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Healthcare Reform

Healthcare ReformCHRONIC DISEASE, PREVENTION & QUALITY

Shanise Thornton, Melinda Williams and Christopher Owens

Keller UniversityHealth insurance & Managed Care

June 23, 2011

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Abstract

Healthcare reform has a tremendous effect on the economy. This paper will explore the reform as

well as its impact on chronic disease, prevention, and quality. Health care reform is thriving to

put American families and small business owners more in control of their own health through

several initiatives. There are several strengths and weakness within the reform. Employers with

more than 50 employees must provide health insurance or pay a fine … There are several key

elements under the reform, one of which is Title IV - Prevention of Chronic Disease and

Improving Public Health (Health Reform Details). This provision addresses the issues of costs

associated with health care services and is focused on changing the way the services are

delivered. Services will be provided for prevention of manageable illnesses.

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Healthcare ReformCHRONIC DISEASE, PREVENTION & QUALITY

There has been a lot of criticism geared towards the reform, however change is inevitable. For

decades, the United States has been concerned with the high cost of medical care. The 2010

Healthcare Reform, otherwise known as the Affordable Care Act, consists of many aspects. We

will explore the reform as well as its impact on chronic disease, prevention, and quality.

Overview of the Healthcare Reform Initiative

In order to gain a better understanding of the Affordable Health Care Act of 2010 also known as

the Health Care Reform, let’s highlight key points of the bill. According to the reform, the main

objective is to provide affordable, quality health care for all Americans in an attempt to reduce

the growth in health care spending (George, 2011). The bill is pushing to create a stable

healthcare budget, to reduce the deficit by more than one hundred billion dollars over the next

ten years (Healthcare Reform Details, 2011). The coverage of this reform is expected to expand

towards thirty two million uninsured Americans (Jackson & Nolen, 2010). The health care

reform strives to put American families and small business owners in control of their own health

by implementing the following provisions:

· Making health insurance more affordable by the year 2014; providing the largest

middle class tax cut for health care in our nation’s history.

· Reducing premium costs for countless millions of families and small business

owners who are currently priced out of coverage.

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· Setting up a new competitive health insurance market.

· Ending discrimination against Americans with pre-existing conditions (Healthcare

Reform Details, 2011).

The reform will also focus on bridging the gap between the House and Senate bills and it will

include new provisions to crack down on waste, fraud and also abuse. The reform will reflect

many policies. Some of the key changes that the Reform will tackle are as follows:

· Eliminating the Nebraska FMAP (Federal Medical Assistance Percentage)

provision and providing significant additional Federal financing to all States for

the expansion of Medicaid.

· Closing the Medicare prescription drug, in other words the “donut hole” coverage

gap by the year 2020.

· Increasing protections for out of pocket costs.

· Increasing the threshold for the excise tax on the most expensive health plans

from twenty three thousand dollars for a family plan to twenty seven thousand

and fifty dollars and starting it in 2018 for all plans (Healthcare Reform Details,

2011).

As you can see, the Health care reform bill has the potential to help the American society with

many changes that will start immediately as well as other changes which will start later. Seniors

that are affected by the donut hole within the current year shall receive a $250 rebate. However,

seniors receiving top shelf prescription brands will receive a fifty percent discount beginning

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later in the year. One of the major benefit’s and outcomes that will come from this reform will be

that every citizen is going to be required to have health care which means that the percentage of

individuals that are healthy will increase.

Strength and Weaknesses of Healthcare Reform

There are strengths and weaknesses of the Healthcare reform for individuals that live within the

United States which include the following:

Strengths-

Prohibits preexisting conditions exclusions periods for children in all new plans (George,

2011). Therefore, if a child has a pre-existing condition he/she will not be denied for care

anymore.

Prohibits dropping people from coverage when they get sick in all individual plans

(Uygur, 2010). This will allow all adults to be able to receive care without having to pay

too much out of pocket or being uncertain if they will be covered. According to

Davenport that passed this bill, this reform will also lower overall expenditures in tandem

with deficit reduction which is a good strength (Davenport, 2011). The implementation

of the bill will not only lower the overall expenditures but it will eliminate lifetime limits

and restrict annual limits on benefits on all plans (George, 2011). By ending lifetime

limits on care, patients will not have to worry about their care and coverage being

dropped mid way through the treatment.

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Within this reform it will allow college adults to stay on their parents coverage until the

age of 26, which is a positive aspect in certain cases for individuals who have not made it

on their own as of yet or who need a little more guidance.

Weaknesses-

Include increasing insurance premiums.

