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Susan Dentzer

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Moving Forward on Health Reform Susan Dentzer Editor-in-Chief Bruce H. Hamory Executive Vice President, Chief Medical Officer Emeritus Geisinger Health System Jon ... – PowerPoint PPT presentation

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Title: Susan Dentzer


1
Moving Forward on Health Reform
  • Susan Dentzer
  • Editor-in-Chief

2
How Health Care Reform Must Bend The Cost Curve
  • David M. Cutler
  • Harvard University

3
The Drivers of Productive Industries
4
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5
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6
Forecast of Cost Savings
Total savings 9.0 trillion
7
What It Will Take
  • Administrative Implementation
  • Shorten demonstration time
  • Openness to new approaches
  • Provider response
  • Changing existing operations
  • New organizational forms

8
Health Reform And Federal Budget Deficits
Likely to Broaden The Gap, Not Reduce It
  • Michael Ramlet
  • Analyst, The Advisory Board Company
  • Douglas Holtz-Eakin
  • President, American Action Forum

9
It Was Ugly Before Reform
Federal Revenues and Noninterest Spending, by
Category
Congressional Budget Offices Alternative Fiscal
Scenario
Percentage () of Gross Domestic Product (GDP)
Source Congressional Budget Office. The
long-term budget outlook. Washington (DC) CBO
2009 Jun.
10
Modest Deficit Reduction Projected

Really
Congressional Budget Office (CBO) Score H.R.
4872, Reconciliation Act of 2010
Billions
CBO Projections 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2010-2019
Total Subsidies 4 11 13 9 70 125 181 204 219 236 1072
Total Cost Savings 2 -2 -11 -18 -43 -51 -59 -75 -91 -109 -455
Total Tax Revenues 0 -8 -15 -43 -77 -90 -114 -123 -131 -141 -739
Net Deficit Effecta 6 1 -14 -50 -48 -15 7 6 -3 -13 -124
                       
CBO Extrapolationsb 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2020-2029
Subsidies (3.4 CAGR) 244 252 261 270 279 288 298 308 319 330 2850
Cost Savings (10.0 CAGR) -120 -132 -145 -160 -176 -193 -212 -234 -257 -283 -1911
Tax Revenues (2.51 CAGR)c -145 -148 -152 -156 -160 -164 -168 -172 -176 -181 -1620
Net Deficit Effecta -20 -28 -36 -46 -56 -68 -82 -97 -114 -134 -681
Notes Components may not sum to totals because
of rounding. aPositive numbers indicate
increases in the deficit, and negative numbers
indicate reductions in the deficit.
bExtrapolations for 2020-2029 calculated using
CBO estimated compounded annual growth rates
(CAGR). cThe CBO pegs tax revenues to the rate of
general inflation. U.S. Breakeven 20-Year
Inflation rate between normal bonds and
inflationary bonds was 2.51 percent (accessed via
Bloomberg, 9 April 2010).
Source Congressional Budget Office. The
long-term budget outlook. Washington (DC) CBO
2009 Jun.
11
Substantial Deficits More Likely

A Lot
Scenario Analysis Summary H.R. 4872,
Reconciliation Act of 2010
Billions

Alternative Scenarios 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2010-19
Official CBO Score 6 1 -14 -50 -48 -15 7 6 -3 -13 -124
Unachievable Savings 0 1 5 10 20 26 32 42 52 65 254
Unscored Budget Effect 8 15 17 18 18 20 23 26 29 35 275
Uncollectable Revenue 0 -1 -2 -5 1 6 14 18 22 27 78
Premiums Reserved 0 0 5 9 10 11 11 9 8 7 70
Net Deficit Effecta 14 16 12 -20 -1 47 89 101 108 119 554
                       
Extrapolated Scenariosb 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2020-29
Subsidies (3.4 CAGR) 244 252 261 270 279 288 298 308 319 330 2850
Cost Savings (10 CAGR) -10 -11 -13 -14 -15 -17 -19 -20 -22 -25 -167
Tax Revenues (2.51 CAGR)c -110 -113 -115 -118 -121 -124 -128 -131 -134 -137 -1232
Net Deficit Effecte 124 128 133 137 142 147 152 157 162 168 1451

