8/6/2009 Prepared by Chuck Kiskade n from StoneTapert 626-23 3-9180 1 Discussion on HealthCare Reform - 2009 $400 Billion Impact on MediCare The Players Why now instead of under Clinton? Which Model will prevail? What will be the impact on Employers and Employees?
A presentation on Health Care Reforms potential impact on Medicare given to a group of 100 retirees in a retirement community.
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
1
Quaker Gardens Discussion on HealthCare Reform - 2009
$400 Billion Impact on MediCare The Players Why now instead of under Clinton? Which Model will prevail? What will be the impact on
Employers and Employees?
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
2
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
3
Impact on MediCare?
Any Changes in Benefits? What will happen to the medical
delivery system? What happens when MediCare is
cut by $400+ Billion over 10 Years?
Myths in HC Reform?
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
4
Possible Changes in M’Care Benefits?
Get the “Hole” out of the Donut for MediCare Part D
Better programs on transition of care from Hospital to other levels of care
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
5
HR 3962 Proposal Improved financial assistance Eliminate Part D cost sharing Eliminate barriers to enrollment Improve communications to eligibles Extended coverage of
immunosuppressive drugs Voluntary advance care planning
services
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
6
HR 3962 Proposal Improvements in calculating income
for calculating part B premiums Create Accountable Care
Organizations to reward medical providers for improvements in Quality of Care
Funding of MediCare graduate medical education
MediCare Rural access protections
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
7
HR 3962 Proposal Nursing Home Transparency Incentivize use of Electronic Medical Records Bundled payments for post-acute care
services Address geographic inequities in provider
payment No Mid-year drug formulary changes allowed Free Generic drugs (Jan 2011)
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
8
HR 3962 Proposal
Medical Home Pilot Coverage and waiver of cost
sharing for preventive medical services
Waiver of deductible for colorectal screening services
Expanding access to vaccines
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
9
HR 3962 Proposal Independence at Home medical pilot
Additional Medicare and Medicaid Savings- $313 - Incorporate productivity adjustments into
Medicare payment updates $110- Reduce hospital subsidies for treating
the uninsured as coverage increases$106
- Pay better prices for Medicare Part D drugs $75- Other $22
Total $948
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
14
The Players Employers Employees Unemployed Retired Organized Medicine (Docs, Hospitals,
HMOs, ancillary Providers, Pharma, etc.) For Profit Insurance Companies & HMO’s States Federal Government
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
15
Why Now?
Health Care costs have doubled in last 8 years
Cost shifting has reached tipping point to trigger federal & state intervention Tipping points are "the levels at which the
momentum for change becomes unstoppable."
$800,000,000,000 in potential savings!
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
16
Macro Cost Shifting
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
17
Pay Full Retail
Macro Cost Shifting
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
18
Pay Full Retail
Best Risks and Underinsured
Macro Cost Shifting
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
19
Pay Full Retail
Best Risks and Underinsured
Poor Risks, Can’t afford Insurance, etc.
Macro Cost Shifting
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
20
Pay Full Retail
Medical paid at $.60 on the dollar
Best Risks and Underinsured
Poor Risks, Can’t afford Insurance, etc.
Macro Cost Shifting
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
21
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
22
Which Model will Prevail? Single Payor System Universal Health Care
With Health Care Exchange that includes a Public Plan or Health Care Co-operative
At State Level? (A program like the HIPC?) At Federal Level?
