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Healthcare Retrospect Part 3: Achieving The Triple Aim


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In part three of this three part series, John Dalton, Advisor Emeritus at BESLER Consulting, discusses the effects of the PPACA and the path towards achieving the triple aim.

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Healthcare Retrospect Part 3: Achieving The Triple Aim

  1. 1. A Brief History of Health Care Reform Healthcare Retrospect Part 3: Achieving The Triple Aim John J. Dalton, FHFMA Senior Advisor Emeritus
  2. 2. 1990s Here’s the real story of the 1990s – the rapid growth of managed care. In New Jersey, it began with US Healthcare’s primary care gatekeeper model in Burlington County and spread rapidly throughout the state.
  3. 3. 1990s The Institute of Medicine’s 1999 report stating that as many as 98,000 preventable deaths occurred in hospitals each year was a much needed wake-up call to the industry. CLABSIs, CAUTIs and SSIs become part of the Board of Trustees dashboard.
  4. 4. The Third Millennium • 2003 – President George W. Bush signs the Medicare Prescription Drug, Improvement, and Modernization Act (MMA), now Medicare Part D, sometimes described as the full employment act for insurors and Big Pharma. • While it provided prescription drug coverage to seniors, it prohibited Medicare from negotiating discounts from drug companies.
  5. 5. The Third Millennium Employer-sponsored insurance was in decline before PPACA. Many experts expect the decline to continue although recent data show a leveling off.
  6. 6. The Third Millennium 2008 Presidential Campaign • John McCain’s proposals included tax credits - $2,500 for individuals and $5,000 for families who do not subscribe to or do not have access to health care through their employer. To help those denied coverage by insurance companies due to pre- existing conditions, McCain proposed working with states to create what he called a "Guaranteed Access Plan." • Barrack Obama calls for creating a National Health Insurance Exchange including private insurance plans and a Medicare-like government run option with coverage guaranteed regardless of health status; require parents to cover their children, but no requirement for adults to buy insurance.
  7. 7. 2010 - PPACA Modeled on Massachusett’s Romneycare, the Patient Protection and Affordable Care Act was signed into Law by President Obama on March 23, 2010.
  8. 8. 2016 - PPACA Love it or hate it, Obamacare is here to stay. Here’s why: 1. 18.2% of Americans uninsured at enactment; 10.4% in 2014 2. Young adults remain on parents’ policy until age 26; more than 2 million have gained coverage 3. No more coverage denials due to pre-existing conditions 4. Coverage rescinded only for fraud or misrepresentation 5. Health exchanges won’t be going away; Accenture projects that by 2018 private exchange enrollment will hit 40 million 6. Even with 22 states not participating, enrollment in Medicaid and CHIP has grown 26% by nearly 11 million people 7. Hospitals with the highest rates of hospital-acquired conditions now receive reduced payments 8. Quality is up and infection rates are down. From 2008-2013, CLABSIs are down 46% and SSIs are down 16%.
  9. 9. 2016 – the Triple Aim PPACA has bent the cost curve, but much remains to be done. The U.S. has the best-equipped hospitals and the most thoroughly trained physicians in the world, yet our outcomes trail other developed countries and the gap is growing. We must go beyond our comfort zones to provide improved care for our patients and better health for the populations we serve. Only then can the per capita cost of care be reduced.
  10. 10. Contact Information BESLER Consulting 3 Independence Way, Suite 201 Princeton, New Jersey 08540 Phone: 609.514.1400 Toll Free: 877.4BESLER Fax: 609.514.1410