><ul><li>Expanding access to vaccines </li></ul>
  8. 9. HR 3962 Proposal <ul><li>Independence at Home medical pilot </li></ul><ul><li>(A) reducing preventable hospitalizations; </li></ul><ul><li>(B) preventing hospital readmissions; </li></ul><ul><li>(C) reducing emergency room visits; </li></ul><ul><li>(D) improving health outcomes commensurate with the beneficiaries’ stage of chronic illness; </li></ul><ul><li>(E) improving the efficiency of care, such as by reducing duplicative diagnostic and laboratory tests; </li></ul><ul><li>(F) reducing the cost of health care services covered under this title; and </li></ul><ul><li>(G) achieving beneficiary and family care giver satisfaction. </li></ul>
  9. 10. What will happen to the M’Care Health Care Delivery System? <ul><li>Basic laws of Supply and Demand … </li></ul><ul><ul><li>Well, if you decrease the payment and keep the demand the same, there could be less providers accepting MediCare’s allowed charges! OUCH! </li></ul></ul>
  10. 11. Where will the $400+ billion in cuts in M’Care come from? <ul><li>the savings comes from cutting billions of dollars in overpayments to insurance companies and eliminating waste, fraud, and abuse </li></ul>
  11. 12. Myths in HC Reform? <ul><li>Cuts in Benefits? </li></ul><ul><li>Rationing with Older Citizens being the last to get needed health care? </li></ul><ul><ul><li>Bureacratic Health Care Panels that say NO? </li></ul></ul><ul><ul><li>Forced Euthanasia? </li></ul></ul><ul><li>HC Reform will Bankrupt America? </li></ul><ul><li>Illegal Immigrants will be covered? </li></ul>
  12. 13. Paying for Health Care Reform <ul><li>Source Health Care Reserve Fund </li></ul><ul><li> ($ in billions) </li></ul><ul><li>10 years </li></ul><ul><li>FY 2010 Budget   $635 </li></ul><ul><li>- Medicare and Medicaid Savings $309 </li></ul><ul><li>- Revenues $ $326 </li></ul><ul><li>Additional Medicare and Medicaid Savings -  $313 </li></ul><ul><li>- Incorporate productivity adjustments into </li></ul><ul><ul><li>Medicare payment updates $110 </li></ul></ul><ul><ul><li>Reduce hospital subsidies for treating the uninsured as  coverage increases $106 </li></ul></ul><ul><ul><li>Pay better prices for Medicare Part D drugs $75 </li></ul></ul><ul><ul><li>Other $22 </li></ul></ul><ul><li>Total $948 </li></ul>
  13. 14. The Players <ul><li>Employers </li></ul><ul><li>Employees </li></ul><ul><li>Unemployed </li></ul><ul><li>Retired </li></ul><ul><li>Organized Medicine (Docs, Hospitals, HMOs, ancillary Providers, Pharma, etc.) </li></ul><ul><li>For Profit Insurance Companies & HMO’s </li></ul><ul><li>States </li></ul><ul><li>Federal Government </li></ul>
  14. 15. Why Now? <ul><li>Health Care costs have doubled in last 8 years </li></ul><ul><li>Cost shifting has reached tipping point to trigger federal & state intervention </li></ul><ul><ul><li>Tipping points are &quot;the levels at which the momentum for change becomes unstoppable.&quot; </li></ul></ul><ul><li>$800,000,000,000 in potential savings! </li></ul>
  15. 16. Macro Cost Shifting
  16. 17. Macro Cost Shifting Pay Full Retail
  17. 18. Macro Cost Shifting Pay Full Retail Best Risks and Underinsured
  18. 19. Macro Cost Shifting Pay Full Retail Best Risks and Underinsured Poor Risks, Can’t afford Insurance, etc.
  19. 20. Macro Cost Shifting Pay Full Retail Medical paid at $.60 on the dollar Best Risks and Underinsured Poor Risks, Can’t afford Insurance, etc.
