Carl Patten, JD, MPHDirector, Florida Blue Center for Health PolicyHealth Care Policy: 2014 and BeyondJanuary 21, 2014

Central Pinellas Chamber of Commerce

Focus on 2014: A Tampa Bay Economic Forecast

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Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

What are we talking about?• Snapshot and outlook of the health policy

environment

• Brief Profile of Pinellas County

• Moving forward, through the perspective of Florida Blue

• The Florida Blue Center for Health Policy

The ACA and a bit more

Update and impact of the ACA

Managing through change

Employers and the ACA

State and Federal Environment

4Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

ACA Enrollment Snapshot 12/31/13• Total Enrollment:

• 2.153 million Overall• 158,030 in Florida

• Categorized by type of marketplace• 957,000 - State-Based Marketplace• 1.2 million - Federally-Facilitated Marketplace (Supported or run by HHS)

• Percentage Enrolled by age• Ages 18-34 (24%) – target is 39% of 7 million (2.2 million)• Ages 55-64 (33%)

• Financial assistance• 79% overall• 83% in Florida• 80% in FFMs• 78% in SBMs

Source: Department of Health and Human Services, Office of the Assistant for Planning and Evaluation

5Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

The anticipated impact of the ACA• More money will be spent on health care

• Projected share of health care spending of GDP in 2020 is 19.2%.

• Projected private insurance health expenditures increase more and its proportionate share of health care spending declines more slowly

• Slows projected growth of Medicare spending

• Increases projected growth of Medicaid spending.

Source: Centers for Medicare and Medicaid Services, Office of the Actuary

6Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Projections and gospel are two different things (at least in the short term)

• Generally health care spending growth has slowed significantly since 2009.

• In 2012 national health expenditures decreased to 17.2% of GDP from 17.3% in 2011.

• Projections for 2012 were 17.9% of GDP

• Annual growth for 2012 was projected at 3.9% versus actual growth of 3.7%

• However the ACA will have its predicted impact, the question is to what degree

Source: Centers for Medicare and Medicaid Service, Office of the Actuary

7Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Premiums/Cost of C

overagePremium Subsidies

Age Rating

Compression

HealthInsurance

Tax

Essential Benefit

Changes

Cost-sharing Subsidies

New Market Rules

3Rs

Competition

MANAGING THROUGH CHANGE

8Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

To Cover or Not To Cover …?• Employer mandate delayed to 2015

• Costs and benefits of coverage

• Cost of penalties

• Recruitment

• Tax credits for small business (sunsets in 2015).

9Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Small Business Health Options Program (SHOP)

• Allows small employers up to 50 full time employees to purchase health insurance coverage for employees

• In 2014, small employers will work directly with insurers to enroll in SHOP coverage

• In 2015, a SHOP marketplace website will be available for enrollment

• Employer choice model

• Tax credit sunsets in 2015

10Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

State Environment• Alignment with ACA will not be robust

– Substantially done with ACA requirements to align state and federal law– Redefining group size– Guessing game, new world, no experience– Adversarial environment is magnified

• Medicaid Expansion

• The safety net in Florida– Low Income Pool, Disproportionate Share Payments

• Issues on the horizon– Provider scope of practice– Telemedicine– Prior authorization and step therapy

11Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Federal Environment• Election year environment

• Implementation of the ACA– Health plan regulation

• SGR Reform

• Balancing responses to the ACA and antitrust concerns

• Active rule making and aggressive enforcement efforts by the IRS– Scrutiny of nonprofit tax status– Unrelated business income– Engagement of political activity by social welfare organizations

Pinellas

Demographics, Public Health and Wellness

13Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Pinellas, Demographics and Economics

• Health care is important to the economy– 12.5% of the employees are in the health care and social assistance sector

• Medicare– Pinellas is getting older. Over 25% of population will be 65 and older.– Although Medicare spending will increase, there will be downward pressure on

reimbursements

• Medicaid and Subsidies– Although income is projected to increase, 14% of households will make less than $15,000

annually in 2018.– 400% of FPL for a family of two is over $62,000 annually.

• Hillsborough– Robust health care sector– Median age is 10 years younger than Pinellas– Median household income is about $3,000 higher than Pinellas

Source: Pinellas County Economic Development and U.S. Census

14Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Pinellas, Public Health and Wellness

• Some very bright spots– Access to care (financially and doctor to population ratio)– Favorable mortality rates regarding heart disease and cancer

• Opportunities for improvement– Communicable and infectious diseases, particularly STDs– Infant mortality– Immunization of children in kindergarten– Unintentional injuries– Domestic violence

• Pinellas indulges, but only so much (so does Hillsborough)– Least favorable rating regarding overweight adults– Most favorable rating regarding obese adults

• Hillsborough– Similar profile, worse regarding communicable and infectious diseases

Source: Florida Charts

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MOVING FORWARD AT

FLORIDA BLUE

VisionA leading innovator enabling healthy communities

MISSION, VISION AND VALUES

Mission

To help people and communities achieve better health

ValuesRespect, Integrity, Imagination, Courage, Excellence

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17Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

HOW HEALTH CARE IS CHANGING…

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Our Delivery System is becoming a Mosaic of Value Models

Patient Centered Medical Homes (PCMH)

Bundled Payment Pilots

Staff Model HMOs

2

1

Physician Groups

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2

ACO Models

3,5

2

1

7

4,6

Medicare Collaborative Care Models

RETAIL CENTERS

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Florida Blue Center for Health Policy

21Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Florida Blue Center for Health Policy

COST QUALITY ACCESSFREE

MARKET

PUBLIC HEALTH

FIVE PILLARS OF PUBLIC POLICY

22Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

The Immovable Object vs.The Irresistible Force

QUESTIONS?

FLORIDA BLUE CENTER FOR HEALTH POLICY

• Website: www.floridablue.com/healthpolicy

• Email: carl.patten@floridablue.com

• Phone: 904-905-4411

• Twitter: @carlwpattenjr