Context and discussion regarding the problems, implications and solutions to health care reform with a contrarian point twist. Includes discussion of The Patient Protection and Affordable Care Act, economic data, insurance data, H.R. 3590, H.R. 4872, a history of health reform. Finally, the presentation outlines the implications for business, physicians and the health care system.
Acs0007 Elements Of Cost Effective Nonemergency Surgical Caremedbookonline
This document discusses 7 elements of cost-effective surgical care. It begins by providing context on rising healthcare costs in the US and issues with traditional definitions of quality that focused on appropriateness. It then discusses the emergence of a new concept of quality defined by structure, process, and outcomes. Critical analysis of medical literature is identified as an important skill for cost-effective care.
This document provides an overview of health reform and how hospitals are responding to changes. It discusses rising healthcare costs in the US compared to other countries. Key aspects of the reform are outlined, including the creation of Accountable Care Organizations and a shift to paying for outcomes rather than procedures. The document also summarizes some of the main ways hospitals are responding, such as aligning with physicians, focusing on the full care continuum, increasing transparency, emphasizing value over volume, and developing a shared community vision. Employer strategies for incentivizing employees to use high quality, low cost providers are also reviewed.
A presentation built by Clay Marsh, MD. executive director of the OSU Center for Personalized Medicine, designed to explain some of the scientific and social angles that are a part of personalized health care.
The webinar will cover Medicaid and health reform, including health insurance exchanges, essential health benefits, and opposition actions. It will provide an overview of Medicaid, why it is a top issue for states in 2012, and 4 things for states to consider as they address Medicaid issues. Enrollment has increased due to the recession and the ACA's 2014 expansion qualifies more people, increasing costs significantly for states.
This document provides an overview of the impact of the recession on unemployment taxes. It begins with an agenda that includes reviewing national unemployment trends, federal unemployment tax law, an example of state-specific impacts, strategies for managing unemployment costs, and a question and answer section. The document then reviews key unemployment terms and statistics. It shows national unemployment rates rising dramatically from 2007 to 2010 along with large increases in initial unemployment claims. State unemployment trust funds have become insolvent as benefits increase during the recession.
This document discusses the key challenges facing the U.S. healthcare system: cost, quality, and access. It notes that total U.S. healthcare expenditures reached $2.7 trillion in 2011, or 17.9% of GDP. Around 15.4% of the population, or 47.96 million people, lacked health insurance in 2012. Private health insurance covered 63.9% of the population, while government programs like Medicaid and Medicare covered 32.6%. International comparisons show the U.S. has higher costs but lower life expectancy and higher mortality rates than countries like Japan and Germany.
This document discusses the key challenges facing the U.S. healthcare system: cost, quality, and access. It provides data showing that in 2011, total U.S. healthcare expenditures reached $2.7 trillion or 17.9% of GDP. For quality, it notes mortality rates are higher in the U.S. than in Japan and Germany. Regarding access, it states that in 2012, 15.4% of Americans (47.96 million) were uninsured. Private health insurance covered 63.9% of Americans in 2012 while government insurance covered 32.6%. The document compares these healthcare statistics between the U.S., Japan, and Germany.
The document summarizes the components and goals of the Affordable Care Act and National Prevention Strategy, and discusses how community prevention programs can help improve health outcomes and lower healthcare costs. It then describes the role of the Massachusetts Healthy Communities System in supporting community prevention efforts across the state to achieve the goals of increased access to care, prevention services, and policy changes that promote public health.
Acs0007 Elements Of Cost Effective Nonemergency Surgical Caremedbookonline
This document discusses 7 elements of cost-effective surgical care. It begins by providing context on rising healthcare costs in the US and issues with traditional definitions of quality that focused on appropriateness. It then discusses the emergence of a new concept of quality defined by structure, process, and outcomes. Critical analysis of medical literature is identified as an important skill for cost-effective care.
This document provides an overview of health reform and how hospitals are responding to changes. It discusses rising healthcare costs in the US compared to other countries. Key aspects of the reform are outlined, including the creation of Accountable Care Organizations and a shift to paying for outcomes rather than procedures. The document also summarizes some of the main ways hospitals are responding, such as aligning with physicians, focusing on the full care continuum, increasing transparency, emphasizing value over volume, and developing a shared community vision. Employer strategies for incentivizing employees to use high quality, low cost providers are also reviewed.
A presentation built by Clay Marsh, MD. executive director of the OSU Center for Personalized Medicine, designed to explain some of the scientific and social angles that are a part of personalized health care.
The webinar will cover Medicaid and health reform, including health insurance exchanges, essential health benefits, and opposition actions. It will provide an overview of Medicaid, why it is a top issue for states in 2012, and 4 things for states to consider as they address Medicaid issues. Enrollment has increased due to the recession and the ACA's 2014 expansion qualifies more people, increasing costs significantly for states.
This document provides an overview of the impact of the recession on unemployment taxes. It begins with an agenda that includes reviewing national unemployment trends, federal unemployment tax law, an example of state-specific impacts, strategies for managing unemployment costs, and a question and answer section. The document then reviews key unemployment terms and statistics. It shows national unemployment rates rising dramatically from 2007 to 2010 along with large increases in initial unemployment claims. State unemployment trust funds have become insolvent as benefits increase during the recession.
This document discusses the key challenges facing the U.S. healthcare system: cost, quality, and access. It notes that total U.S. healthcare expenditures reached $2.7 trillion in 2011, or 17.9% of GDP. Around 15.4% of the population, or 47.96 million people, lacked health insurance in 2012. Private health insurance covered 63.9% of the population, while government programs like Medicaid and Medicare covered 32.6%. International comparisons show the U.S. has higher costs but lower life expectancy and higher mortality rates than countries like Japan and Germany.
This document discusses the key challenges facing the U.S. healthcare system: cost, quality, and access. It provides data showing that in 2011, total U.S. healthcare expenditures reached $2.7 trillion or 17.9% of GDP. For quality, it notes mortality rates are higher in the U.S. than in Japan and Germany. Regarding access, it states that in 2012, 15.4% of Americans (47.96 million) were uninsured. Private health insurance covered 63.9% of Americans in 2012 while government insurance covered 32.6%. The document compares these healthcare statistics between the U.S., Japan, and Germany.