If the secretary estimates for any fiscal year that the aggregate amounts available for

payment of expenses of the high-risk pool will be less than the amount of the expenses,

the Secretary shall make such adjustments as are necessary to eliminate such deficits,

including reducing benefits, increasing premiums, or establishing waiting list (George,

2011).

Patient’s benefits may reduce which may decrease the quality perceived by some patients

and they will have longer waiting times.

Negative effects on the insurance companies.

Negative impact on individuals beginning in 2014; all citizens and legal residents must

have insurance. Violators will be subject to a phased-in excise tax penalty for

noncompliance which will be a $695 annual fine. However, there are some exceptions for

low-income people (Boomers, 2010).

Employers with more than 50 employees must provide health insurance or pay a fine of

$2000 per worker each year if any worker receives federal subsidies to purchase health

insurance. Fines will be applied to the entire number of employees minus some

allowances (Boomers, 2010).

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Despite the positive and negative aspects that people may think of the bill, the reform is still

seen as being very beneficial. One important element of the reform is Title IV - Prevention of

Chronic Disease and Improving Public Health section.

Chronic Disease

In 2010, President Obama moved to reduce the problems our country faced under the current

healthcare system. The Healthcare Reform-Affordable Care Act was signed into policy in the

year 2010. Among the key elements under the reform, is Title IV - Prevention of Chronic

Disease and Improving Public Health (Health Reform Details). This provision addresses the

issues of costs associated with health care services and is focused on changing the way the

services are delivered. From treating the sick, to helping people live healthier lives by promoting

wellness and prevention, reducing the incidences of preventable illness (chronic disease), and

empowering families to be accountable for their own health.

Under Title IV provision, it is also stated that “investing in preventable diseases saves lives and

money not just for families but also for businesses and the nation” (Health Reform Details, n.d.).

So what is driving up the cost of healthcare? Many would say technology others would say

prescription drugs, and still more may say the aging population. The World Health Organization

(2010) states “populations are aging and increasingly, people are living with one or more chronic

condition for decades.” Chronic disease is a defined as a disease or condition that persists for a

long period of time, it may be progressive, it may contribute to disabilities, and oftentimes it has

been linked to deaths. Chronic diseases is usually the results of damaging behaviors such as

tobacco use, lack of physical activity, and poor eating habits (Medicine Net and Free Dictionary,

2011).

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The most common types of chronic diseases are: heart disease, diabetes, asthma, obesity,

hypertension and cancer: One could also conclude that chronic disease is another cost driver of

the health care system. In fact, seventy percent of deaths are related to chronic diseases. Chronic

disease is the leading cause of death in the United States.

Here are some alarming statistics by the Center for Disease Control (CDC) the relating chronic

diseases:

“7 out of 10 deaths among Americans each year from chronic disease”

“Heart disease, cancer and stroke account for more than 50% of all deaths each year”

“1 in every 3 adults is obese and almost 1 in 5 youths are obese with a Body Mass Index (BMI) > 95th percentile of CDC growth chart”

“In 2005, 133 million Americans had at least one chronic disease”

“Diabetes continue to be leading cause of kidney failure, amputations and blindness”(Center for Disease Control, et. tal, Mary 2011).

As you can see, these figures are startling. In 2009, healthcare expenditures grew at a rate of four

percent, totaling two point five trillion and accounting for seventeen point six percent of our

gross domestic product or an average of eight thousand eighty six dollars per person with

increases in spending for Medicaid, Medicare, and private insurers (Goldstein, 2011). The rate

affects all spectrums of our country-the consumer, the employer and our government. Even more

disturbing, out of all expenditures that contribute to our nation’s debt (military/defense,

education, transportation, etc) fifty one percent of these expenditure costs went towards hospital

care and physician services; Services such as dental, nursing home care, home health,

prescription drugs, government/public health activities, investments, and administration. This is

according to a briefing done by the Henry J. Kaiser Family Foundation (March 2010) which

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suggests that controlling costs will mean understanding the root cause from which these costs

were generated.

Chronic disease not only affects healthcare costs in the United States, but is a global issue as

well. Disease management programs and preventive services are becoming more popular as

states and countries seek out ways to lower the costs of providing healthcare. In Japan, a

preliminary program is being conducted in hopes of reducing the number of metabolic syndrome

patients by twenty five percent between 2008 and 2015. Etsuji Okamot (2007) states, “Japan has

the highest number of dialysis patients in the world at 194.3 per 100,000 in 2004. Since half of

chronic renal failure results from diabetes and annual cost for dialysis amounts to fifty thousand

dollars per year, it would be reasonable to assume that savings can be achieved by preventing

dialysis by one patient or by deterring it one year.” For employers, the issues of rising costs,

chronic disease and management are causing major concerns in terms of profits and cost-sharing;

such that it could also affect the status of the economy. For instance, if employers are spending

more on health care costs they may decide or even be forced to pass the higher costs to the

employee, reduce the amount of investments, or decrease employment. They may also have to

deal with higher taxes in order to finance health care expenditures or increase the amount of

government loans. These issues not only may reduce the competitiveness of the US but may also

deter consumer spending on goods and services, and alter retirement savings (Sood, Ghosh,

Escarse, 2007). The US Department of Health and Human Services (HHS) states employers

insure approximately three-fifths of Americans. Originally the employer sponsored health

insurance came into play because the contributions for income and payroll taxes were exempt.

