The document describes Barack Obama and Joe Biden's plan to lower healthcare costs and ensure affordable and accessible health coverage for all Americans. It outlines four main parts of the plan: 1) investing in electronic health records systems, 2) improving access to prevention and disease management programs, 3) lowering costs by addressing anticompetitive practices in the drug and insurance industries, and 4) reducing costs of catastrophic illnesses for employers and employees.
Better health outcomes at less cost - future nhs stage, 4pm, 2 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Got Healthcare? Affordable Care Act PP (July 2013)Kevin Kane
The Affordable Care Act presentation that Citizen Action of Wisconsin presents with around the state. How the ACA impacts you and how to talk about it.
Kegler Brown Hill & Ritter's 2011 Ohio Healthcare Summit offered an in-depth look at National and Ohio Healthcare Reform, Legal Challenges, Regulation and Implications for Healthcare Providers, Medical Malpractice, and the Health Information Exchange.
Better health outcomes at less cost - future nhs stage, 4pm, 2 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Got Healthcare? Affordable Care Act PP (July 2013)Kevin Kane
The Affordable Care Act presentation that Citizen Action of Wisconsin presents with around the state. How the ACA impacts you and how to talk about it.
Kegler Brown Hill & Ritter's 2011 Ohio Healthcare Summit offered an in-depth look at National and Ohio Healthcare Reform, Legal Challenges, Regulation and Implications for Healthcare Providers, Medical Malpractice, and the Health Information Exchange.
Carisa Magee, Manager, Medicaid/CHIP Program Policy Texas Health and Human Services Commission, presented an overview of Medicaid at the "Designing Healthcare in Texas" conference hosted by One Voice Texas, Harris County Healthcare Alliance and Kinder Institute on June 3, 2014.
Obamacare - The Patient Protection and Affordable Care Act - ACAAndrew F. Bennett
This short presentation will help bring you up to speed on the Affordable Healthcare act, eligibility requirements to buy in the online marketplace, and coverage that will be available.
Leveraging Medicare Fee-for-Service Reimbursement to Address Social Determina...PYA, P.C.
This presentation given at the 2019 HCBS Conference by PYA Principals Martie Ross and Kathy Greenlee provides:
- A practical explanation of CCM and RPM billing rules.
- Examples of CBO-delivered aging services for which Medicare reimbursement is available, such as in-home assessment, CCM, medication reconciliation and adherence, health promotion, and chronic disease self-management.
- Explanations for establishing relationships and negotiating contractual arrangements with healthcare providers to maximize funding.
-Examples of financial projects and successful partnerships.
mHealth Israel_US Telehealth + Reimbursement Post CoVID_King & SpaldingLevi Shapiro
Overview of the US Telehealth and Reimbursement Landscape, pre and post CoVID-19. Sections include distinction between telehealth and telemedicine, growth in telemedicine adoption, evolving policies and priorities of CMS and Medicare, intense interest in the telehealth from the public markets, increase in scope and scale of deployments nationwide, reaction of current sector leaders to entry by bigger competitors, market trends and dynamics, regulatory changes, employer deep dive, overview of the employer market, employer wants vs. actions, employer telemedicine deep dive, top impediments including payment models, deployment and compliance, deployment, Plan Benefits, Wellness, GHP, structure, Wellness EAP and DM, non-GHP deployment, ERISA issues, excepted benefits, reimbursement changes, telehealth reimbursement, Remote Physiological Monitoring, Reasonable and Necessary, commercial coverage, etc
According to the MarkNtel Advisors’ research report, “UAE Telehealth Market Analysis, 2021,” the market is likely to grow at a CAGR of around 25% during 2021-26 due to the surging consumer demand & patient acceptance for enhanced quality of care, the burgeoning geriatric population, and the increasing number of chronic diseases, such as cancer, diabetes, and neurological issues.
Philippines: Governing for Quality Improvement in the Context of UHCHFG Project
The Philippine Health Insurance Corporation, or PhilHealth, was created in 1995 to administer the National Health Insurance Program, which aims to provide financial access to health services to all Filipinos. In 1998, PhilHealth established the Sponsored Program to provide coverage for the poor. In 2004, the Philippines passed a law to mandate subsidized coverage of the indigent, and PhilHealth campaigned with the Local Government Units to enroll the poor in their jurisdiction, while the Department of Health invested in the local health service delivery and strengthened its regulatory function (Lagrada, 2009). In 2013, another law was passed requiring PhilHealth to extend the subsidy to the poor and near-poor and to mobilize sin tax revenue to finance the subsidies for these groups. In response to these legal mandates, PhilHealth has streamlined its enrollment processes and has used targeted outreach to rapidly poor and vulnerable groups with the aim of achieving UHC.
