Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Health reform webinair

476 views

Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Health reform webinair

  1. 1. Making the Investments Work: Implementing Health Reform in Florida Leda M. Perez, vice president of Health Initiatives, Collins Center Jack Meyer, principal, Health Management Services Sharon Silow-Carroll, principal, Health Management Services February 17, 2011
  2. 2. Welcome and introduction Page  The Collins Center for Public Policy finds smart solutions to important issues facing the people of Florida and the nation. We are independent, non-partisan, non-profit and passionately committed to lasting results. Health Management Associates is a consulting firm specializing in the fields of health system restructuring, health care program development, health economics and finance, program evaluation, and data analysis, with a special concentration on addressing the needs of the medically indigent and underserved people and assessing the new health reform legislation.
  3. 3. Commissioning the study Page  <ul><li>Foundation to Promote an Open Society (in partnership with the Open Society Institute) funds Collins Center in December 2009 </li></ul><ul><ul><li>- Collins establishes the Florida Stimulus Program, creating an online community </li></ul></ul><ul><ul><li>Reports on American Reinvestment and Recovery Act (ARRA) spending in Florida </li></ul></ul>
  4. 4. Author Jack Meyer, Ph.D. Page 
  5. 5. Author Sharon Silow-Carroll, MSW, MBA Page 
  6. 6. Page 
  7. 7. Goals of the report Page  <ul><li>Present the key features of national health reform in objective, clear terms </li></ul><ul><li>Determine the potential benefits to Florida </li></ul><ul><li>Explain the main challenges involved in implementing the law </li></ul><ul><li>Provide recommendations to address these challenges and maximize the benefits </li></ul>
  8. 8. Should Florida maintain the status quo? Page  <ul><li>Florida has over 4 million uninsured , and this number has been steadily rising </li></ul><ul><li>The state unemployment rate is well above the national average </li></ul><ul><li>Employers, particularly small firms, are under great pressure, and many may drop coverage </li></ul><ul><li>Florida Medicaid has very low eligibility standards , so decline in employer coverage means more uninsured </li></ul>
  9. 9. Should Florida maintain the status quo? Page  <ul><li>Going without insurance has direct costs (e.g. uncompensated care, cost-shift to privately insured) and indirect costs (e.g. work and school absenteeism, lower productivity, premature deaths); indirect costs valued at approx. $8-17billion/year </li></ul>
  10. 10. Key components of health reform <ul><li>Medicaid Expansion </li></ul><ul><li>Health Insurance Exchanges </li></ul><ul><li>Insurance Market Reforms </li></ul><ul><li>Requirements on individuals and employers </li></ul><ul><li>Financing measures </li></ul><ul><li>Grant opportunities </li></ul>
  11. 11. Medicaid expansion <ul><li>Florida would add about 1.0 to 1.4 million enrollees to Medicaid , beginning in 2014 </li></ul><ul><ul><li>— about 0.7 to 1.1 million of these would be newly insured </li></ul></ul><ul><li>The additional cost to the state is about $1.2-$2.5 billion over the period of 2014-2019 (over $66.3b baseline) </li></ul><ul><li>But the state would draw in $20-24 billion , or at least $10 from feds for each dollar it spends </li></ul><ul><li>For the newly eligible people, Florida would get $25 in federal funds for each state dollar </li></ul>
  12. 12. Medicaid expansion <ul><li>Hospitals should realize at least $1 billion in savings from reduced uncompensated care; physicians/other providers will get savings </li></ul><ul><li>Indirect savings will emerge from fewer absences from school and jobs, greater productivity, fewer premature deaths, and better health </li></ul><ul><li>Even if half of indirect costs are realized, the sum of direct and indirect savings to the private and public sectors will more than offset these new state costs </li></ul>
  13. 13. Outreach and enrollment <ul><li>Florida should use 21 st Century enrollment techniques that use data matching from other programs/sources outside health care to determine likely eligibility </li></ul><ul><li>Florida should expand use of community health workers to connect eligible people to programs and help them navigate the health system </li></ul>
  14. 14. Benefits to Florida <ul><li>Improve access to prevention/primary care </li></ul><ul><li>Reduce avoidable ER, hospital admissions </li></ul><ul><li>Improve health outcomes, productivity </li></ul><ul><li>Save on total costs per person </li></ul><ul><li>Reduce uncompensated care burden </li></ul><ul><li>Reduce cost-shift to private payers </li></ul>
  15. 15. Challenges in Medicaid Expansion <ul><li>Assuring an adequate health care work force </li></ul><ul><ul><li>This will require raising, not lowering payments for doctors, nurses, and other professionals </li></ul></ul><ul><li>Preparing to serve a population with complex medical needs </li></ul><ul><ul><li>High incidence of chronic illness among poor and near-poor childless adults </li></ul></ul><ul><li>Finding the funds for the state’s contribution amidst competing needs and capturing some of savings </li></ul>
  16. 16. Health Insurance Exchange <ul><li>Exchange is insurance ‘marketplace’ for individuals and small businesses to compare and purchase health plans, receive subsidies </li></ul><ul><li>Can offer single point of entry to determine eligibility for enrollment and subsidies in Exchange, Medicaid, and CHIP </li></ul><ul><li>FL can create own Exchange(s) rather than let federal government step in and do it </li></ul><ul><ul><li>Choices re: governance, number of exchanges </li></ul></ul><ul><li>Potential for Exchanges to be active purchasers driving savings and quality gains </li></ul>
