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Impact of Health Care Reform on Major Stakeholders

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Impact of Health Care Reform on Major Stakeholders Jeff Korsmo Executive Director, Mayo Clinic Health Policy Center 2010 Health Care Forecast Conference UC Irvine ... – PowerPoint PPT presentation

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Title: Impact of Health Care Reform on Major Stakeholders


1
Impact of Health Care Reform on Major
Stakeholders
  • Jeff KorsmoExecutive Director, Mayo Clinic
    Health Policy Center 2010 Health Care Forecast
    Conference UC Irvine 2/25/2010

2
Mayo Clinic Health Policy Center
  • Goal
  • Influence stakeholders to implementsubstantive
    health care reform before 2011that will enhance
    the quality and availabilityof health care for
    all patients
  • Convener
  • 1,000 thought leaders
  • 1,400 patients
  • 1,000 surveyed
  • 400 on 9-city tour

3
2006 Mayo Clinic National Symposium on Health
Care ReformTop 6 recommendations Rated from
least important to most important and least
urgent to most urgent
Urgency
Importance
Encourage formation of integrated systems
Transparency among systems and physician practices
Results-based reimbursement, with patient
component to incentive plan
Reward consumers for choosing high quality health
plans and providers
Define essential health care services for all
Americans
Build public and business mandate for national
change
4
The Status Quo is Unsustainable
  • A reminder of the current state of American
    health care
  • 46 million uninsured Americans
  • Skyrocketing costs
  • Uneven quality and safety of medical care
  • Lack of access for Medicare and Medicaid patients
  • Medicares imminent collapse

5
Potential Paths
  • House passes Senate bill withsidecar
    legislation via reconciliation
  • Budget reconciliation (requires 51 votes)
  • Many provisions would not be included (i.e.
    insurance reforms)
  • Pass smaller bills to address most pressing
    issues
  • Start over with comprehensive reform
  • Do nothing

6
We All Have to Change
  • Providers
  • Improve outcomes and satisfaction
  • Decrease costs and waste
  • Coordinate care
  • Payers/employers
  • Encourage prevention, compliance and health
  • Value-based benefit design
  • Change payment to reward providers who deliver
    value
  • Patients
  • Prevention/healthier lifestyles
  • Chronic disease adherence
  • Fair financial stake
  • Government
  • Independent health boardto ensure
    transparency, standardize billing and drive pay
    for value
  • Financial help to those in need
  • Support research and education

7
Mayo Clinic Health Policy Center
CornerstonesPrinciples to advance
patient-centered reform

Coordinate care across people, functions,
activities, locations and time.
Create Value
Coordinate Care
Reform the Payment System
Insure Everyone
Improve outcomes and satisfaction. Decrease
medical costs and waste.
Change the ways providers are paid in order to
improve health and minimize waste.
Provide guaranteed, portable health insurance for
all individuals, giving them choice, control and
peace of mind.
8
MCHPC Cornerstones
Reform the Payment System
Insure Everyone
9
It doesnt work to leapa ten-mile chasmin two
five-mile jumps.American Proverb
http//looneytunes.kidswb.com/downloads//wile-e-c
oyote
10
Issue 1 Reform the Payment System to Reward
Value
11
Reform the Payment System to Reward
ValueImplications for Providers
  • Achieve highest outcomes, safety and service
    performance using current and future definitions
  • Help define appropriate new value metrics
  • Improve affordability of care
  • Address underlying cost structure
  • Examine utilization patterns
  • Develop coordinated practices
  • Improve current care-delivery models
  • Explore/innovate new ways to deliver care
  • Demonstrate high-value performance across all
    practice sites
  • Leverage HIT to aid in care coordination

12
Issue 2 Insure Everyone
Senate Bills
House Bill
MCHPC Position
Yes
Yes
Insurance reforms
Yes
Yes
Individual mandate for insurance coverage
Yes State or regional exchanges
Yes National exchange
Choice of private plans through an insurance
exchange
Yes
Yes
Subsidies for low income
Public option dropped during negotiations
  • Includes public option
  • Sets Medicare rates as the floor and average
    private insurance payment as the ceiling Initial
    limits on eligibility

No government-run public option
13
Mayo Clinic Concerns
  • Financing
  • Across-the-board cuts
  • Pay-for-value timeframe and scope
  • Authority and scope of the independent commission
  • Government-run, Medicare-like public plan
  • How to negotiate with the government?
  • Will Medicare rates be the ceiling rather than
    the floor?
  • Slippery slope on eligibility

14
Financial Impact of Proposed Legislation
Provision Impact on Mayo Clinic
Medicare cuts agreed to by the AHA - XX million over 10 years
Sustainable Growth Rate formula  - XX million in 2010 if no fix, plus - XX million/year for 7 years
Medicaid expansion   - XX million /year
Coverage for the uninsured versus current charity care write-offs XX million/year
Value Indexing for physician payments ?
15
Bottom Line Take Steps Toward the Goal
  • Define what we expect from our health care
    delivery system
  • Measure our performance
  • Reward providers that deliver what we expect

16
Questions and Comments
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