The document summarizes the components and goals of the Affordable Care Act and National Prevention Strategy, and discusses how community prevention programs can help improve health outcomes and lower healthcare costs. It then describes the role of the Massachusetts Healthy Communities System in supporting community prevention efforts across the state to achieve the goals of increased access to care, prevention services, and policy changes that promote public health.
Palestra de Rachel David no 3º Fórum Nacional da Saúde Suplementar, realizado pela Federação Nacional de Saúde Suplementar (FenaSaúde), no Sheraton WTC São Paulo Hotel, no dia 6 de outubro de 2017.
This document summarizes Senator Barack Obama's health policy plan, which focuses on achieving universal health care coverage, health care reform, and strengthening public health. It outlines some of the key problems in the current US healthcare system from the perspectives of providers, purchasers, and consumers. Obama's plan would invest in health information technology and reform reimbursement to align with quality. The plan is estimated to cost $50-65 billion annually but could save $120-200 billion through reduced administrative costs, improved disease management, and health IT savings. If implemented, it could lower family insurance costs by $2,500 and cover 10 million more people.
Acs0008 Health Care Economics The Broader Contextmedbookonline
1) US healthcare spending is very high at over $2 trillion annually, yet health outcomes are mixed compared to other developed nations.
2) There is debate around whether rising healthcare costs represent an economic risk, with some arguing costs crowd out other spending while others say spending is acceptable if the value of health is high.
3) A key factor driving higher US costs with no clear improvement in outcomes is the market-based healthcare system, which differs from other countries. Features of healthcare markets like supplier-induced demand and moral hazard may contribute to rising costs.
WealthTrust-Arizona - Five Fallacies for Improving Healthcare WealthTrust-Arizona
Educational workshop presented by WealthTrust-Arizona and world-renowned guest Robert K. Smoldt, Chief Administrative Officer Emeritus at Mayo Clinic and Associate Director of Healthcare Delivery & Policy Programs at Arizona State University. Mr. Smoldt has been involved in health care administration for more than 30 years and is currently pursuing U.S. health reform in close partnership with Mayo Clinic’s Emeritus President and CEO.
At this workshop Robert examines a number of general statements that are, in his view, fallacious.
GHIs operating in Mozambique include the Global Fund, PEPFAR, President's Malaria Initiative, and others focused on specific diseases. While GHIs have increased funding and scale-up of targeted health services, their vertical nature has stressed harmonization efforts and negatively impacted health workers. Overall, GHIs could have achieved better health outcomes by jointly strengthening the overall health system in a more coherent manner.
This document discusses the history and evolution of health insurance in America, including the impact of the Affordable Care Act (ACA). It describes how the ACA sought to regulate health insurance policies, provide coverage to all Americans, and reduce costs. It also examines effects on quality of care, such as the emphasis on accountable care organizations and reducing hospital readmissions. The future of the industry is discussed in terms of ongoing consolidation through mergers and the potential disruption from non-traditional players entering the market.
The document discusses Medicare payments to physicians. It provides estimates of the 10-year cost to repeal the Sustainable Growth Rate (SGR) formula and prevent cuts to physician fees, ranging from $115 billion to $138 billion depending on whether fees are only maintained at current levels or increased. It also notes that Congress has overridden the scheduled SGR fee cuts 15 times since 2003. Additionally, it presents data showing that most Medicare beneficiaries report having a usual source of care, being able to get timely appointments, and not foregoing care at rates higher than privately insured adults. The majority of office-based physicians accept new Medicare patients across all states.
The document discusses reimbursements of healthcare costs in the French general healthcare system as of the end of March 2021. It finds that healthcare reimbursements increased 9.2% compared to the first quarter of 2020 and 8.2% over the past 12 months. Various types of medical costs increased at different rates, with medical tests increasing the most at 123.5% due to COVID-19 testing. The atypical healthcare activity levels in 2020 due to the pandemic impact comparisons between 2020 and 2021.
September is a time for spreading awareness via the Life Insurance Awareness Month (LIAM) campaign. What's key for insurance professionals is to find the best way to connect with consumers on the need for this product. Take a look at our presentation for a few of these important facts and figures that can help convey the right message.
Read More: http://www.genre.com/knowledge/blog/life-insurance-stats-and-facts-en.html
National health spending is projected to grow steadily at around 6.7% per year through 2017, reaching $4.3 trillion. While private spending growth is expected to slow slightly, stronger public spending growth will offset this as Medicare eligibility expands. Overall health spending is expected to outpace GDP growth by 1.9 percentage points annually on average, resulting in health care comprising 19.5% of the economy by 2017.
- Rate hikes by health insurers caused public outrage and distrust as companies initially threatened hikes and then rescinded them, citing mathematical errors. This added to existing concerns about high executive pay and claims processing issues.
- The government is providing funds to create high-risk insurance pools under healthcare reform, but some insurers are opting out and funds may be exhausted quickly as more people enroll than expected.
- Hospitals face challenges in implementing electronic health records to qualify for stimulus funds, due to unclear criteria, lack of IT expertise, and concerns over privacy and security of electronic data. Overall public sentiment toward healthcare reform is mixed and increasingly bleak.
3º FÓRUM DA SAÚDE SUPLEMENTAR - CARMELLA BOCCHINOCNseg
The document discusses challenges and opportunities related to medical devices in the US healthcare system. It provides background on AHIP and trends in US healthcare spending and insurance coverage. It then discusses the medical device industry and market, FDA regulation of devices, payment reform efforts toward value-based care, and examples of alternative payment models like bundled payments that aim to reduce costs and improve outcomes.
This document provides an update on the fiscal health of New York State and analyzes recent credit rating upgrades. Key points:
- New York State received upgrades from the three major rating agencies this summer due to improved budget management practices and recent spending restraint. However, challenges remain including rising Medicaid costs, pension liabilities, and infrastructure needs.