However as insurance premiums continued to increase, employers began to see a potential threat

to their profitability and thus started to institute a change to put more of burden on the employee

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such as: reducing benefits, changing providers, adding high deductible-consumer driven plans

(September 2007).

Fortunately for consumers, The Affordable Care Act calls for employers to take a prospective

approach to seeking ways to lower costs, improve wellness and quality of care by offering

incentives and giving employee’s an opportunity to be in control of their health outcomes.

Management and Prevention

Consumers, as well as healthcare workers, see daily the destruction and devastation that chronic

disease and conditions can place on people’s lives. Beyond the emotional and physical pain,

there’s also the financial strain that people often bear. In an article by Democratic Representative

Jim Moran (Va.), he states “chronic diseases such as cancer, heart disease, diabetes, and arthritis

are the most prevalent and preventable health problems we face.” He goes on to say that

millions of Americans, forty million to be exact, “are without health insurance and one-third

suffer from chronic disease” (2009). Chronic diseases are preventable and can also be very well

managed. The goal of disease management, according to Kongstvedt (2001), is to “reduce

frequency and severity of exacerbation of a chronic illness so that readmission costs are

reduced.” Many of us are not aware and would be very surprised to hear that Pennsylvania was

ranked in the bottom 3rd of states for avoidable chronic disease - hospital related admissions or

that half of our residents have at least one chronic disease that accounts for eighty percent of our

state’s healthcare costs or that four billion was projected to be unnecessary hospital charges for

admissions that could have been avoided because of a chronic condition (Bricker, Baron, Sheirer,

DeWalt, Derrickson, Yunghans, &Gabby, 2010). These statistics were given from a report

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presented by a commission put together among concerned healthcare providers, insurers, nurses,

consumers, educators, state government and labor unions to address the issue of controlling the

cost associated with chronic disease by implementing a program model to be tried and if

successful to become part of the state’s healthcare reform initiative. The goals of the program

are:

To create a reimbursement program that rewards the use of the “chronic care

model” to become team-based, patient-centered, and have quality outcomes…

Promote learning and provide education sessions among constituents.

To improve healthcare resources, utilization, clinical processes.

Reducing the number of re-admissions, avoidable admissions, and ER visits with

savings from other cost measures (Bricker et al., 2010)

Some positive results from the initial reporting from model, results within the three years for

which the program has been conducted. For example: practices are finding better ways to

improve processes, better communication with staff as well as patients, disease management

programs were starting to see positive results in management and less exacerbations. Patients

were more satisfied with care being given, with the education and direction they are receiving,

and the better access to services and even thwarted changing of physicians.

This program model in Pennsylvania is only one example of what can be done in hopes of

preventing and managing chronic illnesses. Other resources that are being used and made

available are, telephone follow-ups, directing patient to website for educational resources, work-

shops and seminar and a host of others will become available as technology advances.

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Ultimately, it is a way to begin to measure the quality and effectiveness of the programs and

services being provided all in the goal of restructuring healthcare.

Quality

Throughout our entire lives, most, if not all, have dealt with the term “quality” in some shape or

form. Whether it was the quality of one’s livelihood, food choice, or even education, we’ve all

partaken in quality in some way. Even though we encountered this concept quite often, we all

have seemingly different various ways of defining the term. When asking a random

Philadelphian her definition of quality, she responded by stating: “Something that adheres to

high standards.” Standards are defined as something established by authority or general consent

as a model or example. Webster defines quality as a degree of excellence, social status, or even a

distinguishing attribute. (Webster, 2011) With all this being stated, we should grasp a clearer and

more concise understanding of quality in regards to healthcare.

Quality health care can be described as aspiring for excellent standards of care. This would

include evaluating the suitability of medical treatments and measures to continuously improve

personal health care in every fields of medicine. For example, accrediting or approving

physicians, offices, hospitals or other health care providers. This is achieved through

accreditation or inspection standards that ensure that proper procedures and staffing ratios are

met. The Institute of Medicine also aims to improve the quality of healthcare through the

following: safety, timely, effective, efficient, equitable & patient centered. Each concept deals

with the idea of continually improving healthcare.

