Medicare: Better, smarter, safer NameTitleOrganization.

THE AFFORDABLE CARE ACTMedicare: Better, smarter, safer

NameTitleOrganization

Reasons for changeThe status quo was unsustainable: Health insurance premiums for family coverage at large

companies rose 114 percent from 2000 to 2010 At small businesses, premiums increased 85 percent

17.9 percent of the nation’s entire economic output is tied up in health care

The share of Americans under 65 covered by job-based health insurance had fallen for nine years in a row, falling to 59 percent in 2009

62 percent of all personal bankruptcies are at least partly the result of medical expenses

High Costs, Low Quality In the United States,

the cost of health care is too high; quality is too low

Nations as diverse as Japan, Spain, Malta and New Zealand spend less than half as much as the U.S., but have better outcomes

Source: University of California Atlas of Global Inequality: Health Care Spending http://ucatlas.ucsc.edu/spend.php

Affordable Care Act at a glance Health reform seeks to:

improve the quality of health care lower the cost of medical care increase access to that care expand the base of people contributing to the system fill gaps created by the old system

Virtually everyone plays a role Large employers are required to contribute Workers are required to contribute 32 million newly insured lower the average cost Doctors and hospitals are required to improve care New programs control rising costs and improve delivery of care

So, What Happens to Medicare?

Improving Medicare coverage

Preventive care carries no co-payments or deductibles beginning in 2011

This includes free: annual physicals colonoscopies mammograms

Free screenings for:

osteoporosis high blood pressure depression diabetes obesity anemia

Lowering costs for seniors Savings on prescription drugs: In 2013, Medicare patients, once they hit the coverage

gap, get a discount of:

52.5 percent off brand-name drugs

21 percent off generic drugs

This is an increase from the 2012 discount of 50 percent for brand name and 14 percent on generics

The discounts rise every year until complete coverage begins in 2020

Helping seniors, improving livesPrescription drugs: In 2011, the drug discount meant that 3.49 million seniors

saved an average of $605 each – more than $2.1 billion in all Seniors in Missouri and Kansas saved more than $70 million

In Missouri, 78,585 seniors saved a total of $46.76 million

In Kansas, 38,692 seniors saved a total of $23.44 million

Preventive Care: In 2011, more than 32.5 million seniors nationwide received at least one free preventive health service

In Missouri, 729,809 seniors received a free preventive service

In Kansas, 313,085 seniors received a free preventive service

Making Medicare better Quality improvements:

Improved coordination of care, which has been found to lower relapse rates and overall costs

Paying doctors according to quality, not volume of procedures

Incentives for hospitals to improve care and reduce infection rates

Expanded enrollment period in the fall

Expanded counseling and enrollment assistance through grants for:

Area Agencies on Aging State Health Insurance Assistance Programs Aging and Disability Resource Centers

$45 million extends funding provided by previous laws

Making Medicare safer High-quality care is cheaper than bad care. One

example: Hospitals

Hospital discharges generate more complaints than any other aspect of Medicare

Expenditures related to re-admission – the “roundtrip to the hospital” – total more than $17 billion a year

Geographic Variation – Medicare 30-Day Hospital Readmissions as a percentage of admissions: All states’ average – 17.5% Iowa average – 15.9% Missouri average – 18.3% Kansas average – 19.2% Bottom five states’ average – 21.8% (Commonwealth Fund State Scorecard on Health system Performance, 2009)

Making Medicare safer Medicare in 2011 launched

Partnership for Patients, a groundbreaking initiative to improve medical careA $1 billion effort to improve

care

Partnership for Patients has two major goals: Reduce preventable hospital-acquired conditions by 40

percent

Reduce hospital readmissions by 20 percent by reducing preventable complications during the transition from one care setting to the next

Making Medicare safer The care transition program seeks to:

improve transitions from hospital to other care settings improve quality of care at each stage reduce readmissions for high risk beneficiaries document savings to Medicare