- While the state's projected budget gap has stabilized below 5% due to spending reforms, additional measures are still needed to fully address structural budget issues according to a state task force.
- The rating upgrades were positive news for investors holding New York related debt, but ongoing monitoring is required as fiscal stresses persist in areas like healthcare spending and retirement obligations.
Over the last twenty years, medical costs associated with lost time workers’ compensation claims has risen dramatically, despite efforts to reform the system. Medical tourism, a popular option for many seeking lower cost health care, is one option that has yet to catch on. Issues of quality of health care in other countries is no different for workers’ compensation patients, as it is for health care patients, and with accreditation from the Joint Commission International (JCI), hospitals that cater to medical tourists offer better care at lower cost than most U.S. hospitals offer. Certain procedures, common to workers’ compensation claims, such as knee replacement, hip replacement and spinal fusion in countries such as India, Thailand and Singapore, are considerably lower cost than those performed in the U.S.
However, legal barriers currently exist not only for medical tourism, but for its implementation for workers’ compensation. Medical malpractice, liability laws, patient privacy and medical records (HIPAA), ERISA, and the PPACA, all present significant obstacles that need to be addressed before such implementation are possible. Case law in the US has recognized limited use of medical tourism, both domestic and international, and opens the door a little for further development in this direction. The globalization of healthcare as evidenced by the tremendous growth of medical tourism in the health care arena, will lead to the implementation of international medical providers into the medical provider network for workers’ compensation.
This document summarizes a presentation by Dr. Ileana Arias from the CDC on prescription drug overdoses from a public health perspective. It describes current trends in overdose deaths involving opioid pain relievers, populations most at risk, and the CDC's strategic focus areas and policy recommendations to address the problem using a public health approach. The CDC aims to enhance surveillance, improve clinical practice, and inform policy to help reduce overdose deaths while ensuring appropriate pain treatment.
The Affordable Care Act fundamentally changed the landscape of the U.S. health care system. With more than five years since the law’s passage, questions remain about how to fix a system that remains broken despite recent reform efforts. Did the Affordable Care Act adequately reform a failing health system, or did that prescription only treat the symptoms of a much larger illness?
The document discusses Medicare spending and proposals for reforming the program. It shows that while Medicare spending growth has slowed in recent years, it still grows significantly faster than GDP. If trends continue, Medicare and other health spending will account for over 17% of GDP by 2037. The document proposes several reforms to make Medicare more sustainable, such as combining Parts A and B, limiting first dollar Medigap coverage, introducing competitive bidding similar to Part D, permanently fixing physician payments, and gradually raising the eligibility age in line with increasing longevity.
Canadian Medicare Presentation at Hofstra UniversitySteven Rohinsky
50%
40%
30%
20%
10%
0%
1998 2004
Source: Canadian Institute for Health
Information.
The Canadian Medicare system is financed through taxes paid by individuals and corporations to provincial and federal governments. 75% of financing comes from public sector funds, while 25% is from private sector payments. Spending on healthcare in Canada is projected to reach $148 billion in 2006, accounting for 10.3% of GDP. The largest areas of spending are on hospitals, drugs, and physicians. Per capita spending varies across provinces and is generally higher in the territories. Most spending growth is on drugs, physicians and other professionals. Nearly two-thirds
Health Financing System of United KingdomAditya Sood
Discussing in brief bout the latest statistics of Health Financing in UK, with emphasis on National Health Services (NHS) model and the key challenges being faced by the UK health system financing.
Learn about 2016 trends in government and private healthcare spending, employer costs, and the patient-as-consumer movement that's spurring new provider models.
C1 Primary Care21st Century Final Presentationisduser
This document provides an overview of a presentation about the importance of primary care in the 21st century healthcare system. The summary is:
Primary care is essential to achieving high-quality, affordable, patient-centered healthcare but faces many challenges in the current system. These include a lack of primary care physicians and nurses, inadequate compensation for primary care providers, and a need for health systems that are coordinated, use health IT effectively, and are led by clinicians. Transforming primary care will require payment reform, greater use of teams, and making primary care practices more patient-centered through a focus on prevention, care coordination, and effective use of health technologies.
Palestra de Rachel David no 3º Fórum Nacional da Saúde Suplementar, realizado pela Federação Nacional de Saúde Suplementar (FenaSaúde), no Sheraton WTC São Paulo Hotel, no dia 6 de outubro de 2017.
This document summarizes Senator Barack Obama's health policy plan, which focuses on achieving universal health care coverage, health care reform, and strengthening public health. It outlines some of the key problems in the current US healthcare system from the perspectives of providers, purchasers, and consumers. Obama's plan would invest in health information technology and reform reimbursement to align with quality. The plan is estimated to cost $50-65 billion annually but could save $120-200 billion through reduced administrative costs, improved disease management, and health IT savings. If implemented, it could lower family insurance costs by $2,500 and cover 10 million more people.
Acs0008 Health Care Economics The Broader Contextmedbookonline
1) US healthcare spending is very high at over $2 trillion annually, yet health outcomes are mixed compared to other developed nations.
2) There is debate around whether rising healthcare costs represent an economic risk, with some arguing costs crowd out other spending while others say spending is acceptable if the value of health is high.
3) A key factor driving higher US costs with no clear improvement in outcomes is the market-based healthcare system, which differs from other countries. Features of healthcare markets like supplier-induced demand and moral hazard may contribute to rising costs.
WealthTrust-Arizona - Five Fallacies for Improving Healthcare WealthTrust-Arizona
Educational workshop presented by WealthTrust-Arizona and world-renowned guest Robert K. Smoldt, Chief Administrative Officer Emeritus at Mayo Clinic and Associate Director of Healthcare Delivery & Policy Programs at Arizona State University. Mr. Smoldt has been involved in health care administration for more than 30 years and is currently pursuing U.S. health reform in close partnership with Mayo Clinic’s Emeritus President and CEO.
At this workshop Robert examines a number of general statements that are, in his view, fallacious.