Notes Components may not sum to totals because
of rounding. aPositive numbers indicate
increases in the deficit, and negative numbers
indicate reductions in the deficit.
bExtrapolations for 2020-2029 calculated using
CBO estimated compounded annual growth rates
(CAGR). cThe CBO pegs tax revenues to the rate of
general inflation. U.S. Breakeven 20-Year
Inflation rate between normal bonds and
inflationary bonds was 2.51 percent (accessed via
Bloomberg, 9 April 2010).
Source Congressional Budget Office. The
long-term budget outlook. Washington (DC) CBO
2009 Jun.
12
Hello Greece?
  • In light of the fiscal threat from growing
    spending, the budgetary impacts of the Patient
    Protection and Affordable Care Act are central to
    any discussion of its merits
  • Even with the budgetary gimmicks, if everything
    goes well there is only a modest projected
    decline in the deficit of 124 billion in the
    first 10 years and 681 billion in the second 10
    years
  • If one accounts for the dubious budgetary
    provisions related to unachievable cost savings,
    unscored budget effects, uncollectible revenue,
    and already reserved premiums, the act would
    raise, not lower, federal deficits by 554
    billion in the first ten years and 1.4 trillion
    over the succeeding 10 years

13
  • Bruce H. Hamory
  • Executive Vice President, Chief Medical Officer
    Emeritus
  • Geisinger Health System

14
Delivery System Reform and Bending the Cost
Curve Rich Umbdenstock American Hospital
Association
15
A Framework for Health Reform
16
  • 12.9 billion prevention fund
  • Increases coverage of preventive
    services
  • No cost sharing for
  • recommended preventive
  • services
  • Annual Medicare wellness visits
  • Grants for workplace
  • wellness programs
  • Creates a national public health
    council with advisory
  • groups
  • 32 million more people with health coverage
  • Shared responsibility
  • Insurance reforms
  • Medicaid expansions
  • Tax credits
  • HIT Medicare/ Medicaid Incentive programs
  • Expansion of broadband technology
  • Funding for HIT infrastructure
  • Pilot programs on payment bundling
  • Accountable Care Organizations
  • Center for Medicare and Medicaid
    Innovation (CMI)
  • Independent Payment Advisory Board (IPAB)
  • Administrative Simplification
  • Comparative effectiveness
  • Hospital Value-Based Purchasing (VBP)
  • Enhanced public reporting
  • Numerous provisions to reduce health
    disparities
  • National quality center

17
Assisting with Health Reform
National Framework for System Reform
Key Health Reform Quality Issues
Education, Tools, Leadership Development and
National Projects to Support Implementation
18
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19
(No Transcript)
20
National Projects
  • Comprehensive Unit-based Patient Safety Program
    (CUSP) to reduce Central Line Associated Blood
    Stream Infections (CLABSI) and Catheter
    Associated Urinary Tract Infections (CAUTI)
  • CLABSI 28 states, over 600 hospitals and growing

21
Work To Be Done
  • Policy Adjustments
  • Readmissions
  • Hospital acquired conditions
  • DSH
  • Additional Issues
  • Campaigns
  • GME slots
  • 340B expansions
  • Medicaid hospital payments
  • Liability reform
  • Coverage (undocumented immigrants)

22
The New Health Reform Law and Private Insurance
  • Scott Keefer
  • Americas Health Insurance Plans

23
Laying the Foundation
Building Up to Successful Implementation
24
2010 Market Reforms and Impact
Impact on Costs and Premiums Provider Capacity?
25
Reforms Reflection through 2015
Changes in Coverage and Cost Impact?
26
Broader Reforms and Key Challenges
27
Sustainability Driving Value in Delivery
28
Implementing Insurance Market Reforms Under the
Federal Health Reform Law
Len M. Nichols, Ph.D. Director, Center For
Health Policy Research and Ethics College of
Health And Human Services George Mason University
29
  • Jon Kingsdale
  • Executive Director
  • Commonwealth Health Insurance Connector Authority

30
PPACA is NOT a Federal Takeover
  • Takeover not 2000 pages, rather, 2 lines
  • Federalism
  • Federal Goals State Implementation
  • McCarran-Ferguson
  • HIPAA
  • Patient Protection and Affordable Care Act

