Health Care Costs : Managed Care, Prospective Payment, and Reimbursement Trends
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Transcript of Health Care Costs : Managed Care, Prospective Payment, and Reimbursement Trends
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Health Care Costs: Managed Care, Prospective
Payment, and Reimbursement Trends
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Employer-sponsored61%
Uninsured18%Medicaid/
Public Health Insurance16%
Private/Non-group
5%
Where does insurance come from?
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Family health coverage in MI
2000 2007
Employer + Employee
$6,817 $12,151
Employer $5,869 $9,587
Employee $948 $2,564
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Cutting back on care
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U.S. Health Care Spending
2008: $2.4 Trillion
2018: $4.4 Trillion2018: $4.4 Trillion
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5
American College of Physicians, Ann Intern Med 2008;148:55-7
Australia Canada GermanyNew
ZealandUnited
KingdomUnited States
Overall Ranking (2007) 3.5 5 2 3.5 1 6Quality Care 4 6 2.5 2.5 1 5
Right Care 5 6 3 4 2 1
Safe Care 4 5 1 3 2 6
Coordinated Care 3 6 4 2 1 5
Pt-Centered Care 3 6 2 1 4 5
Access 3 5 1 2 4 6
Efficiency 4 5 3 2 1 6
Equity 2 5 4 3 1 6
Healthy Lives 1 3 2 4.5 4.5 6
Expenditures per Capita,2004 $2,876 $3,165 $3,005 $2,083 $2,546 $6,102
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Percentage of national health expenditures spent on health
administration, 2003
American College of Physicians, Ann Intern Med 2008;148:55-75
7.3%
0%1%2%3%4%5%6%7%8%
France
Finla
nd
Japan
Canada
United K
ingdom
Netherla
nds
Austria
Austra
lia
Switz
erla
nd
Ger
man
y
United S
tate
s
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Support for Health System Reform
“We can no longer afford to put health care reform on hold.”
~ President Barack Obama, Feb. 24, 2009
“Rising health costs undermine our strength in the global marketplace.”
~ Sens. Baucus and Kennedy, Feb. 26, 2009 WSJ
“We can achieve health-care reform in America . . . if we do it in a truly bipartisan basis.”
~ Sen. John McCain, Feb. 25, 2009, CNN
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Moderator: Melody Barnes
Moderator: Bob Kocher
Sen. Byron Dorgan (D-ND)
Sen. Mike Enzi (R-WY)
Sen. Sheldon Whitehouse (D-RI)
Sen. Orrin Hatch (R-UT)
Rep. Rob Andrews (D-NJ)
Rep. Baron Hill (D-IN)
Rep. Jan Schakowsky (D-IL)
Rep. Jo Ann Emerson (R-MO)
Rep. Allyson Schwartz (D-PA)
Rep. Earl Pomeroy (D-ND)
Rep. John Conyers (D-MI)
SEIU, Dennis Rivera
Business Roundtable, Ken Powell (CEO of General Mills)
American Hospital Association, Rich Umbdenstock
American Cancer Society, Daniel Smith
American Nurses Association, Rebecca Patton
Blue Cross Blue Shield Association, Scott Serota
Consortium for Citizens with Disabilities (CCD) Health Task Force, Peter Thomas
Planned Parenthood, Cecile Richards
National Council of La Raza (NCLR), Janet Murguia
Moderator: Valerie Jarrett
Moderator: Zeke Emanuel
Sen. Chris Dodd (D-CT)
Sen. Robert Bennett (R-UT)
Sen. Bernie Sanders (I-VT)
Sen. Debbie Stabenow (D-MI)
Rep. Steny Hoyer (D-MD)
Rep. Roy Blunt (R-MO)
Rep. Miller (D-CA)
Rep. Buck McKeon (R-CA)
Rep. Rosa DeLauro (D-CT)
Rep. Michael Burgess (R-TX)
Rep. Nathan Deal (R-GA)
National Association of Manufacturers, John Engler
Federation of American Hospitals, Chip Kahn
University of Chicago Medical School, Eric Whitaker
Pfizer, Jeff Kindler
PICO, Scott Hersey Reed
National Partnership for Women and Families, Deb Ness
Racial and Ethnic Health Disparities, Fredette West
Alliance for Retired Americans, Ed Coyle
Moderator: Peter Orszag
Moderator: Secretary Shinseki
Sen. Barbara Mikulski (D-MD)
Sen. Tom Harkin (D-IA)
Sen. Sherrod Brown (D-OH)
Sen. Judd Gregg (R-NH)
Rep. Charles Rangel (D-NY)
Rep. Dave Camp (R-MI)
Rep. Frank Pallone (D-NJ)