GHIs operating in Mozambique include the Global Fund, PEPFAR, President's Malaria Initiative, and others focused on specific diseases. While GHIs have increased funding and scale-up of targeted health services, their vertical nature has stressed harmonization efforts and negatively impacted health workers. Overall, GHIs could have achieved better health outcomes by jointly strengthening the overall health system in a more coherent manner.
This document discusses the history and evolution of health insurance in America, including the impact of the Affordable Care Act (ACA). It describes how the ACA sought to regulate health insurance policies, provide coverage to all Americans, and reduce costs. It also examines effects on quality of care, such as the emphasis on accountable care organizations and reducing hospital readmissions. The future of the industry is discussed in terms of ongoing consolidation through mergers and the potential disruption from non-traditional players entering the market.
The document discusses Medicare payments to physicians. It provides estimates of the 10-year cost to repeal the Sustainable Growth Rate (SGR) formula and prevent cuts to physician fees, ranging from $115 billion to $138 billion depending on whether fees are only maintained at current levels or increased. It also notes that Congress has overridden the scheduled SGR fee cuts 15 times since 2003. Additionally, it presents data showing that most Medicare beneficiaries report having a usual source of care, being able to get timely appointments, and not foregoing care at rates higher than privately insured adults. The majority of office-based physicians accept new Medicare patients across all states.
The document discusses reimbursements of healthcare costs in the French general healthcare system as of the end of March 2021. It finds that healthcare reimbursements increased 9.2% compared to the first quarter of 2020 and 8.2% over the past 12 months. Various types of medical costs increased at different rates, with medical tests increasing the most at 123.5% due to COVID-19 testing. The atypical healthcare activity levels in 2020 due to the pandemic impact comparisons between 2020 and 2021.
September is a time for spreading awareness via the Life Insurance Awareness Month (LIAM) campaign. What's key for insurance professionals is to find the best way to connect with consumers on the need for this product. Take a look at our presentation for a few of these important facts and figures that can help convey the right message.
Read More: http://www.genre.com/knowledge/blog/life-insurance-stats-and-facts-en.html
National health spending is projected to grow steadily at around 6.7% per year through 2017, reaching $4.3 trillion. While private spending growth is expected to slow slightly, stronger public spending growth will offset this as Medicare eligibility expands. Overall health spending is expected to outpace GDP growth by 1.9 percentage points annually on average, resulting in health care comprising 19.5% of the economy by 2017.
- Rate hikes by health insurers caused public outrage and distrust as companies initially threatened hikes and then rescinded them, citing mathematical errors. This added to existing concerns about high executive pay and claims processing issues.
- The government is providing funds to create high-risk insurance pools under healthcare reform, but some insurers are opting out and funds may be exhausted quickly as more people enroll than expected.
- Hospitals face challenges in implementing electronic health records to qualify for stimulus funds, due to unclear criteria, lack of IT expertise, and concerns over privacy and security of electronic data. Overall public sentiment toward healthcare reform is mixed and increasingly bleak.
3º FÓRUM DA SAÚDE SUPLEMENTAR - CARMELLA BOCCHINOCNseg
The document discusses challenges and opportunities related to medical devices in the US healthcare system. It provides background on AHIP and trends in US healthcare spending and insurance coverage. It then discusses the medical device industry and market, FDA regulation of devices, payment reform efforts toward value-based care, and examples of alternative payment models like bundled payments that aim to reduce costs and improve outcomes.
This document provides an update on the fiscal health of New York State and analyzes recent credit rating upgrades. Key points:
- New York State received upgrades from the three major rating agencies this summer due to improved budget management practices and recent spending restraint. However, challenges remain including rising Medicaid costs, pension liabilities, and infrastructure needs.
- While the state's projected budget gap has stabilized below 5% due to spending reforms, additional measures are still needed to fully address structural budget issues according to a state task force.
- The rating upgrades were positive news for investors holding New York related debt, but ongoing monitoring is required as fiscal stresses persist in areas like healthcare spending and retirement obligations.
Over the last twenty years, medical costs associated with lost time workers’ compensation claims has risen dramatically, despite efforts to reform the system. Medical tourism, a popular option for many seeking lower cost health care, is one option that has yet to catch on. Issues of quality of health care in other countries is no different for workers’ compensation patients, as it is for health care patients, and with accreditation from the Joint Commission International (JCI), hospitals that cater to medical tourists offer better care at lower cost than most U.S. hospitals offer. Certain procedures, common to workers’ compensation claims, such as knee replacement, hip replacement and spinal fusion in countries such as India, Thailand and Singapore, are considerably lower cost than those performed in the U.S.
However, legal barriers currently exist not only for medical tourism, but for its implementation for workers’ compensation. Medical malpractice, liability laws, patient privacy and medical records (HIPAA), ERISA, and the PPACA, all present significant obstacles that need to be addressed before such implementation are possible. Case law in the US has recognized limited use of medical tourism, both domestic and international, and opens the door a little for further development in this direction. The globalization of healthcare as evidenced by the tremendous growth of medical tourism in the health care arena, will lead to the implementation of international medical providers into the medical provider network for workers’ compensation.
This document summarizes a presentation by Dr. Ileana Arias from the CDC on prescription drug overdoses from a public health perspective. It describes current trends in overdose deaths involving opioid pain relievers, populations most at risk, and the CDC's strategic focus areas and policy recommendations to address the problem using a public health approach. The CDC aims to enhance surveillance, improve clinical practice, and inform policy to help reduce overdose deaths while ensuring appropriate pain treatment.
The Affordable Care Act fundamentally changed the landscape of the U.S. health care system. With more than five years since the law’s passage, questions remain about how to fix a system that remains broken despite recent reform efforts. Did the Affordable Care Act adequately reform a failing health system, or did that prescription only treat the symptoms of a much larger illness?
The document discusses Medicare spending and proposals for reforming the program. It shows that while Medicare spending growth has slowed in recent years, it still grows significantly faster than GDP. If trends continue, Medicare and other health spending will account for over 17% of GDP by 2037. The document proposes several reforms to make Medicare more sustainable, such as combining Parts A and B, limiting first dollar Medigap coverage, introducing competitive bidding similar to Part D, permanently fixing physician payments, and gradually raising the eligibility age in line with increasing longevity.