31
Examples of Federalism in PPACA
  • Grants to states for Ombudsmen
  • Reporting and regulation of MLRs
  • Setting up an exchange, with federal start-up
    funds, and flexibility in key areas
  • high-risk Pools
  • Annual review of premium increases
  • State insurance departments and regulation of
    immediate and 2014 reforms

32
Successful Implementation
Self-Interest
Authority
Capacity
33
Major Challenges
  • Coordinating Medicaid and Exchange subsidy
    eligibility in the dynamic real world
  • Politics of non-cooperation

34
Playing for Time The Federal high-risk Program
  • Deborah Chollet
  • Mathematica Policy Research

35
Why focus on high-risk individuals?
  • Unlike groups, individuals who apply for coverage
    now can be
  • Denied coverage
  • Offered coverage that excludes care broadly
    related to their condition
  • Charged a much higher premium
  • Even minor conditions can trigger denial,
    exclusions, or a rate up

36
Where do high-risk individuals find coverage now?
  • In 35 states, a state high-risk pool funded by
    premiums, assessments on insurers, state funds
  • In 5 states, the insurance market
  • An insurer of last resort
  • No option if not transferring from group coverage

37
State high-risk pools
  • High premiums
  • Rarely, enrollment limits
  • High cost sharing
  • Annual/lifetime benefit limits
  • Waiting periods for coverage of preexisting
    conditions

38
The Federal High-Risk Program
  • Temporary, pending 2014 market reforms
  • Premiums equal to market rates
  • No waiting periods, lower cost sharing
  • Eligible if
  • Qualifying condition, denied coverage or offered
    exclusion or higher premium
  • Uninsured 6 months or more

39
Ready, Set, Plan, Implement Executing the
Expansion of Medicaid
  • Leighton Ku
  • George Washington University

40
Medicaid Eligibility in a Typical State Now and
2014
Now 2014
Parents 64 of poverty (14,000 family of 4) 138 of poverty (30,000 family of 4)
Adults without Children Not Eligible 138 of poverty (15,000 for one person)
41
Countdown for Key Changes
  • Now
  • States must retain Medicaid CHIP eligibility
    (limited exceptions)
  • States may begin expansions for adults early
  • Soon
  • CMS states begin planning systems development
  • Jan. 2014
  • Expand eligibility for non-elderly adults
  • Narrower benefit packages for newly covered
  • Coordinated applications for Medicaid, CHIP
    health insurance exchanges

42
Big Challenges Ahead
  • Will the health care system be ready?
  • How much will this cost?
  • Will the states be ready?

43
States Opposing Health Reform Have More to Gain
of Medicaid-Eligible Adults Uninsured
Source Authors analysis of March 2009 Current
Population Survey data Notes Opposing states
include Alabama, Alaska, Arizona, Colorado,
Florida, Georgia, Idaho, Indiana, Louisiana,
Michigan, Mississippi, Nebraska, Nevada, North
Dakota, Pennsylvania, South Carolina, South
Dakota, Texas, Utah, Virginia and Washington
state. Estimates are for people 19 to 64 with
income below 138 percent of poverty, adjusted for
immigrant status.
44
New Roles For States In Health Reform
Implementation
  • Alan Weil
  • National Academy for State Health Policy
  • Raymond Scheppach
  • National Governors Association

45
The State To-Do List
  • Medicaid Eligibility Expansion
  • Commercial Health Insurance Regulation
  • Insurance Exchanges
  • Many Other Provisions

46
What States Need
  • Knowledge
  • Executive-Branch Leadership
  • Strategic Plan
  • Operational Plan
  • Needs Assessment
  • Short-Term Plan

47
Conditions For Success
  • Federal Cooperation
  • Stakeholder Engagement
  • State-to-State Learning
  • Vision, Leadership, Commitment and Willingness to
    Take Risks

48
Health Reforms Late-Term Delivery Struggling
with Political Birth Defects
  • Thomas P. Miller
  • American Enterprise Institute

49
Political Strategies
Budget Extenders
Beat the Clock
Smoke Screens
All or Nothing
Health Reform Stooges
50
Rough Road Ahead?
51
  • Raymond C. Scheppach
  • Executive Director
  • National Governors Association

52
  • Thank you!
  • www.HealthAffairs.org
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