Rep. Lois Capps (D-CA)
Rep. Wally Herger (R-CA)
Rep. Xavier Becerra (D-CA)
Rep. Patrick Kennedy (D-RI)
Rep. Eric Cantor (R-VA)
United Food and Commercial Workers International Union (UFCW), Joe Hansen
National Federation of Independent Business (NFIB), Dan Danner
Catholic Health Association, Sister Carol Keehan
Hispanic Medical Association, Elena Rios
America's Health Insurance Plans (AHIP), Karen Ignani
Campaign for Mental Health Reform, Bill Emmett
Asian and Pacific Islander Health Forum, Dr. Ho Tran
Rep. Donna Christensen (D-VI)
Rep. Tim Murphy (R-PA)
Families USA, Ron Pollack
Center for American Progress, John Podesta
Moderator: Nancy-Ann DeParle
Moderator: Diana Farrel
Sen. Max Baucus (D-MT)
Sen. Charles Grassley (R-IA)
Sen. Jeanne Shaheen (D-NH)
Rep. Henry Waxman (D-CA)
Rep. Joe Barton (R-TX)
Rep. Jim Cooper (D-TN)
AFL-CIO, Gerry Shea
Small Business Majority, John Arensmeyer
American Medical Association, Nancy Nielsen
PhRMA, Billy Tauzin
National Indian Health Board, Stacey Bohlen
National Association of People Living with AIDS, Frank Oldham
Moderator: Larry Summers
Moderator: Neera Tanden
Sen. Jay Rockefeller (D-WV)
Sen. Jeff Bingaman (D-NM)
Sen. Ron Wyden (D-OR)
Rep. John Dingell (D-MI)
Rep. Lucille Roybal-Allard (D-CA)
Rep. Mike Ross (D-AR)
Rep. Pete Stark (by phone) (D-CA)
Teamsters, Jim Hoffa
U.S. Chamber of Commerce, Tom Donahue
National Medical Association, Mohammad Akhter
Children's Defense Fund, Marian Wright Edelman
AARP, Bill Novelli
HCAN, Richard Kirsch
University of Miami, Donna Shalala
White House Forum on Health Reform Attendees
Everyday Americans
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Commitment
~AHIP Chief Executive Karen Ignagni, at the Obama health care summit, March 5, 2009
“You have our commitment to play, to contribute and to help pass healthcare reform this year.”
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AMA working closely with:
• Obama Administration
• Senate HELP and Finance
• House Ways and Means; Energy and Commerce
• Health Reform Dialogue Group
• State attorneys general
• State medical societies
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Health System Reform
• Provide health care coverage for all
• Improve quality
• Promote wellness and prevention
• Reform public programs
• Reform health care delivery systems
• Reduce cost and increase value
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46 million uninsured Americans is a national disgrace
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The AMA Plan
•Affordability
•Choice
•Fairness
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Promoting health and wellness
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Determinants of health
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www.ama-assn.org/go/lifesteps
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Annual costs of chronic disease
•Heart disease and stroke $448B•Smoking and tobacco use $193B•Diabetes $174B•Obesity $117B•Cancer $89B•Arthritis $81B•Pregnancy complications $1B (pre-delivery) Total = $1.1Trillion
Source: http://www.cdc.gov/nccdphp/overview.htm
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The Medicare Dilemma
-50%
-40%
-30%
-20%
-10%
0%
10%
20%
30%
40%
50%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Practice Costs
Medicare Cuts
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Michigan physicians likely would…
Discontinue seeing Medicare patients 12%
Decrease the number of Medicare patients
44%
Continue to accept Medicare, but be unable to invest in staff, technology or quality improvement measures
40%
Make no changes 4%
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Stimulus Rhetoric vs. Reality
• Health Information Technology (HIT)
• Comparative Effectiveness Research (CER)
• The first step toward
health system reform
• www.ama-assn.org/go/patients
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