Canadian Medicare Presentation at Hofstra UniversitySteven Rohinsky
50%
40%
30%
20%
10%
0%
1998 2004
Source: Canadian Institute for Health
Information.
The Canadian Medicare system is financed through taxes paid by individuals and corporations to provincial and federal governments. 75% of financing comes from public sector funds, while 25% is from private sector payments. Spending on healthcare in Canada is projected to reach $148 billion in 2006, accounting for 10.3% of GDP. The largest areas of spending are on hospitals, drugs, and physicians. Per capita spending varies across provinces and is generally higher in the territories. Most spending growth is on drugs, physicians and other professionals. Nearly two-thirds
Health Financing System of United KingdomAditya Sood
Discussing in brief bout the latest statistics of Health Financing in UK, with emphasis on National Health Services (NHS) model and the key challenges being faced by the UK health system financing.
Learn about 2016 trends in government and private healthcare spending, employer costs, and the patient-as-consumer movement that's spurring new provider models.
C1 Primary Care21st Century Final Presentationisduser
This document provides an overview of a presentation about the importance of primary care in the 21st century healthcare system. The summary is:
Primary care is essential to achieving high-quality, affordable, patient-centered healthcare but faces many challenges in the current system. These include a lack of primary care physicians and nurses, inadequate compensation for primary care providers, and a need for health systems that are coordinated, use health IT effectively, and are led by clinicians. Transforming primary care will require payment reform, greater use of teams, and making primary care practices more patient-centered through a focus on prevention, care coordination, and effective use of health technologies.
This document summarizes key findings from National Health Accounts conducted in Egypt between 1994-2009. It finds that private out-of-pocket spending remains the largest source of health financing. While total health spending has increased over time, government spending as a percentage of total health spending and of the overall government budget is among the lowest in the region. There are also inequities in spending between rich and poor and urban and rural populations. The document calls for increased public investment in health and reforms to address these inequities and increase the role of comprehensive insurance.
The document discusses opportunities in the elderly care industry. It notes that the US elderly population is growing rapidly and will increase demand for elderly care services. Major opportunities exist in developing solutions to help seniors leverage their assets for additional retirement income and providing cheaper in-home care alternatives to retirement homes. The elderly care sector is poised for consolidation as many small players currently operate with minimal market share. Overall, the aging population will drive significant industry growth and present excellent investment opportunities.
AcademyHealth President and CEO Lisa Simpson's presentation for the Richard and Janet Southby Distinguished Lecutreship in Comparative Health Policy at the George Washington University Hospital on April 24, 2012
Three key points emerged from the document:
1) Patient advocacy groups and unions see the choice of drug as a matter between doctors and patients, and do not want employers, governments, or others interfering in drug decisions.
2) Both patient groups and unions want new drugs and devices to be publicly funded, believing they are safer and more effective, though cost is a major concern for Pharmacare plans and employers.
3) Unions and their members generally support the idea of national Pharmacare but more education is needed to help members understand and support evidence-based managed formularies being negotiated by employers.
The document provides an overview of the American College of Cardiology (ACC). It lists the current leadership of the ACC including the president, president-elect, vice president, and chair of the board of governors. It discusses the mission of the ACC to transform cardiovascular care and improve heart health. It also invites attendees to the upcoming ACC.13 conference in San Francisco and provides disclosure information for the presenter.
This document provides an overview of the US healthcare payer landscape and discusses HawkPartners' expertise in conducting research with payers. The US system includes private insurers, Medicare, Medicaid and other government programs. Commercial insurance and PBM markets are consolidating with large players dominant. Payers now have greater influence over pharmaceutical companies and are seeking strategic partnerships. HawkPartners has experience interviewing key decision makers at leading payers to provide insights into clinical development, market opportunities, and messaging strategies. Case studies demonstrate how their research has informed clients' strategies.
The document discusses several key issues facing the US healthcare system including rising costs, demographic changes, and quality challenges. It notes that US healthcare costs and spending per capita are the highest in the world. Major drivers of rising costs include high prices, administrative overhead, and high utilization of technology. The Affordable Care Act aims to expand coverage, improve access and quality, and control costs. It establishes insurance exchanges, expands Medicaid, includes an individual mandate, and reforms payments to shift to quality-based systems. Implementation is ongoing from 2010 to 2014 and beyond to transform delivery systems and promote primary care, prevention, and coordinated care models.
This document contains 22 figures that provide data on key characteristics of the Medicare population and program in the United States. Some of the key facts presented include:
- In 2010, 55% of Medicare beneficiaries were female, 77% were white, and 44% were between ages 65-74. Chronic conditions, functional impairments, and cognitive issues were common.
- Spending on healthcare makes up a larger share of household budgets for Medicare beneficiaries compared to non-beneficiaries. Out-of-pocket spending includes significant costs for premiums, drugs, and long-term care.
- Medicare Advantage enrollment has grown substantially in recent decades and now covers 30% of beneficiaries nationally. Supplemental coverage comes from a variety
The document discusses how the Affordable Care Act aims to address problems in the US healthcare system like the large number of uninsured, rising costs, and quality and access issues. It will expand coverage to 32 million uninsured through Medicaid expansion and health insurance exchanges. Reforms to payment and delivery systems are also expected to help slow premium growth and reduce costs over time. Implementation will occur gradually through 2019, with many provisions taking effect in 2014 such as the individual mandate, Medicaid expansion, and state-based insurance exchanges.
Health Insurance Plan for the Uninsured - Market research Carlos Traseira
The document provides an overview of the US healthcare business and market research. It includes statistics on healthcare expenditures, sources of payment, insurance coverage rates, and costs facing insured and uninsured individuals. Key findings are that the US spends the most on healthcare as a percentage of GDP, public programs like Medicare and Medicaid account for around half of national healthcare expenditures, and many Americans struggle to afford medical care and insurance due to high and rising costs.
