Delegate Jeannie Haddaway-Riccio's Health Care Presentation 09/16/09Karena Dixon
Presentation on Health Care Reform as presented by Delegate Jeannie Haddaway-Riccio at the Talbot GOP Health Care Forum on Wednesday, September 16th, 2009.
May also be viewed at:
www.votehaddaway.com
This presentation discusses the impact of health reform. It begins by defining the problem, then provides an overview of legislation and the impact on business. It provides a contrarian view of the subject and explains why health reform is really insurance reform. It also introduces the concept of consumer sovereignty,
Health Care Reform Goes Live: Day Three in the Current Climate of ReformCraig B. Garner
An October 3, 2013, presentation on the Affordable Care Act. This presentation includes: (1) Introduction and History; (2) Overview of the Affordable Care Act; (3) Reform from the Patient's Perspective; (4) Health Insurance Exchanges; (5) Delivering Medical Care; (6) Medicaid Expansion; (7) Performance Based Reimbursement; (8) Other Provisions; (9) Challenges; (10) Taxes and Reform
Modern American Health Care: Balancing Performance and Compliance in the Curr...Craig B. Garner
This presentation provides an overview of the Affordable Care Act three years after its passage. It explains how the landmark legislation evolved, what provisions are in place today, and what can we expect in the years to come. The implications for patients, providers and payers are massive, and this presentation is designed to provide a comprehensive overview for anyone interested to learn about health care reform.
Delegate Jeannie Haddaway-Riccio's Health Care Presentation 09/16/09Karena Dixon
Presentation on Health Care Reform as presented by Delegate Jeannie Haddaway-Riccio at the Talbot GOP Health Care Forum on Wednesday, September 16th, 2009.
May also be viewed at:
www.votehaddaway.com
This presentation discusses the impact of health reform. It begins by defining the problem, then provides an overview of legislation and the impact on business. It provides a contrarian view of the subject and explains why health reform is really insurance reform. It also introduces the concept of consumer sovereignty,
Health Care Reform Goes Live: Day Three in the Current Climate of ReformCraig B. Garner
An October 3, 2013, presentation on the Affordable Care Act. This presentation includes: (1) Introduction and History; (2) Overview of the Affordable Care Act; (3) Reform from the Patient's Perspective; (4) Health Insurance Exchanges; (5) Delivering Medical Care; (6) Medicaid Expansion; (7) Performance Based Reimbursement; (8) Other Provisions; (9) Challenges; (10) Taxes and Reform
Modern American Health Care: Balancing Performance and Compliance in the Curr...Craig B. Garner
This presentation provides an overview of the Affordable Care Act three years after its passage. It explains how the landmark legislation evolved, what provisions are in place today, and what can we expect in the years to come. The implications for patients, providers and payers are massive, and this presentation is designed to provide a comprehensive overview for anyone interested to learn about health care reform.
Updated version of our popular PowerPoint presentation that clearly and succinctly lays out the fiscal challenge facing the United States. To see what can be done about it, visit http://crfb.org/go-big
Policy experts Karen A. Campbell, Guinevere Nell, and Paul L. Winfree discuss the need for the repeal of Obamacare in light of potential increases on insurance premiums and the taxing of job creators.
Our biggest problem in healthcare is efficiency (quality of care per dollar spent) and Obamacare doesn't solve it. Our spending is off the charts by any measure (growth over time, % of GDP, per capita) Consumerism as a force of change in Healthcare is just getting started, but there are many barriers in place that serve to protect existing stakeholders in the industry. Knocking down these barriers to competition is what the GOP should be focusing on, but it's not. "Repeal and replace" seems to be a slogan, not a plan. Do Republican lawmakers have the will to make changes that might upset entrenched players?
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
Updated version of our popular PowerPoint presentation that clearly and succinctly lays out the fiscal challenge facing the United States. To see what can be done about it, visit http://crfb.org/go-big
Policy experts Karen A. Campbell, Guinevere Nell, and Paul L. Winfree discuss the need for the repeal of Obamacare in light of potential increases on insurance premiums and the taxing of job creators.
Our biggest problem in healthcare is efficiency (quality of care per dollar spent) and Obamacare doesn't solve it. Our spending is off the charts by any measure (growth over time, % of GDP, per capita) Consumerism as a force of change in Healthcare is just getting started, but there are many barriers in place that serve to protect existing stakeholders in the industry. Knocking down these barriers to competition is what the GOP should be focusing on, but it's not. "Repeal and replace" seems to be a slogan, not a plan. Do Republican lawmakers have the will to make changes that might upset entrenched players?