Community organizations will work with hospitals to improve after-discharge careFocus will be on patients with:

multiple chronic conditions depression cognitive impairments

Making Medicare safer

Hospitals will be penalized when patients are re-admitted within 30 days of discharge for a condition that could have been prevented

Doctors’ fees will be based partly on keeping patients healthy and how well their patients recover from illness or injury

Begins in January 2015

Future hospital payments will be based on treatments that work

Begins in October 2012

Making Medicare smarter Total savings from new initiatives are projected to

be more than $600 billion over 10 years

Medicare spending will continue to rise, but the growth rate will drop through:

Phasing out the extra payments to insurers for Medicare Advantage

More aggressive negotiation with suppliers

More competitive bids on medical devices and drugs

A genuine focus on reducing fraud

These changes extend the life of the Medicare trust fund by 8 years

Groups Left Behind

Early retirees and their spouses

People with existing health conditions

Small businesses and their employees

Young adults

Children

Expanding Access to Care Small businesses and their employees

Small employers get tax credits worth up to 35% of their employee health insurance costs. The credit rises to 50% in 2014

Nonprofits can get a credit of up to 25%, rising to 35% in 2014

Beginning in 2014, employees without health coverage through their jobs will receive tax credits to help them pay for health insurance

Young adults Health insurance policies must now offer coverage to children

under 26, if the plan covers dependents This is a big help to recent graduates and young adults in entry-level

jobs

The Affordable Care Act provides $11 Billion for community health centers over the next 5 years

$1.5 billion for expansion and renovation projects

$9.5 billion for new health centers in underserved areas and expansion of primary care services

$1.5 billion for National Health Service Corps These scholarship programs repay student loans for

providers who agree to work in underserved areas Since 2008, the number of primary care providers has grown:

by 353 in Missouri, the third most in the entire nation by 94 in Kansas, 25th most in the nation

The goal: 16,000 new primary care providers nationwide by 2016

Expanding access to care

Fighting Fraud The law boosts spending on investigations by $350 million

The new emphasis is already paying off:

In fiscal year 2009, anti-fraud efforts recovered: $2.51 billion for Medicare, up 29 percent from 2008 $441 million for Medicaid, up 28 percent

In 2010 and again in 2011, total recoveries for Medicare and Medicaid rose to more than $4 billion

In 2012, fraud recoveries hit a record $4.2 billion

Whistle-blower lawsuits recovered record amounts for two years in a row:

$2.8 billion in 2011 $2.5 billion in 2010

Fighting Fraud – seniors can help

Beefing up Senior Medicare Patrols

These groups – we call them the “fraud squads” – are credited with saving taxpayers more than $100 million since 1997

The program hopes to double the number of Senior Medicare Patrols to 10,000 members

These volunteers show seniors and their caregivers how to: scrutinize Medicare bills for inflated charges report services that were billed, but never provided protect their identity avoid getting taken by scammers

To become a volunteer:

In Missouri: In Kansas: Rona McNally Kelly Loeb

SMP Project Manager Coordinator of VolunteersCare Connection for Aging Services Kansas Dept. of Aging & Disability ServicesWarrensburg, MO Topeka, KS Direct: 660-747-3107 Direct: 785-296-0377Toll Free: 1-888-515-6565 Toll Free: 1-800-860-5260

Simply Awesome Consumer Site: www.Healthcare.gov

New one-stop consumer site for information on insurance options

Details about the new consumer protections under the Affordable Care Act

Information at your finger tips allows you to shop for insurance based on benefits, prices, insurer ratings

Questions?

How the Doughnut Hole WorksFor 2013: You pay the first $325 of your drug costs

After reaching that amount, you pay 25% of the cost of your drugs, while the Part D plan pays the rest, until the total drug costs for you and the plan reach $2,970

At that point, you hit the coverage gap referred to as the “doughnut hole.” You are responsible for the full cost of your drugs for the next $3,764 That amount will bring you to the yearly out-of-pocket spending

maximum of $4,750

After reaching this total, you are responsible only for a small amount of the cost, usually 5% of the cost of your drugs