The document summarizes key issues facing the U.S. healthcare system including rising costs, an increasing number of uninsured and underinsured Americans, and poor health outcomes compared to other developed nations. It attributes these problems partially to the for-profit insurance model which incentivizes denying claims to maximize profits. This leads to high administrative waste as hospitals must employ large staffs to deal with insurance bureaucracies. The majority of healthcare spending is shouldered by the government through programs like Medicare and Medicaid, yet the U.S. still spends over twice as much per capita as other countries without achieving better population health.
This document discusses strategic issues facing the U.S. healthcare system. It argues that the U.S. does not have a functional competitive healthcare market, leading to higher costs, marginal quality improvements, and opportunistic innovation. It analyzes factors contributing to market failure and addiction to the growing healthcare economy. The document advocates for embracing concepts like consumerism, quality reporting, and globalization to increase competition and innovation in healthcare.
This document contains a disclaimer stating that the presentation is for informational purposes only and does not constitute an offer to sell securities. It also contains forward-looking statements and disclaims responsibility for updating or revising these statements. Confidential company information and estimates are also included. The agenda outlines topics on the healthcare industry in India, Fortis Healthcare company overview, recent developments, and financials.
Mercer Capital's Value Focus: Medical Technology | Mid-Year 2021Mercer Capital
Mercer Capital's Medical Technology Industry newsletter provides perspective on valuation issues. Each newsletter also includes macroeconomic trends, public market trends, and comparable public company metrics.
In Spring of 2010 I was on a Georgetown student consulting team that worked on figuring out if it was possible to detect Medicaid fraud from #opendata in small, medium, and large states.
Similar to The Economics of Health Reform: Implications for Health Professionals (20)
The High Performing FQHC of Tomorrow: Expanding the Mission Through MarginSage Growth Partners
This document summarizes a presentation given at the NACHC Conference FOM/IT on October 28, 2015 about the high-performing Federally Qualified Health Center (FQHC) of the future. It discusses major trends like rising healthcare costs, the shift to value-based care, and Medicaid reform that are drawing FQHCs into the changing healthcare economy. It provides examples of FQHCs partnering with Accountable Care Organizations and payers. The presentation argues that FQHCs should embrace transparency, pursue value-based payment opportunities, and actively manage patient populations to succeed in this new environment while continuing their mission.
The document discusses how the US healthcare system is currently pre-industrial and will undergo disruption through industrialization. It argues that healthcare costs are unsustainably high and increasing faster than wages or inflation. As consumers face higher deductibles and premiums, consumerism will drive changes in the system. The document also notes several problems including the instability of Medicare and Medicaid funding, an aging population increasing demand, and significant issues with patient safety. It believes elements of value-based care and payment reform show signs of an emerging industrialized, more efficient healthcare model in the US.
Overtime among nurses is common and costly for healthcare organizations. The document summarizes research showing that 50% of full-time nurses work overtime, averaging 7 overtime hours per week, costing a typical 300-bed hospital $12 million annually in direct and indirect costs. Overtime increases risks of medical errors by nurses by up to 3 times and nurse turnover by 2 times. It decreases patient satisfaction and increases nurse injury rates by 61%. Eliminating overtime could potentially save a hospital over $3.4 million per year through reductions in costs associated with medical errors, turnover, lower patient satisfaction, and nurse injuries.
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There is an overwhelming confluence of interests, incen6ves, and macro-environmental forces that will disrupt the healthcare industry and drive real change.
This document summarizes a presentation given by Sage Growth Partners on the changing healthcare landscape and what physicians should do in response. It argues that payment models are shifting from volume to value, disrupting the traditional medical practice model. To succeed, physicians will need to take on more leadership roles, partner with other providers and payers, and build new capabilities to manage populations and be accountable for quality and cost. The top strategies are becoming the best provider organization, building the best delivery network, or developing an enabling technology platform.
Health Insurance Marketplaces: New Challenges and OpportunitiesSage Growth Partners
The document discusses health insurance marketplaces and the opportunities and challenges they present. It provides information on state and federal exchanges, the impact of exchanges on providers and the marketplace, and actions providers can take to succeed in an exchange-driven market. Specifically, it summarizes enrollment statistics and cost-sharing structures for different metal-tier plans, outlines the individual mandate and subsidies available, and discusses factors that contributed to the success of Kentucky's exchange and the challenges faced by Maryland's exchange.
This document summarizes key points from a presentation on sustaining physician-led healthcare organizations. It discusses the current state of the US healthcare system including challenges around demographics, consumerism, technology, and economics. It then covers implications of the Affordable Care Act, such as Medicaid expansion decisions by states and the growth of high-deductible health plans. Finally, it discusses factors needed to build sustainable organizations, including value-based payments, delivery redesign, and blurred lines between providers and payers.
This document summarizes key points from a presentation on moving companies from good to great. It discusses Jim Collins' research analyzing over 1400 companies to identify characteristics of 11 companies that sustained great performance. The research found that great companies are led by Level 5 Leaders who demonstrate humility and focus on the company, not themselves. It also discusses establishing an ownership culture by first selecting the right people and then defining what needs to be done. The document reviews Collins' five dysfunctions of teams and five functions of high-performing teams.
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This document analyzes the practice environment and economic impacts of physicians in Maryland. It finds that while Maryland relies heavily on physicians, the state faces risks in attracting and retaining physicians due to higher costs of living and doing business compared to neighboring states. Specifically, costs of medical office space and labor are 12-20% higher in Maryland. The document recommends ways to enhance physician enterprises and make Maryland a more attractive place for physicians, such as reducing costs and improving the insurance market.
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Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
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How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
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Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
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Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
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Are you looking for a long-lasting solution to your missing tooth?