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
Universal Health Care: Perceptions, Values, and IssuesRenzo Guinto
From the workshop "Universal Health Care: The First Step to Global Health Equity" held last August 5-9, 2012 in Mumbai, India during the 61st General Assembly March Meeting of the International Federation of Medical Students' Associations (IFMSA). Brought to you by the IFMSA Global Health Equity Initiative (http://www.ifmsa.org/Activities/Initiatives/The-IFMSA-Global-Health-Equity-Initiative).
For more information about the workshop, visit http://www.scribd.com/doc/193822108/Universal-Health-Care-PreGA-Program
January 23, 2017
The Fifth Annual Health Law Year in P/Review symposium featured leading experts discussing major developments during 2016 and what to watch out for in 2017. The discussion at this day-long event covered hot topics in such areas as health policy under the new administration, regulatory issues in clinical research, law at the end-of-life, patient rights and advocacy, pharmaceutical policy, reproductive health, and public health law.
The Fifth Annual Health Law Year in P/Review was sponsored by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, Harvard Health Publications at Harvard Medical School, Health Affairs, the Hastings Center, the Program On Regulation, Therapeutics, And Law (PORTAL) in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital, and the Center for Bioethics at Harvard Medical School, with support from the Oswald DeN. Cammann Fund.
Learn more on our website: http://petrieflom.law.harvard.edu/events/details/5th-annual-health-law-year-in-p-review
Booz Allen convened some of the smartest minds to explore making healthcare more accessible. This report shares the latest healthcare payment trends and what policy experts discovered when planning for different health reform scenarios.
Ethical dilemmas concerning drug pricing-Shrinath GhadgeShrinath Ghadge
There is no straightforward solution to the proper pricing of a pharmaceutical. Numerous factors influence pricing from the company perspective such as return on investment, costs of future R&D efforts, access to federal funding, and size of the patient population, to name a few. In addition the healthcare system in the US is generally much more expensive than other countries, driving up overall costs. A public distrust of pharmaceutical companies' greed has been fueled by recent cases of exorbitant increases in drug prices without clear cause. These instances do raise questions of the ethics employed by some companies
Will New Healthcare Policy Impact Value-Based Healthcare?Health Catalyst
The final days of 2016 were fraught with uncertainty about what Congress and the new Trump Administration would do to the Affordable Care Act (ACA) and the healthcare regulatory landscape overall. So far, in 2017, we do not have much more clarity. Repeal, repeal and replace, repeal and delay, modify without repeal—there are now even more questions than answers and still no consensus Republican plan in sight. Yet healthcare executives would certainly appreciate some modicum of clarity, at least on the narrower topic of whether the shift to value-based healthcare models will continue under whatever new system is coming. This webinar attempts to add clarity by analyzing what we know so far, as reflected in the limited actual evidence that is available.
Join Dan Orenstein, General Counsel, Health Catalyst, as he analyzes these three key pieces of information:
The 21st Century Cures Act (Cures)
The Executive Order on reducing the “burden” of the Affordable Care Act (ACA)
Tom Price’s comments at his confirmation hearings
The Paradigm Shift from Healthcare to Population HealthPractical Playbook
The Practical Playbook
National Meeting 2016
www.practicalplaybook.org
Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement.
The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include:
Session presentations and materials
Poster session content
Photos from the National Meeting
The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting.
The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).
Provides an overview of wellness program trends, including a look at the role of prepaid wellness cards as a central component of employer wellness programs. We will also look at meaningful incentive thresholds and identify obstacles to program adoption.
The Next Revolution in Healthcare: Why the New MSSP Revisions Matter Now More...Health Catalyst
Now more than ever, we are entering a period of rapid change catalyzed by the power of data. On December 21, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the Medicare Shared Savings Program (MSSP), strengthening the financial incentives for ACOs to drive improved outcomes. The health systems that embrace data to achieve financial success will grow while the rest will struggle to compete. View this webinar for a discussion on how to prepare.
The US healthcare system didn’t develop overnight, rather, it is the culmination of a series of revolutions within wealthy parts of the world. In this webinar, we explore the high points of history that have led us to our current challenges. While care has steadily improved over time, the cost of that care has risen at a much more dramatic rate. CMS created the MSSP to help mitigate the growth of these costs while providing better care for individuals and populations. On a larger scale, the program serves to shift the healthcare industry towards fee-for-value.
Despite general frustration related to legislative involvement, history has proven that regulatory changes precede attitudinal changes and the MSSP (combined with accurate, timely data) may be just the piece of legislation to help make value-based care a reality. By viewing this webinar you will learn:
- How the US healthcare industry reached its current state.
- Why financial imperatives drive cultural change in our economic model.
- Ways that the MSSP can help your organization achieve financial success.
- Ideas for how to utilize data to develop better healthcare delivery systems.
