health reform and new jersey
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Health Reform and New Jersey. Sally Roslow 609-275-4224 [email protected]. Agenda. Political Outlook National Healthcare Reform State Update. GOP Challenges. Unlikely to have two-thirds vote necessary to override presidential vetoes Law responds to genuine needs - PowerPoint PPT PresentationTRANSCRIPT
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Health Reform and New Jersey
Sally Roslow
609-275-4224
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Agenda
Political Outlook
National Healthcare Reform
State Update
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
GOP Challenges• Unlikely to have two-thirds vote
necessary to override presidential vetoes
• Law responds to genuine needs
• Law saves government money…repealing provisions could be “spenders”
• Many provisions “connected”
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
National Healthcare Reform
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Key Items in Reform
32 million covered (expansion begins 2014) 923,000 New Jerseyans
300,000 Medicaid 600,000 Exchange
Insurance mandate (2014) Large employers pay $2000/employee fee
Insurance market reforms No lifetime caps Children up to age 26 Can’t deny coverage for pre-existing conditions
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Medicaid expansion – 133% of FPL Tax on Cadillac Plans (2018) Closes Medicare prescription drug
“donut hole” Geographic variation
$400 million carrot for low cost / high quality states
IOM study
Key Items in Reform cont’d
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Readmissions – imposes penalties for “excess” readmissions (heart attack, heart failure & pneumonia)
$7.1 billion over 10 years (2013)
Key Items in Reform cont’d
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Healthcare Reform 2010-2019
Cost – $1 trillion/10 years
Coverage – 32 million
How – Individual and employer mandates
– Medicaid expansion
– Insurance exchanges
NJ Specifics – 923,000 of 1.3 million uninsured covered
– Hospitals will contribute $4.5 billion/ 10 years
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Strategic Directions
Movement away from fee-for-service toward integration
Emphasis on value versus volume
Emphasis on quality versus quantity
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
“The Secretary Shall”
“The Secretary shall…”
Primary Care
Physicians
Specialty Care
Physicians
Outpatient Hospital Care and
ASCs
Inpatient Hospital Acute Care
Long Term Acute
Hospital Care
Inpatient Rehab
Hospital Care
Skilled Nursing Facility
Care
Home Health Care
Medical HomeMedical Home
Acute Care BundlingAcute Care Bundling
Acute Care Episode with PAC BundlingAcute Care Episode with PAC Bundling
Post Acute Care (PAC) Episode BundlingPost Acute Care (PAC) Episode Bundling
Accountable Care OrganizationsAccountable Care Organizations
Rethinking the Organization of CareWhere is your place? What is realistic? What is achievable?
Source: The American Hospital Association (AHA)
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Reinvent ourselves as we continue to provide quality care, largely under old system (volume and procedures) even as we shift to P4P
Anticipate impact of reduced payments from Medicare
Get ready to jump to new way of doing business But don’t jump too soon or too late Many advise acute care hospitals to plan to reduce
costs to maintain profitability at Medicare rates
Strategic Issues for Hospital / Healthcare Leaders
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Strategic Areas to Focus Upon
Enhance efforts to improve quality and patient safety (Focus on outcomes, care coordination, evidence based medicine & comparative effectiveness)
Reduce variation in care in your organization (then region, then state… county)
Increase clinical and operational efficiencies
Reduce avoidable readmissions
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Strategic Areas to Focus Uponcont’d
Conduct community needs assessment (req’d for tax-exempt hospitals)
Assess/strengthen plan for HIT and EHR. Move to doctor/patient/hospital connectivity
Examine readiness for episodic payment, care redesign and ability to manage care across continuum
Foster better alignment with physicians
Quality
Health IT
Clinical Integration
Making Delivery System Reform a Success
Three Keys to Delivery System Reform
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
NJHA Healthcare Reform Resource Center
http://www.njha.com/Reform
Implementation schedule
Grant opportunities
Regulations
News and updates
Resources and links
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
The state is projecting a $10.5 billion budget shortfall on an approximately $30 billion budget
Cuts and reductions in governmental spending are highly anticipated
DHSS looking at consolidating funding
CMS approval of current budget plan still pending Increased assessment moving forward
FY12 State Budget
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Healthcare Reform :State Implementation
NJ Protect High Risk Pool - Initiated August 2010 Administered by Horizon Blue Cross Blue Shield Coverage to approximately 21,000 individuals
Insurance Exchange Must be operational by Jan. 1, 2014 NJ DOBI recently awarded $1 million grant to review
exchange creation
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Healthcare Reform :State Implementation
Insurance Reform August 16, 2010, NJ receives $1 million grant to
conduct premium reviews of health insurance companies
Medicaid Expansion Beginning Jan. 1, 2014, Medicaid coverage will be
expanded to 133% of the federal poverty level for non-elderly individuals
Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association
Questions?