Sustainability and Transition Policy in Action (GF Session) - Tural Gulu, Az...OECD Governance
This presentation was made by Tural Gulu, Azerbaijan, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
For our last webinar of 2018, we hosted an engaging discussion on the updates in National Pharmacare with panelists Bill Dempster, CEO of 3Sixty Public Affairs and Louse Binder, Health Policy Consultant at Save Your Skin Foundation.
A Strategic Case Study of Hospital Administration: hospital consolidationWayne Wei
A case study of consolidation between two different regional hospitals.
It's impact to the resident of community, to peripheral clinics and to the staffs.
A scenario analysis to find out best solution
Carisa Magee, Manager, Medicaid/CHIP Program Policy Texas Health and Human Services Commission, presented an overview of Medicaid at the "Designing Healthcare in Texas" conference hosted by One Voice Texas, Harris County Healthcare Alliance and Kinder Institute on June 3, 2014.
Obamacare - The Patient Protection and Affordable Care Act - ACAAndrew F. Bennett
This short presentation will help bring you up to speed on the Affordable Healthcare act, eligibility requirements to buy in the online marketplace, and coverage that will be available.
Leveraging Medicare Fee-for-Service Reimbursement to Address Social Determina...PYA, P.C.
This presentation given at the 2019 HCBS Conference by PYA Principals Martie Ross and Kathy Greenlee provides:
- A practical explanation of CCM and RPM billing rules.
- Examples of CBO-delivered aging services for which Medicare reimbursement is available, such as in-home assessment, CCM, medication reconciliation and adherence, health promotion, and chronic disease self-management.
- Explanations for establishing relationships and negotiating contractual arrangements with healthcare providers to maximize funding.
-Examples of financial projects and successful partnerships.
mHealth Israel_US Telehealth + Reimbursement Post CoVID_King & SpaldingLevi Shapiro
Overview of the US Telehealth and Reimbursement Landscape, pre and post CoVID-19. Sections include distinction between telehealth and telemedicine, growth in telemedicine adoption, evolving policies and priorities of CMS and Medicare, intense interest in the telehealth from the public markets, increase in scope and scale of deployments nationwide, reaction of current sector leaders to entry by bigger competitors, market trends and dynamics, regulatory changes, employer deep dive, overview of the employer market, employer wants vs. actions, employer telemedicine deep dive, top impediments including payment models, deployment and compliance, deployment, Plan Benefits, Wellness, GHP, structure, Wellness EAP and DM, non-GHP deployment, ERISA issues, excepted benefits, reimbursement changes, telehealth reimbursement, Remote Physiological Monitoring, Reasonable and Necessary, commercial coverage, etc
According to the MarkNtel Advisors’ research report, “UAE Telehealth Market Analysis, 2021,” the market is likely to grow at a CAGR of around 25% during 2021-26 due to the surging consumer demand & patient acceptance for enhanced quality of care, the burgeoning geriatric population, and the increasing number of chronic diseases, such as cancer, diabetes, and neurological issues.
Philippines: Governing for Quality Improvement in the Context of UHCHFG Project
The Philippine Health Insurance Corporation, or PhilHealth, was created in 1995 to administer the National Health Insurance Program, which aims to provide financial access to health services to all Filipinos. In 1998, PhilHealth established the Sponsored Program to provide coverage for the poor. In 2004, the Philippines passed a law to mandate subsidized coverage of the indigent, and PhilHealth campaigned with the Local Government Units to enroll the poor in their jurisdiction, while the Department of Health invested in the local health service delivery and strengthened its regulatory function (Lagrada, 2009). In 2013, another law was passed requiring PhilHealth to extend the subsidy to the poor and near-poor and to mobilize sin tax revenue to finance the subsidies for these groups. In response to these legal mandates, PhilHealth has streamlined its enrollment processes and has used targeted outreach to rapidly poor and vulnerable groups with the aim of achieving UHC.