Dr. Will Caldwell is a strong proponent of the use of data analytics to promote good health and save lives. His area of expertise rests in technology-enabled health care delivery models and value-based care platforms. We hope that you will view this webinar and learn from his 17-years of work as a data-informed clinician.
Healthcare is in crisis. While this is not news for many
countries, we believe what is now different is that the
current paths of many healthcare systems around the
world will become unsustainable by 2015.
This may seem a contrarian conclusion, given the efforts
of competent and dedicated healthcare professionals
and the promise of genomics, regenerative medicine, and
information-based medicine. Yet, it is also true that costs
are rising rapidly; quality is poor or inconsistent; and
access or choice in many countries is inadequate.
The presentation describes an integrated health model for population management through the American Health Data Institute (AHDI) that has been in place for over 10 years with proven results for over 2.5 million members nationwide. The system relies on the use of sophisticated data analytics, identification of the chronically ill and those most likely to incur large claims, establishment of a regimen of care with follow up, Nurse Navigator oversight of care for the chronically ill, active management of large episodic claimants, identification of the chronically ill and triage to the most cost effective and quality medical providers, and active and effective wellness and biometric screening tools.
Technology is disrupting healthcare just as it has in so many other areas of life. New players and
new approaches are proliferating but while the changes may seem dazzlingly diverse there is a single, underlying driving force. Digital transformation in healthcare has many elements: health data privacy, ethical AI, IOT solutions, many brought to the market by new disruptors. These are all valuable elements of transformation, but ultimately they are steering to a single goal; empathetic care of
the empowered patient. In this increasingly patient-centric future it is the empathetic care, not the technology itself, that will prove to be the outstanding feature. The market leaders in this landscape will be those who embrace and explore its possibilities.
Living in a hyper-connected world, patients have never been so well informed or had so much decision- making power, at least when it comes to chronic diseases. Less dependent on their doctors for advice, increasingly able and willing to take greater control of their own health, they feel empowered by the vast amount of health information available online, on apps, and by the array of health and fitness wearables.
Such consumer digital empowerment is pushing rapid change in healthcare provision. Industry leaders across providers, insurers, medical technology and the pharmaceuticals industry, need to re-imagine
the traditional spectrum of sales, marketing and commercialisation processes by developing empathetic engagement tools to accompany and support the patient on their personal journey. This digital transformation imperative becomes a huge challenge because of the complexity of the industry ecosystem and the varying models in APAC.
With widely varying reimbursement and access challenges across APAC countries, coupled with diverse social and cultural norms, it is important for pharma, insurance, and healthcare providers to work together with partners who have local, real-world expertise when it comes to understanding patient behaviours. Together those partnerships can deliver solutions that will impact patient lives positively. Across APAC the opportunities are considerable with a huge growing market for medication and care, but there are also significant cultural and financial hurdles to the uptake of treatments.
Similar to Session 3 - Healthcare Policy Content - Diehl (20)
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
1. Health Policy: Awareness and Application
CDR Glen Diehl, PhD
Program Director, Healthcare Administration and Policy
Uniformed Services University
3-1
2. What Are We Going to Discuss
Today?
• Section 1: Health policy, values and cost
• Section 2: Fundamentals of health policy
• Section 3: Policy, history and reform
• Section 4: Health policy stakeholders
• Section 5: Government and the health policy
making process
3-2
3. What is Health Policy?
Junior Staffers say:
• Directives for Executive Departments
• It seems expensive
• Happens in a vacuum
• A lot of old people seem concerned about it
• My Member is telling constituent groups he supports
policy that strengthens healthcare
• I think it has something to do with reform
• Don’t they throw a good party
• But there is more…..
3-3
4. What is Health Policy?
• A pattern of government decisions and actions intended to
address a perceived health problem
• A statement of a decision regarding a goal in health care and a
plan for achieving that goal. For example, to prevent an
epidemic, a program for inoculating a population is developed
and implemented
• A means to set a political agenda involving healthcare delivery
and health status
• The placement of resources against health care issues and
challenges
Its all of these but I like the following:
• An amalgamation of values affecting healthcare from political,
economic and legal perspectives
3-4
5. Why Values?
A simple phrase provides an illustration: “appropriate for governmental action”
Do we all agree on what is appropriate for governmental action?
- individual preferences vs. needs of the overall population
Policy is about compromise and the exchange of value relationships. It is also
about allocation and redistribution
Health policy example:
- Is healthcare a right?
If yes, then government should probably guarantee that right and healthcare
becomes appropriate for governmental action
If no, then differences in access to healthcare are seen more as a condition than
a problem
3-5
6. What Values Are We Talking About?
• Liberty Health policy is sometimes
about value trade-offs:
• Equity
• Justice
ex. Immunization
• Security programs, health
• Efficiency surveillance programs,
organ transplants, tiered
• Transparency healthcare systems,
• Capacity etc…
3-6
7. Why is Health Policy important?
• Healthcare Costs as a % of Gross Domestic Product is
projected at 20% by 2016.
