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8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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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
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8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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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
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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
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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
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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
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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
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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
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HR 3962 Proposal Independence at Home medical pilot
(A) reducing preventable hospitalizations; (B) preventing hospital readmissions; (C) reducing emergency room visits; (D) improving health outcomes commensurate
with the beneficiaries’ stage of chronic illness; (E) improving the efficiency of care, such as by
reducing duplicative diagnostic and laboratory tests;
(F) reducing the cost of health care services covered under this title; and(G) achieving beneficiary and family care giver satisfaction.
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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What will happen to the M’Care Health Care Delivery System?
Basic laws of Supply and Demand … Well, if you decrease the payment and keep the
demand the same, there could be less providers accepting MediCare’s allowed charges! OUCH!
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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Where will the $400+ billion in cuts in M’Care
come from?
the savings comes from cutting billions of dollars in overpayments to insurance companies and eliminating waste, fraud, and abuse
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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Myths in HC Reform? Cuts in Benefits? Rationing with Older Citizens being
the last to get needed health care? Bureacratic Health Care Panels that
say NO? Forced Euthanasia?
HC Reform will Bankrupt America? Illegal Immigrants will be covered?
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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Paying for Health Care ReformSource Health Care Reserve
Fund ($ in billions) 10 years
FY 2010 Budget $635 - Medicare and Medicaid Savings $309 - Revenues$ $326
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
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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
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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
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Macro Cost Shifting
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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Pay Full Retail
Macro Cost Shifting
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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Pay Full Retail
Best Risks and Underinsured
Macro Cost Shifting
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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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
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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
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8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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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
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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
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8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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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
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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
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8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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NOW – Silos of Payment
Doctors HMO’s
Hospitals
Nursing Homes and ECF’s
$$$
$$$$$$
$$$$$$
$$$$$$
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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NOW – Silos of Payment
Doctors HMO’s
Hospitals
Nursing Homes and ECF’s
$$$
$$$$$$
$$$$$$
$$$$$$
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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FUTURE? Bundled payment
Doctors HMO’s
Hospitals
Nursing Homes and ECF’s
$$$
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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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
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Information and Data Sources
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Health Care Reform Web Sites AARP.org commonwealthfund.org/ healthreform.gov/ mailmanschool.org/facultypubs/
womenshealthcarereform.pdf whitehouse.gov/assets/documents/
CEA_Health_Care_Report.pdf reuters.com/article/healthNews/
idUSTRE56K01720090721 hudson.org/files/documents/
20090612_JB_Kuttner_longterm_fiscal_impact_health_reform.pdf
8/6/2009 Prepared by Chuck Kiskaden from StoneTapert 626-233-9180
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http://randcompare.org/http://randcompare.org/current/http://randcompare.org/options/http://randcompare.org/options/mechanism/refundable_tax_credit http://randcompare.org/options/mechanism/purchasing_pools
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
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Health Care Web Sites
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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
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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
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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
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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/
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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
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The end
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