Sustainability and Transition Policy in Action (GF Session) - Tural Gulu, Az...OECD Governance
This presentation was made by Tural Gulu, Azerbaijan, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
For our last webinar of 2018, we hosted an engaging discussion on the updates in National Pharmacare with panelists Bill Dempster, CEO of 3Sixty Public Affairs and Louse Binder, Health Policy Consultant at Save Your Skin Foundation.
A Strategic Case Study of Hospital Administration: hospital consolidationWayne Wei
A case study of consolidation between two different regional hospitals.
It's impact to the resident of community, to peripheral clinics and to the staffs.
A scenario analysis to find out best solution
Market Analysis for Umbilical Cord and Stem Cell Storage in TaiwanWayne Wei
Outlined:
1. Operation Process
2. Analysis for Economic and Environment aspect
3. Market and Customer research
4. Benchmark: Baby Bank- A SWOT Analysis
A strategic analysis and SWOT approach to demonstrate the decision pathway, business deployment and action plan of a promising type of healthcare business.
Surveys a series of ethical, economic, clinical and also safety issues relating to the application of informatics to healthcare, focusing especially on the role of informatics in the Patient Protection and Affordable Care Act. Talk presented in the University at Buffalo Clinical/Research Ethics Seminar - Ethics, Informatics and Obamacare, November 20, 2012. Slides are available here: http://ontology.buffalo.edu/13/ethics-informatics-obamacare.pptx
Seminar 9 health care delivery system in united states of americaDr. Ankit Mohapatra
Health care organization
Health financing in US
Payment mechanism
Health expenditure
Human and physical recourses
Public health
Patient pathway into health care
Provision of services
ACA
US vs India Healthcare
Fair Market Value: What Rural Providers Need to Know PYA, P.C.
PYA Principal Tynan Olechny and Senior Manager Annapoorani Bhat provided important information for rural providers related to fair market value and commercial reasonableness considerations during a National Rural Health Association webinar, “Valuations: What Rural Providers Need to Know."
Presentation by James Smith of the American Continental Group at the Sept. 30, 2013 83rd Texas Post-Legislative Conference hosted by One Voice Texas, United Way of Greater Houston and the Harris County Healthcare Alliance.
Introduction to the pharmaceutical market and practiceWayne Wei
As a lecturer for "Basic Principles of Drug Discovery and Development" for Department of Life Sciences, National Central of University for two years.
In charge of "Introduction to the pharmaceutical market and practice".
Speech for ITIer on 2/10/2015 to introduce scope of BIO industry, especially for pharmaceutical industry.
In the next session, a brief introduction to Drug Development and Drug Marketing.
Finally, the career opportunities which maybe suitable for a international business talents are concluded.
Introducing four programs, Fast Track, Breakthrough, Accelerated Approval, Priority Review which are about facilitating and expediting new drug developments for curing or improving unmet medical needs.
Introducing how a pharmaceutical business development manager think about pharmaceutical business and how to entry a new country with local distributors and health agencies.
REHABA Program (Rehabilitation Business Administration program)Wayne Wei
My Proposal for enhancing rehabilitation staff's business sense and knowledge for surviving and winning in this uncertain healthcare environment.
The course is flexible in teaching hours and contents in seven modules which are basic, environment, quality, marketing, innovation, human resource, and financial management.
A summary for Relational Coordination, an emerging method to enhance the organizational coordination and let all the staffs of Healthcare team can aim on delivering superior medical service to the patient under well-controlled cost.
It is believed that Relational Coordination could be a solution to current problems of Healthcare industry form the dilemma of quality and cost concerns.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Obama & Biden's health reform: ACCESSIBLE HEALTH COVERAGE FOR ALL
1. BARACK OBAMA AND JOE BIDEN’S
PLAN TO LOWER HEALTH CARE COSTS
AND ENSURE AFFORDABLE,
ACCESSIBLE HEALTH COVERAGE FOR
ALL
電子病 期末報告歷
描述美國全民健保法
條與未來實施狀況
P97843012 魏文一
1
2. (1) INVEST IN ELECTRONIC HEALTH INFORMATION
TECHNOLOGY SYSTEMS.
(2) IMPROVE ACCESS TO PREVENTION AND
PROVEN DISEASE MANAGEMENT PROGRAMS.
(3) LOWER COSTS BY TAKING ON ANTICOMPETITIVE
ACTIONS IN THE DRUG AND INSURANCE
COMPANIES.