• Health reform (arguably the biggest policy issue for the
Obama Administration
• Status of the un-insured – How many and what should we do?
• Pandemic disease – The potential to destabilize nations and
regions that are unprepared.
• Technology and innovation – Who should have access and
who controls costs?
• Medical liability – The effects of tort reform
• Understanding incentives in healthcare
• Managing uncertainty: adverse selection and moral hazard
3-7
8. National Health Expenditures
$4,500 25%
$4,000
20%
$3,500
$3,000
15%
$2,500
$2,000
10%
$1,500
$1,000
5%
$500
$0 0%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
National Health Expenditures (NHE) NHE as percent of GDP
9. Did You Know???
• Total U.S. healthcare spending: $2.1 trillion
• As part of all economic activity: 16.3%
• Avg. increase in employee based
insurance premiums since 1999: 120%
• Avg. increases in wages since 1999: 29%
• Proportion of personal bankruptcies
related to illness of medical bills: 62.1%
• Increase since 2001 in the proportion
of personal bankruptcies caused by
medical problems: 50%
3-9
10. Why Does Healthcare Cost So Much?
“This is one of those cases in which the imagination is baffled by the
facts.” - Adam Smith
If we pay more in the U.S. for healthcare this must mean the following:
•The aging of the population drives health spending
Aging adds only about a .5% in per capita health spending for
industrialized nations
• We get better quality from our healthcare system than other nations
Not necessarily, a WHO study ranked the U.S. 37th in healthcare
amongst other nations.
• We get better health outcomes from our system
Again, this is not always the case. In fact the U.S. does not do as
well in preventive care or treatment for many acute conditions
3-10
11. Lets Take Another Look At Healthcare Costs
The most prominent drivers of healthcare costs are:
• The Gross Domestic Product (GDP) per capita of an
industrialized nation appears to be a strong indicator on
the amount of per capita health care spending
• We pay higher prices for the same health goods and
services offered in many other nations
• We have significantly higher administrative overhead costs
• We tend to use more high cost, high-tech equipment and
procedures than other countries
• We cannot discount the effect of “defensive medicine”
triggered by American tort laws
3-11
13. Why is Health Policy Important inside the
MHS?
• Taking care of Wounded, • Psychological health, readiness
Injured, and Ill service- and resiliency
members • Cost of care in direct care system
• Humanitarian assistance, vs. purchased care system
disaster relief support and • Global health and force health
capacity building protection surveillance
• TRICARE copay modification • Viability of residency training,
(sustaining the benefit Part II) other educational programs and
• JTF Capital Medical Region research
• Recaptialization of MHS • Partnerships and sharing with VA,
facilities HHS, DOS and other Agencies
• and activities
Information technology sharing
and integration • Investment, recruitment and
retention of human capital
3-13
14. Growth in the Unified Medical Budget
(Excluding GWOT)
Increase
over FY2000
$70,000 $46.7B
268%
$60,000 $12.1B –26%
$2.5B – 5%
$50,000
$5.2B – 11%
($M)
$40,000 $9.0B – 19%
$30,000
$18.0B – 39%
$20,000
FY2000
Baseline
$17.4B
$10,000
$0
FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15
FY2000 Unified Medical Program Price Inflation Volume/Intensity/Cost Share Creep, etc.
