Len Nichols, PhD - “How This Time is Different: Medicare & Medicaid 1965 – 2015″

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From the 2015 PQC Annual Conference

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Len Nichols, PhD - “How This Time is Different: Medicare & Medicaid 1965 – 2015″

  1. 1. WHY THIS TIME IS DIFFERENT: THE ECONOMICS FORCING SYSTEM REFORM Len M. Nichols, Ph.D. George Mason University PQC Annual Conference Washington, DC October 1, 2015 www.chpre.org 1
  2. 2. OVERVIEW • What Causes Reform Conversations? • What Caused Reform to Actually Happen? • The Pressures on Public Programs Will Not Go Away • Tools, Opportunities, and Challenges www.chpre.org 2
  3. 3. GROWTH IN HEALTH SPENDING, SHARE OF GDP OF HEALTH SPENDING 0 2 4 6 8 10 12 14 16 18 20 1960 1970 1980 1990 2000 2001 2002 2003 2004 2004 2006 2007 2008 2009 2010 2011 2012 2013 NHE g pc NHE/GDP
  4. 4. Median Family Income: $66,632
  5. 5. WHAT FAMILIES SAW BEFORE 2009 42300 4868 61521 12298 0 10000 20000 30000 40000 50000 60000 70000 Family Income Familly Premium 1996 2008 44.8% increase 152.6% increase
  6. 6. RELATIVE COST OF HEALTH INSURANCE 10.6 17.5 0 2 4 6 8 10 12 14 16 18 20 Family Premium / Family Income* 1996 2008
  7. 7. 12
  8. 8. 13
  9. 9. LIFE EXPECTANCY At BIRTH: US ranks 39th, at 78.6 Japan #1, at 82.7 At 65: US ranks 37th, at 19.1 (so USLE(65) = 84.1 Japan #1, at 20.2 (JLE(65) = 85.2 Our elderly gain 3 extra years in Life Expectancy on the world, surely some/most of that is due to Medicare 10/13/2015 www.chpre.org 14
  10. 10. PERCENTAGE OF POPULATION OVER 64 YEARS OLD 4.1 8.1 9.9 12.6 12.4 13 16.1 19.3 20 20.2 0 5 10 15 20 25 1900 1950 1970 1990 2000 2010 2020 2030 2040 2050
  11. 11. NOTES: Under discussion indicates executive activity supporting adoption of the Medicaid expansion. *AR, IA, IN, MI, and PA have approved Section 1115 waivers. Coverage under the PA waiver went into effect on January 1, 2015, but the newly-elected governor may opt for a state plan amendment. Coverage under the IN waiver is set to begin February 1, 2015. NH has submitted a waiver to continue their expansion via premium assistance. WI covers adults up to 100% FPL in Medicaid, but did not adopt the ACA expansion. SOURCE: “Status of State Action on the Medicaid Expansion Decision,” KFF State Health Facts, updated January 27, 2015. http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ CURRENT STATUS OF STATE MEDICAID EXPANSION DECISIONS WY WI* WV WA VA VT UT TX TN SD SC RI PA* OR OK OH ND NC NY NM NJ NH* NV NE MT MO MS MN MI* MA MD ME LA KYKS IA* IN*IL ID HI GA FL DC DE CT CO CA AR*AZ AK AL Adopted (29 States including DC) Adoption under discussion (7 States) Not Adopting At This Time (15 States)
  12. 12. 17
  13. 13. FOLLOWING RESULTS FROM THE OREGON HEALTH INSURANCE EXPERIMENT HTTP://WWW.NBER.ORG/OREGON/
  14. 14. SUMMARY OF OREGON RESULTS SO FAR Improved self-reported health status Improved perceived mental health Increased diagnosis and treatment for diabetes Increased diagnosis of and treatment for depression Reduced financial strains Increased ED use
  15. 15. Sommers et al Annals of Internal Medicine 160(9)
  16. 16. Sommers et al
  17. 17. MORTALITY REDUCTION CONFIRMS IOM AND CEA PROJECTIONS, $ 130B-180B PER YEAR Longer Life Healthier Life Productivity+
  18. 18. INCENTIVE REALIGNMENTCUTS
  19. 19. 31
  20. 20. Population Health Experience of Care Per Capita Cost IHI Triple Aim
  21. 21. 34
  22. 22. 35
  23. 23. 36
  24. 24. 37
  25. 25. 10/13/2015 www.chpre.org 38 COMPLEX ADAPTIVE SYSTEMS Pattern Regularities Feedback Feedback Agents
  26. 26. www.chpre.org 40 Thrive? Obesity Diabetes Admits for uncontrolled HbA1c Control Diet, Exercise + Motivation Gov Plan MD H Patient Family and Community PCMHs, ACOs, Shared Savings?
  27. 27. www.chpre.org 41 CHALLENGES AND OPPORTUNITIES • Improve actionable evidence base on what affects behavior and outcomes • Integrate enrollment, claims and clinical data • Link data and incentives to providers and patients across payers • Build collaborative incentive and motivational structures for true population health pursuit • Plans, providers, patients, communities and governments • Broaden focus beyond health system to social system • Simplify and focus on what really matters to people
  28. 28. www.chpre.org 42 COMMENTS AND QUESTIONS • lnichol9@gmu.edu • Twitter = @LenMNichols • www.chpre.org

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