(4) REDUCE COSTS OF CATASTROPHIC ILLNESSES
FOR EMPLOYERS AND THEIR EMPLOYEES.
2
3. (1) GUARANTEED ELIGIBILITY.
(2) NEW AFFORDABLE, ACCESSIBLE HEALTH
INSURANCE OPTIONS.
(3) TAX CREDITS FOR FAMILIES AND SMALL
BUSINESSES.
(4) EMPLOYER CONTRIBUTION.
(5) REQUIRE COVERAGE OF CHILDREN.
(6) EXPANSION OF MEDICAID AND SCHIP.
(7) FLEXIBILITY FOR STATE PLANS.
3
4. (1) EMPLOYERS.
(2) SCHOOL SYSTEMS.
(3) WORKFORCE.
(4) INDIVIDUALS AND
FAMILIES.
(5) FEDERAL, STATE,
AND LOCAL
GOVERNMENTS.
4
24. HEARA: The Healt hcare and
Educat ion Af f ordabilit y
Reconciliat ion Act of 2010
• contained tax and budget related changes
to the PPACA
• passed through reconciliation process
24
25. • Health insurance market reform
• Health insurance market exchanges
• MEDICAID and CHIP
• Medicare
• Workforce and other provisions
PPACA: Pat ient Prot ect and
Af f ordable Care Act (1)
25
26. • Health insurance market reform : (1)
– High-Risk Health Insurance Pool Program
– Health insurance for young adults
– Pre-existing medical conditions
– Lifetime and annual limits on benefits
– Community living assistance services and
support program (CLASS act)
PPACA: Pat ient Prot ect and
Af f ordable Care Act (2)
26
27. • Health insurance market reform: (2)
– Individual responsibility
– Employer responsibility
– Excise tax on health insurers
PPACA: Pat ient Prot ect and
Af f ordable Care Act (3)
27
28. • Health insurance market exchanges:
– Health insurance exchanges
– Premium assistance credits, caps on out-of-
pocket costs for health plans
– Health care choice compacts
PPACA: Pat ient Prot ect and
Af f ordable Care Act (4)
28
29. • MEDICAID and CHIP:
– Medicaid expansion
– CHIP
– Medicaid medical home pilot
– Medicaid emergency psychiatric
demonstration
– Medicaid community-based services
– Medicaid accountable care organization pilot
program
PPACA: Pat ient Prot ect and
Af f ordable Care Act (5)
29
30. PPACA: Pat ient Prot ect and
Af f ordable Care Act (6)
• Medicare:
– Specialized Medicare advantage plans for
special needs individuals
– Medicare Part D
– Medicare medical home pilot program
– Medicare accountable care organization
30
31. PPACA: Pat ient Prot ect and
Af f ordable Care Act (7)
• Workforce and other provisions: (1)
– Co-location of primary and specialty care in
community-based behavioral health settings
– National health service corps
– Training for behavioral health professionals
– Loan repayment for pediatric behavioral
health specialists in underserved areas
31
32. PPACA: Pat ient Prot ect and
Af f ordable Care Act (8)
• Workforce and other provisions: (2)
– Educating primary care providers about
behavioral health
– Community transformation grants
– Community health workforce grants
– National health care workforce commission
– Federal definition of community mental health
centers
32
33. The Promise
• All Americans guaranteed affordable,
high quality healthcare
• The freedom to choose whatever doctor
or health plan you want
• all that a savings of some $2,500 per
family
33
34. Feat ures
• individual mandate
• sufficient coverage
• elimination of
underwriting
• tax equity, subsidy
(indiv vs group)
• public plan to
compete
• emphasis on
prevention and
wellness
• elimination of waste
• electronic data
keeping
• comparative
effectiveness
34
35. I mpact on st akeholders-1
• Employer
– Eliminate and reduce the favored tax of healthcare
expense ($194.2B a year)
– less control over plan designs offered to employees
• Carriers
– Competition from ''public plan''
– inability to underwrite
– increased regulation
– shift to individual policies
35
36. I mpact on st akeholders-2
• TPAs (Third party administration)
– potential loss of FSA( 財務監管局 )/HRA(Health
reimbursement account) admin
– potential gain of FSA substitution
– shift from groups to individuals
• Broker and agents
– Competition from connectors
– shift to individual market
– relief from underwriting
36
37. I mpact on st akeholders-3
• individuals
– requirement to purchase insurance
– Tax credits and subsidy
– Reduced the tax advantage of HSAs, FSAs and
itemized deduction of medical expense
– New ''sin taxes'' on products such as alcohol and
sugary soft drinks
37
38. I mpact on st akeholders-4
• providers
– Reduced Medicare spending on home healthcare,
durable medical equipment, medical imaging and
prescription drugs
– increased demand for services, especially primary
care
– 5% bonus payment for office visits and other ''primary
care services''
– Medicare
38
39. Medicare policies
• increase payments to doctors who
regularly exceed ''national benchmarks''
for the quality of care
• Bonuses to hospitals that provide superior
care for heart attack, pneumonia and
selected other conditions
• Doctors could receive extra payments if
they hire nurses to manage follow-up care
for chronic cases
39
40. Medicare policies
• Government set national standards for
the appropriate use of CT scans, MRI and
other diagnostic imaging techniques
• Make single bundled payment for all
services provided to a hospital patient.