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The Economics of Health Reform: Implications for Health Professionals
1. THE ECONOMICS OF HEALTH REFORM:
IMPLICATIONS FOR HEALTH PROFESSIONALS
Don McDaniel
April 27, 2010
2. AGENDA
» A Context for our Discussion
» The Seemingly Intractable Problems
» A Deeper Dive
» Implications
» One Contrarian’s View
2
3. THE PATIENT PROTECTION AND AFFORDABLE
CARE ACT
» Expanded Coverage
» Individual Mandate
» Employer Requirements
» Insurance Market Reforms
» Subsidies and Penalties
» Health Exchanges
3
4. HEALTHCARE: THE ECONOMIC ENGINE
1. United States $14.3 T
2. Japan $ 4.8 T
3. China $ 4.2 T GDP 2008 (USD)
4. Germany $ 3.8 T
5. France $ 2.9 T
6. UK $ 2.8 T
7. US health economy $ 2.4 T
8. Italy $ 2.4 T
4
Sources: International Monetary Fund and Centers for Medicare and Medicaid.
6. INSURANCE TAKE-UP 1990 - 2007
1990 2006 2007
73.2%
Pr i va te 67.9%
67.5%
13.0%
M edi ca r e 13.6%
13.8%
9.7%
M edi ca i d 12.9%
13.2%
4.0%
Oth er
3.6%
G over nm ent
3.7%
13.9%
U ni ns ur ed 15.8%
15.3%
0% 10% 20% 30% 40% 50% 60% 70% 80%
6
Source: US Census Bureau, Current Population Survey, 2008 Annual and Social Economic Supplement. Data
released March 2008.
Table HI05. Health Insurance Coverage Status and Type of Coverage by State and Age for All People: 2007.
Link: http://pubdb3.census.gov/macro/032008/health/h05_000.htm.
8. PROBLEM #1
HEALTH EXPENDITURES AS A PERCENTAGE OF GDP
* 2009 – 2018 Projected
8
Source: Centers for Medicare and Medicaid Services
9. PROBLEM #2
AVERAGE PERCENTAGE INCREASE IN HEALTH INSURANCE
PREMIUMS COMPARED TO OTHER INDICATORS, 1988 -2007
20%
18% Health Insurance Premiums Workers' Earnings Overall Inflation
16%
14%
12%
10%
8%
6%
4%
2% 3.7%
0%
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
9
10. PROBLEM #3
GROWTH IN MEDICARE SPENDING VS.
PRIVATE HEALTH INSURANCE SPENDING
Medicare Private Health Insurance
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
-2%
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06
10
Source: American Hospital Association via the Centers for Medicare & Medicaid
Services, Office of the Actuary. Data Released January 8, 2008
11. AGGREGATE HOSPITAL PAYMENT-TO-COST RATIOS
FOR PRIVATE PAYERS, MEDICARE, AND MEDICAID
11
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2008, for
community hospitals.
(1) Includes Medicaid Disproportionate Share payments
12. HOSPITAL PAYMENT SHORTFALL RELATIVE TO COSTS FOR
MEDICARE, MEDICAID, AND OTHER GOVERNMENT
Medicare
Medicaid
Other Government
12
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2008, for
community hospitals.
(1) Costs reflect a cap of 1.0 on the cost-to-charge ratio.
15. NATIONAL SUPPLY & DEMAND PROJECTIONS FOR FTE RNS
15
Source: National Center For Health Workforce Analysis, Bureau of Health Professions, Health
Resources and Services Administration. (2004). What Is Behind HRSA’s Projected Supply, Demand, and
Shortage of Registered Nurses? Link: ftp://ftp.hrsa.gov/bhpr/workforce/behindshortage.pdf.
16. PROBLEM # 5
THE DEMOGRAPHIC TSUNAMI
» One-quarter of all Medicare recipients
» Have five or more chronic conditions
» See, on average, 13 physicians per year
» Secure 50 prescriptions per year
» Over 13,000 different drugs being sold in the U.S. in
2007 – 16x what was available 50 years ago
» Over 900,000 physicians in the U.S. – 75% are in
practices of less than 8 physicians
» Payment system issues – hard to support a “system” of
care
16
17. PROBLEM #6
NUMBER OF FULL-TIME AND PART-TIME HOSPITAL
EMPLOYEES
17
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2008, for
community hospitals.
18. PROBLEM #7
ARRESTED DEVELOPMENT: CONSUMER SOVEREIGNTY
2008 What do things really cost?
Out-of-Pocket
12%
Other
» We don’t demand price
13%
transparency
Other
Private
7% » We don’t demand better
Medicaid(
excluding S-
Private
information to inform our
CHIP)
15%
Insurance
33% purchase decisions
Medicare
» Consumer demand should
20%
drive supply-side reform
18
Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group
19. “WE SPEND SO MUCH BECAUSE WE SPEND
SO LITTLE…”