New Users <65 Explicit Benefit Changes to <65 Explicit Benefit Changes to 65+, i.e. TFL
Volume/Intensity/CostShare Creep, etc is the residual after all explicit causes have been removed
New users accounts for increase in percentage of eligible beneficiaries under 65 who rely on TRICARE (See Slide
11 for trend)
Explicit Benefit Changes <65 are estimates base on legislative changes to the benefit (See Slide 8 for examples)
Explicit Benefit Changes to 65+ is the Normal cost to the department minus the Level of Effort for MTF Care prior
to the MERCHF
15. Increased DoD Health Benefits
1940s-1950s
Title 10 Legislated Benefit 2002
Space Required for Active Duty TRICARE Plus
Space Available for Families and Retirees TRICARE For Life
1966 TRICARE Prime Remote for AD Family Members
CHAMPUS Legislated Benefit
Civilian Health Care where MTFs do not exist. 2003
Families and Retirees <65 TRICARE Online
1993 TRICARE implements HIPPA Patient Privacy Standard
TRICARE Managed Care Legislation Elimination of AD Family Member Co-Pays
Automatic enrollment for Active Duty
Space Required for TRICARE Prime enrollees 2004
Space Available for Non-enrollees Transitional Assistance Management Program (TAMP) Expansion
Guard/Reserve TRICARE (Early Eligibility, Reserve Family Demo)
1995-1998 Elimination of Non-Availability Statements (NAS)
TRICARE Triple Option Benefits
2005
Prime, Extra and Standard
TRICARE Reserve Select
TRICARE Senior Prime Demonstration
Extended Health Care Option/Home Health Care (ECHO / EHHC)
TRICARE Maternity Care Options
1999-2000
Further Expansion:
2006
Prime Remote for Active Duty
TRICARE provider rates >=Medicare Extended TRICARE benefits for dependents whose sponsor dies on
Beneficiary Counseling & Assistance Coordinators
Active Duty
Limit deductibles/co-pays for nursing home residents under the
Pharmacy Program
Enhanced Benefit
Enhancement of TRICARE Reserve Select coverage
2001
Catastrophic Cap Reduced to $3,000
Enhanced TRICARE Retiree Dental Program 2007
TRICARE Senior Pharmacy Expansion of TRICARE Reserve Select coverage to All
Elimination of Prime Co-pays for AD Family Members Reservists
Extension of Medical and Dental Benefits to Survivors Three year Extension of Joint DoD/VA Incentive Program
School Physicals Planning/Management – Claims Processing Standardization
Entitlement for Medal of Honor Recipients Expanded Disease Management Programs
TRICARE Prime Travel Entitlement Coverage of Forensic Exams for Sexual Assaults
Chiropractic Care Program Dental anesthesia for pediatric cases
16. Budget Impact
DoD Forecast
$70.00
If DoD Health Budget
grows at recent trend
$60.00 rates, it will reach
$64B, or 10.4% of
DoD topline in 2015
$50.00
Annual Total If DoD Health
Defense
$40.00 Budget managed to
Health 8% of DoD topline,
Expenditures budget would be
($B) $30.00
$46 in 2015
$20.00
$10.00
$0.00
FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15
Maintain Health Budget at 8% of Total DoD Budget Projections are for 10.4% by FY2015
17. Implications
• Without intervention, health care costs will
consume a larger and larger portion of DoD
budget
• In extreme case, budget pressures could impact
delivery of benefit and/or operation of Direct
Care System
• Increasing cost shares could blunt some but not
all of the growth
22. Fundamentals of Health Policy
Market failure and why it occurs:
• Public goods
• Externalities
• Asymmetry of information
• Lack of competition
• Redistribution of income
3-22
23. Policy Definitions
• Market failure
- When markets do not provide resource allocations that
are fully acceptable
- This situation allows for a potential role of government to
“improve” allocations or provide some form of corrective
intervention
• Examples of market failure
- National Defense
- Monopolies
- Healthcare???
3-23
24. Policy Fundamentals
• Public Goods
- Non-rival in consumption – You and I both consume
without affecting one another’s consumption of the
good ex. National park
- Non-excludable – the good is provided to everyone
ex. national defense or a lighthouse
Is healthcare a public good? It depends…
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25. Policy Definitions …
Externalities – Unintended / unplanned effects of market
behavior. This may be positive or negative.
Ex. immunizations – positive externality
medical error – negative externality
Lack of Competition
- Monopoly – A market where there is a single provider
- Monopsony – A market where there is a single buyer
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26. Policy Definitions …
Redistribution of income – transferring income or benefits from
one group to another. In healthcare this equates to two large
programs:
- Medicare
- Medicaid
- Healthcare reform may also cause a redistribution if the
individual mandate requires one group to subsidy another
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27. Policy Definitions…
Imperfect Information - Buyers and sellers are assumed to have
complete information about products and services. In the absence of
information, markets may not allocate resources properly:
Moral hazard – when one party in a transaction has more information
than another and does not behave responsibly.
ex. Presence of health insurance causes someone to take fewer
health related precautions
Adverse selection – This occurs when high risk consumers, who know
about their own health status, subscribe to an insured group composed
of lower risk individuals.
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28. Health Policy Decision-Making Tools
• Cost- benefit analysis
• Cost effectiveness analysis
• Quality Adjusted Life Years (QALYs)
• Disability Adjusted Life Years (DALYs)
• Game Theory
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30. Policy and History
q Adam Smith “Wealth of Nations” 1776
- “The first duty of the sovereign is that of protecting the society from the
violence and invasion of other independent societies”. = National Defense
- “The second duty of the sovereign is that of protecting, as far as possible,
every member of the society from the injustice or oppression of every other
member of it, or the duty of establishing an exact administration of justice”.
= Administration of justice
- “The third and last duty of the sovereign or commonwealth is that of
erecting and maintaining those public institutions and those public works,
which, though they may be in the highest degree advantageous to a great
society, are, however, of such a nature, that the profit could never repay the
expense to any individual or small number of individuals, and which it
therefore cannot be expected that any individual or small number of
individuals should erect or maintain”. = Public goods
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31. More… Policy and History
• John Maynard Keynes (1926), “Liberalism and Labour”
- “The political problem of mankind is to combine three
things: economic efficiency, social justice, and individual
liberty.”