  17. 17. Benefits of Exchanges <ul><li>Broad choice of private insurance for people who have had no choice or very limited choice </li></ul><ul><li>Subsidies scaled to income will help moderate and middle-income people afford coverage </li></ul><ul><li>Exchanges could improve quality and lower costs through smart purchasing </li></ul>
  18. 18. Exchange Challenges <ul><li>Build an electronic-based system of determining eligibility for multiple programs </li></ul><ul><li>Create secure data sharing with federal agencies </li></ul><ul><li>Match federal tax credits with household contribution and get total to health plans </li></ul><ul><li>Develop capacity to assess health plans on rates, quality of care, provider networks, medical loss ratio </li></ul>
  19. 19. Insurance Market Reforms <ul><li>2010: already in force </li></ul><ul><li>No lifetime caps, restricted annual caps, limits on rescinding </li></ul><ul><li>Children may stay on parents’ plans until age 26 </li></ul><ul><li>No pre-existing condition exclusions for kids </li></ul><ul><li>2011 </li></ul><ul><li>Plans must report how premiums are spent </li></ul><ul><li>Process for state review of premium increases </li></ul>
  20. 20. Insurance Market Reforms <ul><li>2012 </li></ul><ul><li>Rebates to consumers if MLR<80% (indiv/sm grp) or 85% (large) </li></ul><ul><li>2014 </li></ul><ul><li>Guaranteed issue and renewability (no one denied) </li></ul><ul><li>Rates may not vary with health status, limited variation on age </li></ul><ul><li>No annual limits on value of coverage </li></ul>
  21. 21. Benefits of Insurance Market Reforms <ul><li>Child (and later, anyone) with disability or prior illness will not be denied coverage or face exorbitant rates </li></ul><ul><li>Young adult without job-based insurance can remain on parent’s plan until age 26 </li></ul><ul><li>Person requiring expensive treatments would not see coverage terminated after reaching plan cap </li></ul><ul><li>Older adults not yet eligible for Medicare would see more affordable insurance rates </li></ul>
  22. 22. Insurance Market Reform Challenges <ul><li>Premiums for younger workers likely to rise; some may decline coverage and pay the modest penalty </li></ul><ul><li>State must develop and implement new regulations and procedures to review insurers’ premiums and how they are used </li></ul><ul><li>State must determine whether rate increases are “reasonable” to keep premiums affordable, without leading to many insurers leaving the state </li></ul>
  23. 23. Federal Funding Opportunities <ul><li>Community Health Centers </li></ul><ul><li>Expand capacity, test wellness plans </li></ul><ul><li>Medicaid </li></ul><ul><li>“ Health homes” for chronically ill patients </li></ul><ul><li>Quality measurement program </li></ul><ul><li>Global & Bundled payment demos </li></ul><ul><li>Pediatric Accountable Care Organization demo </li></ul><ul><li>Employers </li></ul><ul><li>Workplace wellness programs </li></ul><ul><li>Other: med malpractice demo, diabetes prevention… </li></ul>
  24. 24. Employer & Individual Obligations <ul><li>Employers </li></ul><ul><li>Small businesses not required to provide insurance; but if they do, eligible for up to 30% tax credit </li></ul><ul><li>Businesses with more than 50 workers must offer coverage or pay an assessment </li></ul><ul><li>Businesses with up to 100 workers may buy through Exchange; larger firms may do so in 2017 </li></ul><ul><li>Firms with more than 200 employees must automatically enroll workers unless they opt out </li></ul><ul><li>Individuals </li></ul><ul><li>2014: US citizens & legal residents must obtain coverage or pay penalty (exemptions for hardship cases) </li></ul>
  25. 25. Financing <ul><li>Smaller increases in Medicare payments to providers </li></ul><ul><li>Lower payments to Medicare Advantage plans </li></ul><ul><li>Board recommends cost-containment strategies if Medicare grows too fast </li></ul><ul><li>0.9% payroll tax increase for couples $250k+ and individuals $200k+, and 3.8% tax on unearned income for high-income taxpayers (affecting about 2% households) </li></ul><ul><li>Excise tax on insurers selling “Cadillac” policies </li></ul><ul><li>$2,500 limit on FSA medical contributions </li></ul><ul><li>Fees on pharmaceutical and medical device manufacturers, health insurers, and tanning salons </li></ul>
  26. 26. Action Steps <ul><li>Prepare Medicaid </li></ul><ul><li>Innovative outreach and enrollment of those newly eligible for Medicaid </li></ul><ul><ul><li>Community Health Workers, auto-enroll, etc. </li></ul></ul><ul><li>Statewide plan for Medicaid managed care </li></ul><ul><ul><li>with quality and access protections </li></ul></ul><ul><li>Assess and address higher-risk and chronic care needs of newly eligible </li></ul><ul><ul><li>E.g. care management, self-management education, transitional care </li></ul></ul><ul><li>Apply for federal grants (planning, demos, etc.) </li></ul>
  27. 27. Action Steps <ul><li>Design Insurance Exchange </li></ul><ul><li>Consumer-friendly web portal for screening, eligibility determination, links to appropriate programs & subsidies </li></ul><ul><li>Insurance risk-adjustment mechanism </li></ul><ul><li>Health plan accountability for cost and quality </li></ul><ul><ul><li>E.g. develop & collect quality measures for diabetes </li></ul></ul><ul><li>Enact Necessary Legislation </li></ul><ul><li>Authority to Insurance department and AHCA to implement reforms </li></ul>
  28. 28. Page  Thank you. Do You Have Any Questions? ? ? ?
  29. 29. Page  Thank you. To download the report visit: http://www.collinscenter.org Contact information: Leda Perez: [email_address] Jack Meyer: jmeyer@healthmanagement.com

×