Obamacare: Why Should You Care?

Presenters:Jermaine Paul / Danyale Ellis

Art Estler / Anwer Kahn

State of Healthcare Increasing Uninsured Population

Estimated 45 million individuals lack health insurance Non-elderly adults make up the largest percentage of the uninsured 80% of uninsured are comprised of individuals from working families

Unsustainable Rising Cost Total health expenditures reached $2.3 trillion in 2008 16.2% of the Gross Domestic Product (GDP) Aging population Overutilization of services Medical bills are the #1 cause of bankruptcy Increasing number of medical errors

Underinvestment in prevention and public health Lack of access to preventative services Poor personal choices

The SolutionHealth Care and Education Affordability Reconciliation Act of 2010 & Patient Protection and Affordable Care ActExpand health insurance coverage to 32 million individuals

Expansion of Medicaid eligibility• Requires states to expand Medicaid to include childless adults• Expanded to 133 percent of the federal poverty level

Individual Mandate• In 2014, everyone must purchase health insurance or face an annual fine

of a flat dollar amount or percent of income Employer Mandate

• In 2014, 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

Preventative care Plan will be required to provide free preventative care

• Not subject to deductible or co-payment

The Solution Cont. Health Insurance Exchanges

Uninsured and self employed can purchase insurance through state-based exchanges

Subsidies available for families between 100% -400% of the federal poverty level

Separate exchanges for small businesses• Tax credits will be made available to companies

Insurance Companies Insurers will be prohibited from denying coverage for pre-existing

conditions Insurers required to provide coverage for non-dependent children up to age

26 under their parents’ plan Bans annual caps and lifetime maximums on coverage

Electronic Health Information Technology Investment Electronic Medical Records

Cost of Health Care Reform Congressional Budget Office (CBO) score

The plan will cost $940 billion over the next 10 years

Cuts the deficit by $143 billion in the first 10 years

Cuts the deficit by $1.2 trillion in the second 10 years

Reduces annual growth in Medicare expenditures by 1.4 percentage

points per year

Financing Medicare Payroll Tax

Beginning in 2012, the Medicare Payroll Tax will be expanded to include unearned income. That will be a 3.8% tax on investment income for families making more than $250,000 per year ($200,000 for individuals)

Excise Tax Beginning in 2018, insurance companies will pay a 40% excise tax on

"Cadillac" high-end insurance plans worth over $27,500 for families ($10,200 for individuals)

10% excise tax on indoor tanning services Beginning in 2013, medical device manufacturers will pay a 2.9%

excise tax on the sale of any product

Financing Cont. Medicare Advantage Plans

Government payments will be reduced by $132 billion over the next 10 years

New “Fees” In 2011, new fees will be imposed for brand-name drug makers based

on market share in 2011 In 2014, new fees will be imposed on health insurance companies

based on market share

Enhance Fraud Abuse Checks New screening procedures will be implemented to help eliminate fraud

and waste

Healthcare Reform: Federally Qualified Healthcare

FacilitiesPresented By:Danyale Ellis

FQHCs Role in ObamaCareYou may be asking yourself, “How does FQHC’s relate to the Healthcare bill?” The current healthcare system does not have the capacity to serve the anticipated millions of individuals who will transition from uninsured to insured once the law goes into effect. Thus, President Obama has and will invest in community health centers to take on a large percentage of the care.

Federally Qualified Health Centers Created under federal law over 40 years ago Receive Federal Grant: Section 330 of the Public

Health Service Act Administrated by Health Resources and Services

Administration (HRSA) 1,200 centers nation-wide Serve over 18 million patients Over a dozen located in Cook County

Federally Qualified Health Centers They provide a variety of services:

Primary Care Case Management Transportation Dental Care Mental Health Pharmacy

Current Reform Bill ImpactsThe current healthcare system does not have the capacity to care for the millions of Americans who will transition from uninsured to insured. Thus, President Obama has and will invest in community health centers to take on a large percentage of the care.

Federal Stimulus Money What has happened? Through Federal Stimulus Dollars in 2009,

community health centers: Opened new health centers; Purchased Electronic Health Records Systems; Took on growing number of uninsured; and Renovated or built new facilities

Healthcare ReformWhat will happen?

Through the healthcare reform bill, community health care centers will receive $11.9 billion over the next five years in order to expand their operational capacity to serve nearly 20 million new patients.

Federally Qualified Health Centers

Currently serves over 18 million patients, after the implementation of the healthcare bill, they will nearly double the number of patients served. Due to the funding received through the healthcare reform act, federally qualified health centers will continue to provide quality and affordable health care services to serve those in need

Health Care Reform: Prevention

Presented By:Arthur Elster, MD, MJ

Leading Causes of Death: 30-40 yrs

Causes Female (%) Male (%)Cancer 21% 8%Unintentional Injury 21% 30.5%Ht Dis. 10% 12%Suicide 6% 12.5%Homicide 4% 8%HIV Dis. 4% 4%Stroke 3% 2%Diabetes Mellitus 2.5% 2%Liver Dis. 2% 2%

Preventable Causes of Death• Tobacco (18%)• Poor Diet and Physical Activity (16.5%)• Alcohol Consumption (3.5%)• Microbial Agents (3%)• Toxic Agents (2.5%)• Motor Vehicle (2%)• Firearms (1%)• Sexual Behavior…including HIV (1%) • Illicit Drug Use (1%)

Non-preventable ….around 50%

Current Issues US health care and insurance industries center on

acute care, not prevention (exception….non-for-profit HMO)

The greatest advances in health over the past several decades have come from public health and preventive medicine

Wellness is often presumed to reside in the personal domain

But… an ounce of prevention (may be) worth a pound of cure

What are Preventive Services?Screening, counseling, and immunizations services aimed at “otherwise well populations” delivered in an office setting

Health Care Reform and Preventive Services

 "A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements for evidence-based items or services that have in effect a rating of `A' or `B' in the current recommendations of the United States Preventive Services Task Force."