• Richard Musgrave (1958), “The Theory of Public Finance”
- Implementation of government policies have the following
effects: allocation of resources, distribution of income and
wealth, and stabilization.
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32. Notable Health Policy Scholars
Kenneth Arrow
Victor Fuchs
Uwe Reinhardt
John Iglehart
Mark Pauly
Stuart Altman
Donald Berwick
Alexandra Shields
Charles Lindblom
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34. Modern U.S. Healthcare History in
Short
1940s
• National health care expenditures are 4.0% of Gross National Product
• Wage and price controls are placed on American employers. Many
companies begin to offer health benefits to compensate for lower wages
• President Truman offers national health program but plan is
denounced by AMA and a House Subcommittee calls his plan a
communist plot
• Hill-Burton Act helps fund the building of new hospitals
1950s
• National health care expenditures are 4.5% of Gross National Product
• Federal responsibility for sick and poor is established
• Americans have a system of private insurance for those who can
afford it and welfare services for the poor
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35. Modern U.S. Healthcare History
in Short
1960s
• National health care expenditures are 6% of GNP
• Medicare and Medicaid signed into law by President Johnson
• 700 companies selling health insurance
1970s
• National health care expenditures are 8% of GNP
• HMO Act of 1973 provides grants and loans to expand HMOs and
offer alternative to traditional insurance
• President Nixon’s plan for National Health Insurance rejected
• RAND Study – Concludes that insurance with no copays = greater
usage
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36. U.S. Healthcare History
Continued…
1980s
• National health care expenditures are 10.5% of GNP
• COBRA of 1985 extends health coverage to those losing a job
• Medicare shifts to DRGs
• Large scale shift to privatization, contracting and corporate medicine
begins
1990s
• National health care expenditures are 13% of GNP
• Health care costs rise at double the rate of inflation. In an effort to
control
costs managed care expands
• President Clinton’s healthcare reform plan defeated by Congress
• HIPAA and SCHIP passed into law
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37. U.S. Healthcare History …
2001 – September 11th and anthrax attacks (bio-terrorism
becomes real)
2003 – Major expansion of Medicare prescription drug
benefit
2004 – HSPD 10 – First major inter-agency bioterrorism
directive
2006 – Massachusetts health reform plan
2008-2009 – Healthcare Reform???
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38. The Reform Debate
Comprehensive reform – Major overhaul of the current U.S.
healthcare system
VS.
Incremental reform – Tinkering with the existing system
The trend for healthcare reform in the U.S. points toward
incrementalism. The most significant comprehensive
reform in U.S. healthcare has been Medicare and Medicaid
as part of the Social Security Act of 1965.
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39. The Reform Debate
So, Why Reform???:
• Costs are growing at an increasing rate
• Growing number of un insured
• Diminishing access to care
• Concern over the health of U.S. economy and
unemployment
• Growing number of health coverage limitations,
increasing co pays fear of
uncovered catastrophic event
• Gaps in the quality of healthcare being provided
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40. What Will Reform Look Like?
International Flavor???
1. The Beveridge Model: William Beveridge
- Healthcare is financed by government through tax payments
- Government acts as sole payer, controls what doctors can do and
what is charged
- Examples: Great Britain, Spain, New Zealand, Cuba and most of
Scandinavia
2. The Bismarck Model: Otto Von Bismarck
- This model uses an insurance system with insurers called
“sickness funds” (about 240 funds)
- Financed jointly by employers and employees through payroll
deductions; tight government cost control regulation
- Examples: Germany, France, Netherlands, Japan, Switzerland
3. The National Health Insurance Model (NHI)
- NHI provides care for all eligible residents
- Care is offered primarily through private sector providers
- Funding for NHI is thru provincial and federal personal/corporate taxes
- Examples: Canada, Taiwan and South Korea
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41. International Flavor con’t
4. Out of Pocket Model:
- Many separate healthcare systems
- Loosely related components that include financing, insurance,
delivery
and payment
- Lack of overall “system-wide” planning and coordination
- Examples: United States and many other nations
Other features of the out of pocket model include:
- Generally those with affluence and money receive care
- In rural areas of the world millions of people may never see a
physician
- In emergency situations patients may be admitted for life-saving
care to
a medical facility if one is available
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42. But Healthcare In The U.S. Is
Somewhat Different
The Beveridge Model – This looks similar to the care
provided in the MHS and the VA
The Bismarck Model – This resembles workers who
receive healthcare benefits through their employer like
General Motors or UPS
NHI Model – Medicare closely parallels the NHI/Canada
model
Out of Pocket Model – This is how uninsured and higher
income categories generally receive care in the U.S.