  20. 22. Which Model will Prevail? <ul><li>Single Payor System </li></ul><ul><li>Universal Health Care </li></ul><ul><ul><li>With Health Care Exchange that includes a Public Plan or Health Care Co-operative </li></ul></ul><ul><ul><ul><li>At State Level? (A program like the HIPC?) </li></ul></ul></ul><ul><ul><ul><li>At Federal Level? </li></ul></ul></ul><ul><ul><li>Pay or Play for employers </li></ul></ul><ul><ul><li>Guaranteed Coverage (no exclusions for pre-existing conditions and no cherry picking) </li></ul></ul><ul><ul><li>Minimum benefit level established </li></ul></ul><ul><ul><li>Federal and State subsidies </li></ul></ul><ul><ul><ul><li>Probably at 400% of Federal Poverty Level </li></ul></ul></ul><ul><ul><li>Minimum ER contribution levels set (like SF city regs) </li></ul></ul>
  21. 23. <ul><li>Payment Reform </li></ul><ul><li>Health Care Payment Reform That Rewards Value, Not Volume </li></ul><ul><li>Bundling payments to cover care over a specified period, revising fees to increase compensation for primary care, and offering providers financial incentives to serve as patient-centered medical homes </li></ul><ul><li>Quality Improvement </li></ul><ul><li>Health Information Technology Policy </li></ul><ul><li>Evidence Based Medicine and a Business Case for Health Information Technology </li></ul>Business Case for Investing in HC Reform
  22. 25. Ideas on how to lower HC Costs <ul><li>Competitive Public Plan </li></ul><ul><li>Change MediCare payment structure </li></ul><ul><ul><li>Reduce annual increases to providers </li></ul></ul><ul><ul><li>Reduce payments to M’Care Advantage Plans (now 14% higher than FFS docs) </li></ul></ul><ul><ul><li>Pharma discounts for Seniors Rx in the Doughnut Hole </li></ul></ul>
  23. 26. Ideas on how to lower HC Costs <ul><li>Use Best Practices and Evidence Based Medicine </li></ul><ul><ul><li>Conduct Comparative Effectiveness Research at new proposed “ Center for Quality Improvement” </li></ul></ul><ul><ul><ul><li>Docs and Hospitals </li></ul></ul></ul><ul><ul><li>Create Incentives for delivering Quality Medical Care </li></ul></ul><ul><ul><li>Bundle Payments to Providers to encourage “coordinated care” across provider spectrum </li></ul></ul>
  24. 28. NOW – Silos of Payment Doctors HMO’s Hospitals Nursing Homes and ECF’s $$$ $$$ $$$ $$$ $$$ $$$ $$$
  25. 29. NOW – Silos of Payment Doctors HMO’s Hospitals Nursing Homes and ECF’s $$$ $$$ $$$ $$$ $$$ $$$ $$$
  26. 30. FUTURE? Bundled payment Doctors HMO’s Hospitals Nursing Homes and ECF’s $$$
  27. 31. Ideas on how to lower HC Costs <ul><li>Mandate that everyone be covered by all carriers with no pre-existing condition exclusions and no adverse selection rating. </li></ul>
  28. 32. Information and Data Sources
  29. 33. Health Care Reform Web Sites <ul><li>AARP.org </li></ul><ul><li>commonwealthfund.org / </li></ul><ul><li>healthreform.gov / </li></ul><ul><li>mailmanschool.org/facultypubs/womenshealthcarereform.pdf </li></ul><ul><li>whitehouse.gov/assets/documents/CEA_Health_Care_Report.pdf </li></ul><ul><li>reuters.com/article/healthNews/idUSTRE56K01720090721 </li></ul><ul><li>hudson.org/files/documents/20090612_JB_Kuttner_longterm_fiscal_impact_health_reform.pdf </li></ul>
