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PPACA and the Future of Allied Health
- 1. Looking into the Crystal Ball of Health Care Reform: Patient Protection and Affordable Care Act (PPACA) and the Allied Health Professions Carolyn Watts, Ph.D. Professor and Chair Department of Health Administration, Virginia Commonwealth University
- 3. Primary Question: Is Health Care a “Social Good”? YES for elderly, certain YES for most low income Americans NO individuals, disabled 1965 2014
- 4. Financing Context $8300/person Mixed public/private 50% 17% of GDP (in 2009) Medicare Medicaid Employers Uninsured 15% 20% 67% 18% of population of population of non-elderly of population Up to 2/3 of all births
- 5. Delivery System Context Volume- based payment Illness – not health – based care Decades of profession al control
- 6. Proposed by 6 presidents Crowd-out of Rising un- other public programs employment Pressure for Reform Rising Increasing enrollment in expenditures public programs Fragile state of delivery system
- 7. Cost as % of income at all Global time high business • 12.6% in 1996 disadvantage • 23.2% in 2010 Approaching Changing national debt demographics cliff More Pressures
- 8. Still More Pressures Rise of chronic illness/obesity More evidence/information New technology
- 9. What Did We Expect?
- 10. Health Care Reform: PPACA Individual Employer mandates responsibility • Subsidies • Tax credits • Fines • Fines
- 11. PPACA • Limits on underwriting and exclusions • Older dependent children coverage Insurance rules • 2018: tax on first dollar coverage • “Expedia” for private insurance Exchanges • States or federal government (default)
- 12. PPACA • Eliminate categories; 133% FPL • Federal government pays 100% for 3 Medicaid years expansion • “Donut Hole” • Preventive services Medicare • Provider payment reductions payment cuts; benefit increases • Increases in Medicare payroll tax
- 13. PPACA • Accountable Care Organizations Delivery and • Bundled payment payment demonstrations • Innovation Center • Incentives for employers Wellness • Mandated coverage of prevention
- 14. PPACA: Myths All Americans must have coverage Exemptions for: • Very low income • Insurance costs > 8% of income • Religious beliefs, incarceration, Native Americans
- 15. PPACA: Myths Everyone must have the same coverage • Essential benefit package as floor • Choices through employer/exchange
- 16. PPACA: More Myths All businesses must provide coverage • Small businesses (< 50 employees) exempt • = 96% of 6M businesses • 96% of other businesses already do • 10,000 businesses (.2%) will be affected
- 17. …and More Myths Government will take over insurance • MUST contract with at least 2 private insurance companies in every US market
- 18. …and More Myths Medicare benefits will be drastically cut • Increases for traditional Medicare • Drug coverage • Preventive services • Reduced payments for Medicare HMOs
- 19. …Still More Myths “Death Panels” will limit care provided • Funding of new evidence base, but CMS prohibited from using it • Pres. G.W. Bush-era legislation allows coverage of integrated advance planning • Independent coverage of advance planning taken out of PPACA
- 20. So Far…. 54M Saved $3.7B on 3M Young adults $321M Insurance rebates to small 54M People got newly drugs seniors new dependent businesses (more to big free preventive coverage business) services
- 21. Evolving government role Evolving employer role Future Evolving insurance markets Evolving delivery system Evolving consumer role Evolving technology
- 22. Future Evolving government role Impact of States and Medicare elections Medicaid payment/rules
- 23. Future Evolving employer role Insurance What if they Wellness coverage and drop coverage? programs benefit changes Harvard study: $3.72 HC Value-based insurance So savings, $2.73 absenteeism design what? savings from $1 wellness program
- 24. Future Evolving insurance markets Provider Integration Impact of Consolidation payment with providers exchanges changes
- 25. Future Evolving delivery system Consolidation Physician Scope of Retail and Transparency employment practice medicine integration
- 26. Future Evolving consumer role Responsibility Responsibility for health & for financing metrics
- 27. Future Evolving technology Genetic New Robotics Telemedicine E-medicine medicine pharmaceuticals
- 28. What are the Opportunities for Allied Health? Greater demand Different Expanding payment Medicaid (?) models OPPORTUNITIES for ALLIED HEALTH More Evolving consumer scope of engagement practice Team-based medicine
- 29. What are the Challenges for Allied Health? Different Lower payment payment rates models More concentrated Shrinking interests Medicaid (?) (payers, syste ms) CHALLENGES