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43. Politics and Compromise
What happened?
2008 - Presidential election campaign healthcare reform becomes one of the
key issues
2009 – Obama Administration takes office
Spring – Meetings with industry leaders and healthcare proposal generated
July – A series of healthcare reform bills are proposed in House Committees
August – Summer recess was used to hold town hall meetings on healthcare
Fall – Posturing for reform between Democrats and Republicans and between
the House and Senate
November – The House passes the Affordable Health Care for America Act
H.R. 3962 and forwards this to the Senate. The vote 220-215.
December – The Senate completely revises the House bill and passes H.R.
3950 on Christmas Eve. The vote 60-39.
2010 - President Obama stays the course
January – Sen. Brown (R-MA) elected to fill Sen. Kennedy’s seat. This
breaks the Democrat hold on filibuster proof majority in the Senate and
causes many to rethink their position on healthcare reform
February – President Obama’s unveils revised reform package based on the
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44. Politics and Compromise
2010 – Healthcare reform passed
March – H.R. 3950 Patient Protection and Affordable Care Act signed into
law 3/23/10
H.R. 4572 Health Care and Education Affordability Reconciliation Act
signed into law on 3/31/10
Why two healthcare reform bills?
- H.R. 3950 became the base bill or essentially the placeholder to all the
reconciliation process to be used for H.R. 4572
- H.R. 4572 became the amended health care reform act. It also included
student financial aid reform.
What is reconciliation and why was it used?
- Reconciliation is a process that allows for an up or down vote on
budget resolutions and avoids the Senate’s filibuster rules.
- Reconciliation also requires the bill to meet both short and long term
deficit reduction goals
- Provision of reconciliation bills not affecting revenues or outlays of the
federal government are prohibited.
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45. Bill Comparison
House Bill Senate Bill Reconciliation Bill
Passed House 11/07/09 by a vote of Passed Senate 12/24/09 by a vote of 60 Amends the Senate bill, by a vote of
220-215 to 39 220-211
$1.2 trillion $940 billion
Gross cost of coverage provisions $875 billion
$138 billion
Net savings $138 billion $118 billion
36 million more people would have
31 million more people would have 32 million more people would have
coverage than under current law. In
coverage than under current law. In coverage than under current law. In
Insurance coverage expansion total, 94% of the population would be
total, 92% of the population would be total, 95% of the population would be
insured
insured insured
15 million Americans would be added to 15 million Americans would be added to 16 million Americans would be added to
Expansion of Medicaid
Medicaid Medicaid Medicaid
Number of American who would remain 23 million
18 million 24 million
uninsured
4 million fewer people would have
4 million fewer people would have
6 million more people will get employer employer coverage than under current
Change in employer-provided insurance employer coverage than under current
coverage law
law
Average subsidy for people buying
$6,800 per year $5,800 per year $6,000 per year
insurance with government aid
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46. How does it impact you?
Some highlights extracted from the bill:
- Dependent children will be permitted to remain on their parents’ insurance until
their 26th birthday.
- Insurers are prohibited from dropping policy-holders when they get sick.
- Medicare is expanded to small, rural hospitals and facilities.
-Insurers are prohibited from discriminating against or charging higher rates for
any individuals based on pre-existing medical conditions.
-Insurers are prohibited from establishing annual spending caps.
- Imposes a $2000 per employee tax penalty on employers with over 50 employees
who do not offer health insurance to their full-time workers.
-Imposes a penalty of $95 , or up to 1% of income, whichever is greater, on
individuals who do not secure insurance; this will rise to $695, or 2.5% of income
by 2016.
-Chain restaurants with over 20 locations are required to display caloric content of
their foods on menus and vending machines.
-Establish health insurance exchanges, and subsidization of premiums for
individuals with income up to 400% of the poverty line, as well as single adults.
- Indoor tanning services are subjected to a 10% service tax.
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48. Basic Tenets of Reform
1) Provision of virtually universal health care to
U.S. citizenry
2) Limiting the costs of health care by reducing
growth rate of costs
3) No rationing of health care in new system
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51. Stakeholders in Health Policy
• The President
- Office of Management and Budget (OMB)
• Congress - Oversight Committees for MHS only include:
- House Armed Services Committee (HASC)
- Senate Armed Services Committee (SASC)
- House Appropriations Committee (HAC)
- Senate Appropriations Committee (SAC)
• Executive Departments:
- Health and Human Services
- Defense
- State
- VA
• Advocacy groups and lobbyists: ex. Military coalition
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52. Stakeholder’s in More Generic
Terms
• Patients and consumers - demanders
• Healthcare providers or producers –
suppliers
• Insurers or third party payers
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53. Section 5: Government and
the Health Policy Making
Process
“To do for people what needs to be done, but which they cannot,
by individual effort, do at all, or do so well, for themselves”
- Abraham Lincoln
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54. The Primary Objectives of
Government?