18.00% 60.00%
16.00%
Percentage of Out-of-Pocket Expenditures
50.00%
14.00%
NHE as Percentage of GDP
40.00%
12.00%
30.00%
10.00%
8.00%
20.00%
6.00%
10.00%
4.00%
0.00%
2.00%
0.00% -10.00%
19
20. HEALTH REFORM 2010
H.R. 3590 THE PATIENT PROTECTION AND AFFORDABLE CARE
ACT
H.R. 4872 THE HEALTH CARE AND EDUCATION TAX CREDIT
RECONCILIATION ACT OF 2010
20
21. BIG THEMES
» Coverage expansion to 32 million people by 2019
» Expands Medicaid to 133% of FPL ~ 16 million new
enrollees in Medicaid and SCHIP
» Eliminates coverage denials due to pre-existing
conditions
» Closes Part D “doughnut hole” for seniors
» Increases Medicaid payments to PCPs
21
22. HEALTH REFORM - CHRONOLOGY
2010
» Insurance reforms
» Eliminates lifetime limits
» Small business tax credit – sliding scale tax credit for
businesses with < 25 employees
» Age 26 – can stay on parents policy
22
23. HEALTH REFORM - CHRONOLOGY
2011
» W-2 reporting – health benefits
» Brand-name drug tax ~ $33B in new fees
» OTC drugs not eligible for reimbursement from
FSA/HAS/HRA
» Federally-subsidized long-term care program –
employers can participate through payroll deductions
23
24. HEALTH REFORM - CHRONOLOGY
2012
» Medicare Advantage – reduction in payments
2013
» New FSA limits
» Medical device 2.3% excise tax
» Medicare payroll tax base increase
» Medicare investment tax – 3.8%
» Medicaid reimbursements to increase to 100% of
Medicare
24
25. HEALTH REFORM - CHRONOLOGY
2014
» Medicaid eligibility expansion – up to 133% of FPL
» Premium credit subsidies – up to 400% of FPL
» Insurance Exchanges come online – “qualified” plans for individuals
and small businesses
» Individual mandate – “carry or penalty” - $695/year to $2,085 or 2.5%
of household income
» Employer requirements - >50 employees have to provide insurance
or incur penalty – up to $2,000/$3,000 per employee
» Federal health insurance premium tax – will raise almost $70 Billion
through 2019 - passed on through premiums
» DSH cuts
» Pre-x and annual limits prohibited
25
27. HOW TO PAY FOR IT?
» Cuts to Medicare spending by as much as $575 Billion
» Parts A and B and future market basket: $233 Billion
» Elimination of Medicare Improvement Fund: $27 Billion
» Medicare Advantage: $145 Billion
» DSH payments: $50 Billion
» Freeze income threshold for Part B: $8 Billion
» Independent Payment Advisory Board: $24 Billion
» Increase in HI payroll tax: $63 Billion
Source: CMS Office of the Actuary
28. HOW TO PAY FOR IT?
» Projected funding sources for health reform – 10 years:
» Individual penalties - $17B
» Employer penalties - $52B
» New Taxes/Assessments on Industry - $107B
» Cadillac Tax on High Premiums - $32B
Source: Congressional Budget Office
29. IN THE CROSSHAIRS
» Consumer directed plans with HSAs
» 8 million Americans currently participating
» Medicare Advantage plans
» 10.2 million (22% of total Medicare book) currently
participating
» 40% of African-Americans and 54% of Latino seniors
participate in MA – mimics Medigap without the added
cost
29
31. MASSACHUSETTS REFORM PLATFORM
» Individual Mandate
» Employer Mandate
» All employers with 10 or more employees. $295 fine per
employee if insurance is not offered
» Middle-Class Subsidies
» Commonwealth Care for all families with income up to
300% of the federal poverty level
» The Connector
» Acts as an exchange for individuals and small business
» Very familiar to National legislation!
31
32. ACCESS TO CARE
» Health insurance does not guarantee access to care!
» An additional 400,000 people are attempting to access the
same number of physicians
» Wait time went from 33 days to ~ 50 days
» 75% of non-urgent ED visits are due to physician shortages
32
33. WAIT TIME ACROSS THE US - 2007
City % of Population Number of Average wait to see
Uninsured Physicians per a specialist
1,000 people
Boston, Mass 9.4% 4.53 49.6
Philadelphia, PA 11.3% 3.32 27.0
Los Angeles, CA 20.5% 2.60 24.2
Houston, TX 27.1% 2.15 23.4
Minneapolis, MN 9.6% 2.81 19.8
New York, NY 15.2% 4.00 19.2
Denver, CO 18.4% 2.65 15.4
Miami, FL 24.2% 2.53 15.4
Seattle, WA 13.6% 2.62 14.2
33
Source: National Center for Policy Analysis
34. MASSHEALTH: MASSCOST?
» State spending on healthcare has increased by 45%
($595 million) since 2006
» Commonwealth Care was estimated at $725 million
annually: 2010 projection is at $880 million
» Health insurance premiums are growing at a rate of 8-
10% a year, nearly twice the national average.
34
36. IMPACT ON PHYSICIANS
» Medicaid Coverage Expansion
» Dramatic cuts to Medicare- $575 Billion
» Reimbursement challenges for private insurers
» Ban on physician-owned hospitals
Source: CMS Office of the Actuary
37. IMPACT ON BUSINESS
» Small business already gets the shaft!
» Highly regulated markets
» Very concentrated insurance markets
» Highest growth in premium YOY
» Higher cost per benefit – most cost-shifted market
» New mandates, new taxes and expansion of entitlement
programs – all good for business?
» Industry taxes on medical devices, pharmaceuticals and
health insurers will likely be passed on
37
38. IMPACT ON BUSINESS
» Incentives point to “Pay vs. Play” for
employers, especially small employers
» Signals seem to favor push of new insured's to public
programs or State Health Exchanges
» PWC study states 10-year premium growth in
commercial premiums will be 40% higher than without
reform legislation*
» Where’s the innovation in plan design, benefits and
financing?
38
*Source: PWC, “Potential Impact of Health Reform on the Cost of Private Health
Insurance Coverage”, 10/09
39. ONE SCENARIO –
HEALTH CARE DEATH SPIRAL
» Medicare in crisis fueled by cuts to fund reform
» Public payors further reduce reimbursement
» Private insurance market “crowd-out” – public programs a bigger “slice” of providers
business
» Private insurance reforms hamper effective pricing/down-ward pressure on reimbursement
» Untold pressure on “physician entrepreneur” - further widening of physician shortage
(especially PCPs)
» Extreme costs and workforce pressures compel explicit rationing of health services
» No “innovation” premium
» Migration of entrepreneurs and capital to other industries
39
40. OH, BY THE WAY…
» Projects Health Reform will increase National Health
Expenditure by $311 billion by 2019
» $77 billion more than the estimate by the Congressional
Budget Office in December 2009
» Expanded coverage will lead to greater utilization of services
coupled with lower federal payments to providers
» 50% of Medicare advantage enrollees
» Also predicts that 15% of hospitals could be driven into the
red
Source: CMS Office of the Actuary
41. “LOW HANGING FRUIT”
1. Fuel growth in CDHC vehicles (HSAs)
2. Equalize tax laws with respect to employer-
sponsored vs. individual market health insurance
3. Allow interstate commerce for health insurance
4. Repeal all coverage mandates
5. Enact substantive tort reform
41
42. THANKS
Don McDaniel
dmcdaniel@sage-growth.com
http://twitter.com/don_mcdaniel
http://www.linkedin.com/in/rdmcdaniel
(o)410.534.1161
(m)443.904.2882
42