(Bad for nursing homes, home care,
hospice, etc.)
40
41. I mpact on st akeholders-5
• Pharmaceuticals
– Reduce government spending on prescription
drugs
– Re-importation of drugs from other countries
to lower costs
– Shift insurance coverage toward prevention,
could increase sales for heart, diabetes and
other drugs that patients take long-term
– Increased Rx spend by $15~$18B
41
42. I mpact on st akeholders-6
• Wellness
– Tax credits or other subsidies it employers
who offer wellness programs that meet
federal criteria
– Make it easier for employers to use financial
rewards or penalties to promote healthy
behavior among employees
42
43. I mpact on st akeholders-7
• Health IT providers
– $20B in Stimulus money
– Electronic Health Records
• Marketing communications
– Need to communicate new programs
• Benefits attorneys
– Need to interpret new regulations
43
44. 期待
• additional information and guidance from the
DHHS, Congress, IRS, insurance industry
• Repeal and replace
• Reduce costs
• Will employers eliminate coverage when the
Exchanges are implemented?
• What happens in 2018 when the Cadillac Tax
become effective?
44
46. Early implement at ion
• Small business tax credits
• Temporary retiree medical reinsurance pool to
help employers lower costs for early retirees
(2010~2014)
• insurance market reforms
• 10% excise tax on indoor tanning services
(July1)
• Health & Human Services (HHS) to develop
informational website portal (July1)
• Relief begins for retirees in the Medicare Part D
coverage gap ''donut hole''
46
47. Six mont hs af t er enact ment
• eliminate lifetime limits and annual limit restrictions
• eliminate pre-existing condition limitations for children
• expand dependent coverage
• cover preventive care
• require nondiscrimination testing
• New coverage appeals processes
• emergency services must be covered as in-network
services
• designate any in-network doctor as a primary care
physician
47
48. 2011
• spending account restrictions
• new W-2 reporting requirements
• CLASS Act (Community Living Assistance
Services and Supports Act)
• Uniform standards developed by HHS for
communicating benefit provisions
48
49. 2012 & 2013
• implement uniform standards for communicating benefit
information with $1000 fine for each failure
• Salary reduction to FSAs are limited to $2,500, with annual
index (2013)
• Employers must notify employees plan benefits and Exchanges
• Annual comparative effectiveness research fee of $2 per
member assessed on fully insured plans
• Individuals with earnings greater than $200,000 and households
with earnings greater than $250,000 subject to additional taxes
• eliminate the tax reduction for employers who receive
Medicare D retiree drug subsidy payments
• New taxes on the industry providers and manufactures
49
50. 2014
• Requires U.S. citizens and legal residents to have insurance or
pay penalty
• State based Exchanges established for individuals and small
groups to purchase coverage with required benefit plans being
offered
• Employers with 50+ employees are required to coverage or pay
a penalty
• minimum essential benefits must be offered to individuals and
small groups outside the exchange- Grandfathered and large
employers plans are exempt
• Premium and cost sharing credits for low-income individuals
(up to 400% of FPL)
• Employers with 200+ employees must automatically enroll
employees (out-put)
• Maximum waiting period limited to 90 days 50
51. Beyond 2014
• Insurance industry taxes begin which
impact fully insured plans
• eliminate pre-existing condition
limitations and annual limits
• Cadillac Tax becomes effective in 2018
51