• Maintain law, order and defense
• Improve efficiency
• Redistribute income/wealth
What is efficiency?
• Technical efficiency – “do not waste resources”
• Cost-effectiveness – “produce each output at the least cost”
• Allocative efficiency – “produce the types and amounts of healthcare
output which people value most”
What is redistribution of income/wealth?
• The transfer of income, wealth or property from some individuals to
others.
• Income redistribution is supposed to even the amount of income that
individuals are permitted to earn
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55. And Then There is Equity
Fairness in the provision of healthcare services and
the improvement of health status
- Should certain features of healthcare mean that
it is distributed differently from other goods and
services?
- Does it matter who receives healthcare goods
and services?
- Is the process to distribute health care services
and goods equitable?
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56. Government Policy Instruments
• Authorizations - Authorizing legislation sets policies
and funding limits for agencies/programs.
• Appropriations - Appropriations legislation is what a
department or agency needs before it can cut a
check or sign a contract.
• Tax policy
• Use of regulations
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57. How Do We Pay For Health Policy?
• General taxation
• Social insurance
• User charges
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58. The Two Primary Theories of Policy
Public interest – This model assumes there are two
primary objectives of government:
1) Improve efficiency in the market when there are:
- monopolization
- existence of externalities
2) Redistribute income in a more equitable manner
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59. The Two Primary Theories of Policy
Economic (Self interest) - This model assumes
the primary objective of government is the
redistribution of wealth. It also implies that
wealth in most cases is redistributed to those
that offer political support.
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60. Other Theories of Policy
- The Iron Triangle
- Power Clusters
- Kings and Kingmakers
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61. Now We Include the Objectives of Health
Policy
Allocation – The cost effectiveness of the production and
procurement of appropriate healthcare goods and services
Distribution – Fair financing, fair access to healthcare goods and
services, and fair payment to providers
Sustainable development – Development of appropriate
incentives for performance and health, policy development
and the management of change, and a sustainable resource
base over the long-term.
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63. The Healthcare Marketplace
Economic Exchanges in
Market Transactions
Demanders Suppliers
(Buyers) (Sellers)
Negotiation
Adapted from : Longest, BB. Health Policymaking in the United States, 3rd edition
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DoD’s health care benefit has largely been driven by Congressional action. With the military drawdown of the early 90’s, access to military hospitals for retirees and retiree family members became more limited, resulting in increased reliance on private sector care. The TRICARE benefit is a rich benefit when compared to most private sector health plans. Largely as the result of lobbying by beneficiary groups, Congress continues to add new benefits. These new benefits demand increasingly more funding from DoD’s budget “top line” each year. In addition, some new benefits are expected to be funded from within the existing DHP appropriation amounts (“carve out”).
This slide portrays current projections of total DoD Health Expenditures. This includes O&M, RDT&E, Procurement, MILPERS, and MILCON as well as the Department’s Normal Cost Contribution to the Medicare Eligible Retiree Health Care Fund (MERHCF). It does not include projected receipts out of the MERCHF. These projections are from the FY08 President’s Budget through FY13 but does include all dollars in the Escrow Account, as well as restoring projected savings from Sustain the Benefit (STB) . For FY14 and FY15, conservative growth rates of 6.5% for health expenditures were used. For FY06 and FY07, figures include supplemental dollars but there is no projection for supplemental dollars beyond FY07. Total DoD topline is also from the FY08 PB with projected growth in FY14 and FY15 of 2.1%. For FY07, DoD Health Expenditures are 6.7% of the DoD topline which is lower than normal because of supplementals to the topline. For FY08, without supplementals, DoD Health Expenditures (assuming no savings from STB) are projected at 8.4% of the DoD topline. This will grow to 11.4% by FY15 which is lower than previously expected (12%) only because of larger growth in the projected DoD topline. The red bars represent the increases in DoD Health Expenditures above the level if they were to be maintained at 8% (the green bars). STB was one method to reduce the red bars but would not have reduced them completely. (For FY15 the savings were projected at $5.4B compared to a shortfall of $19.4B).
Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery December 2009June 2009 Unlike healthcare, the political process does, to some extent, follow the market model The demanders – interested parties who seek something from The suppliers – may be any branch of government There is a negotiation process involved in the exchange Desire is to have a mutually acceptable outcome BUT Difference between economic marketplace and political marketplace Economic – buyers reap the benefits of choices, and bear costs Political – not always so straightforward – costs often imposed on future generations However, remember – policies are always developed to achieve someone’s policy objectives