Pay or Play for employers Guaranteed Coverage (no exclusions for pre-existing
conditions and no cherry picking) Minimum benefit level established Federal and State subsidies
Probably at 400% of Federal Poverty Level Minimum ER contribution levels set (like SF city regs)
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
23
Payment ReformHealth Care Payment Reform That Rewards Value, Not Volume
Bundling payments to cover care over a specified period, revising fees to increase compensation for primary care, and offering providers financial incentives to serve as patient-centered medical homes
Quality ImprovementHealth Information Technology Policy Evidence Based Medicine and a Business Case for Health
Information Technology
Business Case for Investing in HC Reform
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
24
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
25
Ideas on how to lower HC Costs
Competitive Public Plan Change MediCare payment structure
Reduce annual increases to providers Reduce payments to M’Care Advantage
Plans (now 14% higher than FFS docs) Pharma discounts for Seniors Rx in the
Doughnut Hole
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
26
Ideas on how to lower HC Costs
Use Best Practices and Evidence Based Medicine Conduct Comparative Effectiveness
Research at new proposed “ Center for Quality Improvement”
Docs and Hospitals Create Incentives for delivering Quality
Medical Care Bundle Payments to Providers to encourage
“coordinated care” across provider spectrum
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
27
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
28
NOW – Silos of Payment
Doctors HMO’s
Hospitals
Nursing Homes and ECF’s
$$$
$$$$$$
$$$$$$
$$$$$$
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
29
NOW – Silos of Payment
Doctors HMO’s
Hospitals
Nursing Homes and ECF’s
$$$
$$$$$$
$$$$$$
$$$$$$
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
30
FUTURE? Bundled payment
Doctors HMO’s
Hospitals
Nursing Homes and ECF’s
$$$
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
31
Ideas on how to lower HC Costs
Mandate that everyone be covered by all carriers with no pre-existing condition exclusions and no adverse selection rating.
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
32
Information and Data Sources
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
33
Health Care Reform Web Sites AARP.org commonwealthfund.org/ healthreform.gov/ mailmanschool.org/facultypubs/
Massachusetts “Health Care Connector”http://randcompare.org/options/mechanism/employer_mandate
Pay or Play explainedMandates (Cal, Or, WA passed and subs
repealed)Hawaii 1974Mass 2006
Health Care Reform Web Sites
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
35
Health Care Web Sites
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
36
Medical Info/Research www.medem.com - modern medical library www.ncqa.com - Nat'l Committee on Qual.
Assurance www.doctorsolve.com/ - Info on drugs in Canada www.coverfingtheuninsured.org www.insureusa.org http://www.prevent.org/ - information on disease
prevention and health promotion policies and practices
www.cmwf.org/index.htm - Commonwealth Fund
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
37
Employee Empowerment & Health Wellness
www.4women.gov - Nat'l Women’s Health site www.ivanhoe.com - Medical Breakthroughs http://vm.cfsan.fda.gov - US FDA Food Safety Ctr. www.healthyroads.com – ASHP wellness product www.new.chcf.org - Cal Health Care Fndn www.mrmib.ca.gov – MRMIB http://www.opa.ca.gov/report_card/. - Cal Office of Patient
Advocate www.healthcarecoach.com/ www.mayoclinic.com http://www.doclopedia.com- Use doclopedia to put your medical
history, prescriptions, and bills in one convenient space for FREE
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
38
Employee Empowerment & Health Wellness
http://www.hhs.gov/transparency/ - The “Four” Value Driven Health Care Principles. Health care transparency provides consumers with the information necessary, and the incentive, to choose health care providers based on value.
www.netwellness.org – 100 health topics to find in-depth information on hundreds of diseases and wellness issues
http://www.insureuonline.org/ - The National Association of Insurance Commissioners (NAIC) has created the Insure U — Get Smart About Insurance program to help consumers make educated decisions.
www.organizedwisdom.com - OrganizedWisdom is a collaborative health information community, combining professional and user-generated health content with social networking technologies to help people make the most informed health decisions possible.
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
39
Provider/Health Plan Report Cards www.healthscope.org www.lumetra.org - dedicated to measurably
improving the quality, safety, and integrity of healthcare.
www.aahp.org - Amer Assn of Health Plans www.chcf.org – California Health Care
Foundation www.healthcarecoverageguide.org – Cal
Health Care Foundation web site www.guiadecoberturadesalud.org – CHCF
hispanic site for small employers www. benefitscheckup.org/
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
40
Government Web Sites www.cdc.gov - Center for Disease Control www.medlineplus.gov www.medicare.gov/ - info on Part D drug plans www.leginfo.ca.go - Cal ins code www.dmhc.ca.gov - Dept Managed Health
Care www.mrmib.org – High Risk Ins pools
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
41
The end
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
42
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180