Us Preventive Services Task Force:Sample of Recommendations

Screening for: HIV STD High Blood Pressure, Type II Diabetes (in people with marginally high B.P.) Cervical Cancer Colorectal Cancer Depression

Mammography (50-74 yrs) Tobacco Cessation Counseling Screening and Intensive Counseling for Obesity

For the complete list, see www.ahrq.gov/clinic/cps3dix.htm

The Changing Landscape of American Healthcare

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Presented By:Anwer Khan

Discussion Points Playing Ball

Managing Change

Making an Impact:

Data Integration

“Meaningful” Application

Playing Ball – Broad & Complex FieldThe healthcare landscape is becoming increasingly more broad and complex...

tomorrow's healthcare organization must be built on a platform of information-driven transparency; one that illustrates:

Compelling Cost Savings Repeatable Outcomes Plausible Innovation

Cheaper catastrophic coverage

No Denials for Pre-existing Conditions or Lifetime

Limits

More Access to Information – personal portals and

electronic health records

Higher taxes and premiums for upper income earners

Overtime health care costs will rise – forcing the need to

save a significant amount for your and potentially your

parent’s future

Increased competition across insurers and care providers

will require more due diligence from you

Good Bad

ForYou:

Playing Ball – Principal Components of Healthcare Reform

The “ABCDE” of

Today’s Healthcare: Access Best Quality Cost Disparities Effectiveness

President Obama’s FY 2010 Budget overview:

Reduce long-term growth of health care costs for businesses and government.

Protect families from bankruptcy or debt because of health care costs.

Guarantee choice of doctors and health plans.

Invest in prevention and wellness. Improve patient safety and quality

care. Assure affordable, quality health

coverage for all Americans. Maintain coverage when you change

or lose your job. End barriers to coverage for people

with pre-existing medical conditions.

Playing Ball – Balancing Cost, Quality & Outcomes

Achieving equilibrium is the responsibility of every member of the Healthcare Ecosystem, including the

Patient

Delivery CostsQuality of OutcomesCare

Delivery Equilibrium

Performance Incentives

Privacy

Competitive Position

Patient Education

Data Transparency

Resource Mix

Physician Education

Loss of Position

Managing Change– Good and BadPlayer Trend Rationale for Perspective

Member/ Patient Fear of coverage and lowering of quality of care and erosion of trust in the patient-provider relationship

Reform will cause the cost of insurance to be higher and consumers will be forced to start saving more and planning better to take care of themselves. In some cases where family values are strong, pooling of risk may occur.

Payer Providers and customers are having more direct integration, alienating payers. Rising cost of insurance is driving payer margins down.

The balance of market power will shift to a greater degree to providers and customers. Fear of losing business will cause the payers to band together to gain market share and gain efficiencies of cost. Moving towards an oligopoly will seem to bring balance to the power of payers.

Provider Greater transparency will lead to greater education and demand from the member, driving decision making to be more from the members’ end.

Greater coverage will increase demand and in general raise prices and increase economic power of providers. More informed customers may demand more services ignoring the providers’ opinion, which still leads to greater demand and opportunity for providers.

Pharma/ Life Science

Marketing and innovation remain the key strategies.

Pharmaceutical and Life Sciences companies are unique in that they have fully functioning departments that are not working in silos today. The regulatory rules are not at the core of their operations unlike claims adjudication for TPA’s and payors. They have a greater array of opportunities presented to them via greater information technology (business intelligence) and social technology (web 2.0) to effectively market and follow member trends in the economy.

Managing Change–Individual and Collective Calls to Action

Player Call to Action Trigger Date based on HC Reform Timeline

Member/ Patient Start saving for expected and extensive coverage gaps through conventional investment vehicles and hedging risk across tribal mechanisms (extended family medical pooling).

Today

Payer Pursue M&A opportunities with other benefits management entities.

Identify and develop new derivative products that are aligned with regulatory and market demands.

January, 2011 – January 2013

Provider Go from Hospital to Hospitality model. (ancillary services, improved patient satisfaction, better occupancy management, best of class facilities)

Accelerate IT adoption across provider and patient communities.

July, 2012 - July, 2014

Pharma/ Life Science Follow the pill. (Who’s prescribing and who is using)

Shift from traditional to digital marketing.January, 2011 ->

Making an Impact: High Performance MedicineClinical Operations at the intersection of Business and Technology

Streamline business processes: Pre-registration Provider Information request Reimbursement information capture Fulfillment of patient information requests Ensure adequate privacy and security

protections for personal health information Patient Satisfaction

Qualify for meaningful use incentive payments Increase referral volume from community

providers Minimize redundant procedures Reduce in-patient re-admits Improve quality, safety, efficiency, and reduce

health disparities Engage patients and families Improve care coordination Improve population and public health Enhance patient safety by reducing medication

errors system-wide

Clinical PracticeBusiness Growth

Business GrowthInformation Technology

Information Technology

Expand disease management programs by supporting activities for certain patients with chronic illnesses

Increase capture of ancillary services Improve cost effectiveness through

managing utilization trends and analysis of variance

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Thank You!