Keith J. Mueller presented on the Fifth Iowa Family Impact Seminar held on December 3, 2013 in Des Moines, IA. The presentation focused on how the Affordable Care Act is aiming to achieve better care, better health, and lower costs through various reforms. This includes making insurance more affordable and accessible, promoting value-based payments, and shifting to a system focused on population health, prevention, and engagement of consumers. While the impacts of these changes are still unfolding, the overall system is becoming more affordable, higher quality, and focused on wellness and personal responsibility.

1. The Fifth Iowa Family Impact SeminarThe Fifth Iowa Family Impact Seminar
December 3, December 3, 20132013
Des Moines, IADes Moines, IA
Keith J. Mueller, Ph.D.
Director, RUPRI Center for Rural Health Policy Analysis
Head, Department of Health Management and Policy
College of Public Health
University of Iowa

2. Better Care
Better HealthBetter Health
Lower Cost
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3. h h ff d b l Better care through affordability
and quality improvement
B tt h lth th h f  Better health through focus on
patient panels and population
healthhealth
 Lower cost through
administrative price setting and administrative price setting and
system reform
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4. Affordable co erage for ins rance meeting  Affordable coverage for insurance meeting
essential benefits requirements (requires
examining possibilities fair comparisons examining possibilities, fair comparisons,
power of market incentives because of
pooled customers)pooled customers)
 Promoting quality related incentives,
measurablemeasurable
 Includes patient satisfaction
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5. f Shift to value measures that
include ongoing health status
k Strategies to keep patient
panel healthy, spills over to
lpopulation
 Healthy communities
d b lsupported by Title IV
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6. Pa ment red ctions to Medicare  Payment reductions to Medicare
Advantage plans and Medicare
providersproviders
 Shift to value based purchasing
Reforms such as bundled payment  Reforms such as bundled payment,
accountable care organizations, non
payment for “never events” and payment for “never events” and
hospital readmissions
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7. f The ACA is only part of that change, hard to
know the direction of influence between
bl dpublic and private sectors
 Squeezing out costs: effects see in recent
f h l f dreport from the Council of Economic Advisors
 System is getting smarter, leaner
l h Everyone’s role is changing
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8. f Pressures from payers
 Shifts to consumer
b lresponsibilities
 Behaviors of providers
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9.  For providers, such as Critical
Access Hospitals
f For payers using information
systems differently
d For consumers needing to
learn more and be more
d d kengaged in decision making
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10.  Healthcare Leaders Healthcare Leaders
• Changes in Delivery
• Changes in Finance• Changes in Finance
 State and Local Administrative agencies
Implementing the ACA• Implementing the ACA
• Public Health Functions
 Analysts Analysts
 Consumer Groups
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11. k h f k h We took the fork in the
road
Th l d i di  The long and winding
road?
Th ill b b  There will be bumps,
cracks
Not sure yet of the final  Not sure yet of the final
destination
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12.  Aff d bl t it bl h d Affordable: costs equitably shared
 Accessible: primary care readily
accessibleaccessible
 Community‐focused: priority on wellness,
personal responsibility, and public healthpersonal responsibility, and public health
 High‐quality: quality improvement a
central focus
 Patient‐centered: partnership between
patient and health team
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13. P l h l h d i fl ibili  Preserve rural health system design flexibility:
local access to public health, emergency medical,
and primary care services
 Expand and transform primary care: PCMH as
organizing framework, use of all primary care g g p y
professionals in most efficient manner possible
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14.  Use health information to manage  Use health information to manage
and coordinate care: records,
i t iregistries
 Deliver value in measurable way
h b b fthat can be basis for payment
 Collaborate to integrate services
 Strive for healthy communities
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15. h C f l l h liThe RUPRI Center for Rural Health Policy
Analysis
h // h i d / ihttp://cph.uiowa.edu/rupri
The RUPRI Health Panel
http://www.rupri.org
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16. Department of Health Management and Policy
College of Public Healthg
105 River Street, N232A, CPHB
Iowa City, IA 52242
319‐384‐3832
keith‐mueller@uiowa.edu
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