Navigating HIPAA & Recent Healthcare Reform: What You Need to Know.
Healthcare Reform And You
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Transcript of Healthcare Reform And You
Healthcare Reform and You.
Presented by:Martin Trussell, SVP First Horizon Msaver, Inc.
HealthCampNash, May 30, 2009
Healthcare Reform and You.
Healthcare Reform
� Why now?
� What will it look like?
� How will it affect me?� Carriers & TPAs
� Brokers & Agents
� Employers
� Individuals
� Providers
� Others…
Healthcare Reform and You.
Why Now?
� Economic crisis.
� Medicare and Medicaid.
� Stakeholder consensus.
� Needs to happen in 1st Term.
Healthcare Reform and You.
Why Now?
� National healthcare spending reached $2.2 trillion, or $7,421 per person, in 2007 representing more than 16% of the gross domestic product.
� Continuing at the same pace, it will reach 20.3% of the country's gross domestic product by 2018.
Healthcare Reform and You.
Why Now?
� 32% of state budgets now go to paying for Medicaid.
� Growth rates for Medicare is unsustainable.
Healthcare Reform and You.
What will it look like?
� We don’t know, for sure.
� Legislation to be revealed in June.
� Passed by July 31.
Healthcare Reform and You.
What will it look like?
� The promise:
� All Americans guaranteed affordable,
� high-quality healthcare
� the freedom to choose whatever doctor or health plan they want,
� all at a savings of some $2,500 per family.
Healthcare Reform and You.
What will it look like?
� The cost: $1.5 trillion.
Healthcare Reform and You.
What will it look like?
� Individual mandate.
� Sufficient coverage.
� Elimination of underwriting.
� Tax equity, subsidy (indiv. vs. group).
� Public Plan to complete.
� Emphasis on prevention & wellness.
� Elimination of waste.
� Electronic data keeping.
� Comparative effectiveness.
Healthcare Reform and You.
Employer
� Elimination or reduction the favored tax status of healthcare expenses.
� Revenue “lost” to current policy at $194.2 billion a year.
� Less control over plan designs offered to employees.
� Loss of members to individual plans.
Healthcare Reform and You.
Carriers
� Competition from “Public Plan.”
� Inability to underwrite.
� Increased regulation.
� Shift to individual policies.
� Looking for $2T in savings.
Healthcare Reform and You.
TPAs
� Potential loss of FSA/HRA admin.
� Potential gain of HSA substantiation.
� Shift from groups to individuals.
Healthcare Reform and You.
Brokers and Agents
� Competition from “Connectors.”
� Shift to individual market.
� Relief from underwriting.
Healthcare Reform and You.
Individuals
� Requirement to purchase insurance.
� Tax credits or subsidy.
� Reduced the tax advantages of HSAs, FSAs and itemized deductions of medical expenses.
� New “sin taxes” on products such as alcohol and sugary soft drinks.
Healthcare Reform and You.
Providers
� Reduced Medicare spending on home healthcare, durable medical equipment, medical imaging and prescription drugs.
� Increased demand for services, especially primary care.
� 5% bonus payment for office visits and other “primary care services.”
� Input on “best practices.”
� Looking for $2T in savings.
Healthcare Reform and You.
Providers (Medicare)
� Increase payments to doctors who regularly exceed “national benchmarks” for the quality of care.
� Bonuses to hospitals that provide superior care for heart attacks, heart failure, pneumonia and selected other conditions.
� Doctors could receive extra payments if they hire nurses to manage follow-up care for chronic cases.
� Government to set national standards for the appropriate use of CAT scans, magnetic resonance and other diagnostic imaging techniques.
Healthcare Reform and You.
Providers (Medicare)
� Medicare would make a single “bundled payment” for all the services provided to a hospital patient.
� Bad for nursing homes, home care, hospice, etc.
Healthcare Reform and You.
Pharmaceuticals
� Reduce government spending on prescription drugs.
� Re-importation of drugs from other countries to lower costs.
� Shifting insurance coverage toward prevention, could increase sales for heart, diabetes and other drugs that patients take long term.
� Increased Rx spend by $15 to $18 billion.
� Looking for the $2T in savings.
Healthcare Reform and You.
Wellness
� Tax credits or other subsidies to employers who offer wellness programs that meet federal criteria.
� Make it easier for employers to use financial rewards or penalties to promote healthy behavior among employees.
Healthcare Reform and You.
Health IT Providers
� $20 billion in Stimulus Money.
� Electronic Health Records.
Healthcare Reform and You.
Marketing Communications
� Need to communicate new programs.
Healthcare Reform and You.
Benefits Attorneys
� Need to interpret new regs.
Healthcare Reform and You.
Thank you.
Martin Trussell, SVP First Horizon Msaver, Inc.
HealthCampNash, May 30, 2009