An organization that regulates and sets the standards for accreditation is known as the Joint

Commission on Accreditation of Healthcare Organizations, also known as (JCAHO). The Joint

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Commission on Accreditation of Healthcare Organizations is an independent nonprofit

organization which accredits more than nineteen thousand healthcare organizations across the

United States. Their accreditation is known nationwide as the symbol of quality that reflects an

organizations commitment in meeting high performance standards. (Joint commission, 2011)

Another quality measuring organization is The National Committee for Quality Assurance also

known as (NCQA).

The Affordable Care Act of 2010 lists quality as one of many important elements covered in the

national healthcare reform. In short it aims for quality improvement through establishing national

priorities via performance improvement such as quality bonuses payments. Here’s a snippet of

what the bill addresses under title IV:

Improving transparency of information on long term care facilities

o Nursing home compare Medicare website

o Improving staff training

o Preventive training

Physician payments

The Affordable care Act goes into nursing home transparency by stating in limens term, that the

social security act has been modified by being required to disclose information pertaining to

ownership as well as any other disclosure parties involved. Such information includes facilities

workers information, I.e. name, position, basic bio of personnel. Also the organizational

structure, as well as a compliance and ethical program that is effective in the prevention of crime

and administrative violations under this act.

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In referencing the physician payment section, which is noted as the sunshine provision, it directly

relates to confidentiality, delayed reporting, reporting, and entities that bill Medicare; it also

involves quality bonus payments. Here medical professionals have the chance to gain additional

incentive for reporting particular quality measures. This gives the medical staff to gain from1.5

% to 3% their total allowed charges for covered Medicare physician fee schedule services. To

redeem this physician must report at least 80% of their eligible cases.

In relation to quality healthcare and chronic disease, Joanne Kenen, a blogger for The New

Health Dialogue, has managed to give a clear insight on current healthcare issues discussed at a

past AARP forum on Capitol Hill.“…They'll tell you about medical specialists who don't

coordinate with one another. Patients who are sent home from the hospital or rehab without

adequate information about follow up care and complex medication regimes. They’ll also speak

of delays in getting patients the care they need when they need it. In short, a fragmented,

disconnected system that seems unaware that it's supposed to be all about the patient…” In her

opening blog statement, I’ve found her critics all too accurately correct. Just as many other

citizens, I’m too dealing with a family member who’s recently been diagnosed with a chronic

disease. Throughout the past three years, physicians where confused and or unclear on their

patients diagnoses, and blatantly told use that they had flawed records that which where

supposed to be beneficial in effectively communicating their patents situation. There’s been to

many times where my loved one was admitted into the ER department to only be held for a few

days then discharged only to come home with a complex medication schedule, and have the

same situations re occur weeks later. All in all, not one facility has managed to grant my family

member the needed care in which he needs; I believe that because of this three year headache,

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they’ve managed to turn an acute illness into a chronic one. Regardless of my personal

experiences with the quality of care, far too many others can relate to my story as well.

The chart above illustrates a survey conducted roughly eleven years ago. It shows family

members overall quality concerns for vastly ill patients in various settings. Dark blue

representing patience’s sent home with hospice care; hospice care refers to providing humane

and compassionate care for people in their last phases of incurable disease so that they may live

as fully and comfortably as possible. The second color code is red which relates to Nursing

homes. Thirdly we have light blue which represents home with home care…I.e. Visiting nursing

services, basically all health and supportive services administrated at home. Last but not least we

have orange which represents hospital services. All in all through analyzing this chart one will

notice the poor quality in not one, but all healthcare settings, these numbers are far too high for

any health service group, especially for facilities that are heavily administrated through

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accreditation agencies. These figures portray lack of compassion, communication, and

effectiveness when dealing with direct patient care.

Conclusion

With many of its changes that will and have taken place, the Health care reform bill has the

potential to help the American society. Citizens that are affected by the large cost of prescription

drugs will have a decreased donut hole to look forward to via rebates and or discounts. Young

adults will be able to remain on their parents’ healthcare coverage up until the age of twenty six.

Most importantly, all will have coverage under the reform. This means more patient care that

will result in higher healthcare revenue, which will result in overall contribution to the nation’s

gross domestic production rate. This continues improvement will benefit an entire nation.

Through proper education, people can make better decisions, which then leads to prevention of

illnesses such as heart disease, diabetes, asthma, obesity, hypertension and cancer. Now that the

change has come it’s time for us to stand up to sickness and accept health. We must say no to

ignorance and yes to education. We can do this. We just have to take the steps…

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