The document discusses various aspects of healthcare reform with a focus on the impact of a proposed $400 billion cut to Medicare over ten years, exploring its effects on benefits, the delivery system, and stakeholders. It presents proposals from HR 3962 aimed at improving Medicare, reducing costs, and addressing issues such as hospital readmissions and health outcomes. Additionally, it poses critical questions about the future healthcare models and the implications for different groups, including employers, employees, and insured individuals.

1. Quaker Gardens Discussion on HealthCare Reform - 2009 $400 Billion Impact on MediCare The Players Why now instead of under Clinton? Which Model will prevail? What will be the impact on Employers and Employees?

3. Impact on MediCare? Any Changes in Benefits? What will happen to the medical delivery system? What happens when MediCare is cut by $400+ Billion over 10 Years? Myths in HC Reform?

4. Possible Changes in M’Care Benefits? Get the “Hole” out of the Donut for MediCare Part D Better programs on transition of care from Hospital to other levels of care

5. HR 3962 Proposal Improved financial assistance Eliminate Part D cost sharing Eliminate barriers to enrollment Improve communications to eligibles Extended coverage of immunosuppressive drugs Voluntary advance care planning services

6. HR 3962 Proposal Improvements in calculating income for calculating part B premiums Create Accountable Care Organizations to reward medical providers for improvements in Quality of Care Funding of MediCare graduate medical education MediCare Rural access protections

7. HR 3962 Proposal Nursing Home Transparency Incentivize use of Electronic Medical Records Bundled payments for post-acute care services Address geographic inequities in provider payment No Mid-year drug formulary changes allowed Free Generic drugs (Jan 2011)

8. HR 3962 Proposal Medical Home Pilot Coverage and waiver of cost sharing for preventive medical services Waiver of deductible for colorectal screening services Expanding access to vaccines

9. HR 3962 Proposal Independence at Home medical pilot (A) reducing preventable hospitalizations; (B) preventing hospital readmissions; (C) reducing emergency room visits; (D) improving health outcomes commensurate with the beneficiaries’ stage of chronic illness; (E) improving the efficiency of care, such as by reducing duplicative diagnostic and laboratory tests; (F) reducing the cost of health care services covered under this title; and (G) achieving beneficiary and family care giver satisfaction.

10. What will happen to the M’Care Health Care Delivery System? Basic laws of Supply and Demand … Well, if you decrease the payment and keep the demand the same, there could be less providers accepting MediCare’s allowed charges! OUCH!

11. Where will the $400+ billion in cuts in M’Care come from? the savings comes from cutting billions of dollars in overpayments to insurance companies and eliminating waste, fraud, and abuse

12. Myths in HC Reform? Cuts in Benefits? Rationing with Older Citizens being the last to get needed health care? Bureacratic Health Care Panels that say NO? Forced Euthanasia? HC Reform will Bankrupt America? Illegal Immigrants will be covered?

13. Paying for Health Care Reform Source Health Care Reserve Fund ($ in billions) 10 years FY 2010 Budget $635 - Medicare and Medicaid Savings $309 - Revenues $ $326 Additional Medicare and Medicaid Savings - $313 - Incorporate productivity adjustments into Medicare payment updates $110 Reduce hospital subsidies for treating the uninsured as coverage increases $106 Pay better prices for Medicare Part D drugs $75 Other $22 Total $948

14. The Players Employers Employees Unemployed Retired Organized Medicine (Docs, Hospitals, HMOs, ancillary Providers, Pharma, etc.) For Profit Insurance Companies & HMO’s States Federal Government

15. Why Now? Health Care costs have doubled in last 8 years Cost shifting has reached tipping point to trigger federal & state intervention Tipping points are "the levels at which the momentum for change becomes unstoppable." $800,000,000,000 in potential savings!

16. Macro Cost Shifting

17. Macro Cost Shifting Pay Full Retail

18. Macro Cost Shifting Pay Full Retail Best Risks and Underinsured

19. Macro Cost Shifting Pay Full Retail Best Risks and Underinsured Poor Risks, Can’t afford Insurance, etc.

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.