  30. 34. <ul><li>http:// randcompare.org / </li></ul><ul><li>http:// randcompare.org /current/ </li></ul><ul><li>http:// randcompare.org /options/ </li></ul><ul><li>http:// randcompare.org/options/mechanism/refundable_tax_credit </li></ul><ul><li>http:// randcompare.org/options/mechanism/purchasing_pools </li></ul><ul><li>Massachusetts “Health Care Connector” </li></ul><ul><li>http:// randcompare.org/options/mechanism/employer_mandate </li></ul><ul><li>Pay or Play explained </li></ul><ul><li>Mandates (Cal, Or, WA passed and subs repealed) </li></ul><ul><li>Hawaii 1974 </li></ul><ul><li>Mass 2006 </li></ul>Health Care Reform Web Sites
  31. 35. Health Care Web Sites
  32. 36. Medical Info/Research <ul><li>www.medem.com - modern medical library </li></ul><ul><li>www.ncqa.com - Nat'l Committee on Qual. Assurance </li></ul><ul><li>www.doctorsolve.com / - Info on drugs in Canada </li></ul><ul><li>www.coverfingtheuninsured.org </li></ul><ul><li>www.insureusa.org </li></ul><ul><li>http://www.prevent.org/ - information on disease prevention and health promotion policies and practices </li></ul><ul><li>www.cmwf.org/index.htm - Commonwealth Fund </li></ul>
  33. 37. Employee Empowerment & Health Wellness <ul><li>www.4women.gov - Nat'l Women’s Health site </li></ul><ul><li>www.ivanhoe.com - Medical Breakthroughs </li></ul><ul><li>http:// vm.cfsan.fda.gov - US FDA Food Safety Ctr. </li></ul><ul><li>www.healthyroads.com – ASHP wellness product </li></ul><ul><li>www.new.chcf.org - Cal Health Care Fndn </li></ul><ul><li>www.mrmib.ca.gov – MRMIB </li></ul><ul><li>http:// www.opa.ca.gov/report_card / . - Cal Office of Patient Advocate </li></ul><ul><li>www.healthcarecoach.com/ </li></ul><ul><li>www.mayoclinic.com </li></ul><ul><li>http:// www.doclopedia.com - Use doclopedia to put your medical history, prescriptions, and bills in one convenient space for FREE </li></ul>
  34. 38. Employee Empowerment & Health Wellness <ul><li>http://www.hhs.gov/transparency/ - The “Four” Value Driven Health Care Principles. Health care transparency provides consumers with the information necessary, and the incentive, to choose health care providers based on value. </li></ul><ul><li>www.netwellness.org – 100 health topics to find in-depth information on hundreds of diseases and wellness issues </li></ul><ul><li>http://www.insureuonline.org/ - The National Association of Insurance Commissioners (NAIC) has created the Insure U — Get Smart About Insurance program to help consumers make educated decisions. </li></ul><ul><li>www.organizedwisdom.com - OrganizedWisdom is a collaborative health information community, combining professional and user-generated health content with social networking technologies to help people make the most informed health decisions possible . </li></ul>
  35. 39. Provider/Health Plan Report Cards <ul><li>www.healthscope.org </li></ul><ul><li>www.lumetra.org - dedicated to measurably improving the quality, safety, and integrity of healthcare. </li></ul><ul><li>www.aahp.org - Amer Assn of Health Plans </li></ul><ul><li>www.chcf.org – California Health Care Foundation </li></ul><ul><li>www.healthcarecoverageguide.org – Cal Health Care Foundation web site </li></ul><ul><li>www.guiadecoberturadesalud.org – CHCF hispanic site for small employers </li></ul><ul><li>www. benefitscheckup.org/ </li></ul>
  36. 40. Government Web Sites <ul><li>www.cdc.gov - Center for Disease Control </li></ul><ul><li>www.medlineplus.gov </li></ul><ul><li>www.medicare.gov / - info on Part D drug plans </li></ul><ul><li>www.leginfo.ca.go - Cal ins code </li></ul><ul><li>www.dmhc.ca.gov - Dept Managed Health Care </li></ul><ul><li>www.mrmib.org – High Risk Ins pools </li></ul>
  37. 41. The end Questions????

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