22. Which Model will Prevail? Single Payor System Universal Health Care With Health Care Exchange that includes a Public Plan or Health Care Co-operative At State Level? (A program like the HIPC?) At Federal Level? Pay or Play for employers Guaranteed Coverage (no exclusions for pre-existing conditions and no cherry picking) Minimum benefit level established Federal and State subsidies Probably at 400% of Federal Poverty Level Minimum ER contribution levels set (like SF city regs)

23. Payment Reform Health Care Payment Reform That Rewards Value, Not Volume 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 Quality Improvement Health Information Technology Policy Evidence Based Medicine and a Business Case for Health Information Technology Business Case for Investing in HC Reform

25. Ideas on how to lower HC Costs Competitive Public Plan Change MediCare payment structure Reduce annual increases to providers Reduce payments to M’Care Advantage Plans (now 14% higher than FFS docs) Pharma discounts for Seniors Rx in the Doughnut Hole

26. Ideas on how to lower HC Costs Use Best Practices and Evidence Based Medicine Conduct Comparative Effectiveness Research at new proposed “ Center for Quality Improvement” Docs and Hospitals Create Incentives for delivering Quality Medical Care Bundle Payments to Providers to encourage “coordinated care” across provider spectrum

28. NOW – Silos of Payment Doctors HMO’s Hospitals Nursing Homes and ECF’s $$$ $$$ $$$ $$$ $$$ $$$ $$$

29. NOW – Silos of Payment Doctors HMO’s Hospitals Nursing Homes and ECF’s $$$ $$$ $$$ $$$ $$$ $$$ $$$

30. FUTURE? Bundled payment Doctors HMO’s Hospitals Nursing Homes and ECF’s $$$

31. Ideas on how to lower HC Costs Mandate that everyone be covered by all carriers with no pre-existing condition exclusions and no adverse selection rating.

32. Information and Data Sources

33. Health Care Reform Web Sites AARP.org commonwealthfund.org / healthreform.gov / mailmanschool.org/facultypubs/womenshealthcarereform.pdf whitehouse.gov/assets/documents/CEA_Health_Care_Report.pdf reuters.com/article/healthNews/idUSTRE56K01720090721 hudson.org/files/documents/20090612_JB_Kuttner_longterm_fiscal_impact_health_reform.pdf

34. http:// randcompare.org / http:// randcompare.org /current/ http:// randcompare.org /options/ http:// randcompare.org/options/mechanism/refundable_tax_credit http:// randcompare.org/options/mechanism/purchasing_pools Massachusetts “Health Care Connector” http:// randcompare.org/options/mechanism/employer_mandate Pay or Play explained Mandates (Cal, Or, WA passed and subs repealed) Hawaii 1974 Mass 2006 Health Care Reform Web Sites

35. Health Care Web Sites

36. Medical Info/Research www.medem.com - modern medical library www.ncqa.com - Nat'l Committee on Qual. Assurance www.doctorsolve.com / - Info on drugs in Canada www.coverfingtheuninsured.org www.insureusa.org http://www.prevent.org/ - information on disease prevention and health promotion policies and practices www.cmwf.org/index.htm - Commonwealth Fund

37. Employee Empowerment & Health Wellness www.4women.gov - Nat'l Women’s Health site www.ivanhoe.com - Medical Breakthroughs http:// vm.cfsan.fda.gov - US FDA Food Safety Ctr. www.healthyroads.com – ASHP wellness product www.new.chcf.org - Cal Health Care Fndn www.mrmib.ca.gov – MRMIB http:// www.opa.ca.gov/report_card / . - Cal Office of Patient Advocate www.healthcarecoach.com/ www.mayoclinic.com http:// www.doclopedia.com - Use doclopedia to put your medical history, prescriptions, and bills in one convenient space for FREE

38. Employee Empowerment & Health Wellness 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. www.netwellness.org – 100 health topics to find in-depth information on hundreds of diseases and wellness issues 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. 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 .

39. Provider/Health Plan Report Cards www.healthscope.org www.lumetra.org - dedicated to measurably improving the quality, safety, and integrity of healthcare. www.aahp.org - Amer Assn of Health Plans www.chcf.org – California Health Care Foundation www.healthcarecoverageguide.org – Cal Health Care Foundation web site www.guiadecoberturadesalud.org – CHCF hispanic site for small employers www. benefitscheckup.org/

40. Government Web Sites www.cdc.gov - Center for Disease Control www.medlineplus.gov www.medicare.gov / - info on Part D drug plans www.leginfo.ca.go - Cal ins code www.dmhc.ca.gov - Dept Managed Health Care www.mrmib.org – High Risk Ins pools

41. The end Questions????