Deloitte Center for Health Solutions

October 29, 2012

Monday memo

Health reform update

This week’s headlines: My take

Implementation update - Study: premium rate review - CMS: 2.3 million Medicare beneficiaries saved an average of $657 on prescription drugs - Physicians hesitant to participate in Medicare with looming SGR fix - Study: safety net hospitals hurt by cuts in DSH payments, lower Medicaid enrollment

Legislative update - Class action lawsuit settled, Medicare enrollees with long-term medical problems

entitled to coverage

- Study: Medicaid block grants could cut $1.7 trillion in Medicaid

- Compounding update: compounding pharmacy license revoked, CDC finds facility contaminated

- House GOP claims HHS improperly using tax dollars in promoting ACA

- Senate HELP Committee seeks feedback on track and trace system policy change

State update - State employee health costs

- Massachusetts health department officials issued warnings to compounding center

- State round-up

Industry news - Report: decline in the number of employers offering retiree health benefits

- Updated recommendations for cervical cancer screening and hormone therapy

- Report: medical devices spending up almost 1%

- Study: declines in U.S. biomedical and health R&D funding threaten global competition

Quotable

Fact file

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Deloitte Center for Health Solutions research

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My take

From Paul Keckley, Executive Director, Deloitte Center for Health Solutions

I speak to groups about health care three to four times weekly, but in my 35 years, last

Wednesday’s was a first. The topic was simple enough: “what middle market employers

should know about health reform and what they can do to prepare.” The audience: 1,100

business executives gathered at the Ohio State University-GE Capital 2012 National

Middle Market Summit in Columbus, Ohio. The agenda: some serious heavy weights—

Warren Buffett, Jeff Immelt, and rock star-entrepreneur Sammy Hagar—a/k/a The Red

Rocker—who I followed on the program.

I was probably the only one in the room that could not sing along with his 1984 hit “I Can’t

Drive 55” and my suit and tie definitely contrasted with his tee shirt and sandals. When I

took the stage, I had a sinking feeling that health care was last on the audience members’

minds: after all, they had just given the 65-year-old music legend a standing “O” as much

for his success as an entrepreneur (Cabo Wabo Tequila, Sammy’s Beach Bar Rum) as

his music. Sometimes I feel like a brown shoe at a white tie affair: it was certainly the case

last week.

Here’s what I told the group:

Health care is a big deal. It impacts everyone. It is the fastest growing line item

expense in the budgets of the federal and state government, and one of the fastest

for companies that provide insurance coverage and in the average U.S. household.

And it touches everyone.

Health costs can be reduced, but only if the health care system—including

individuals, policymakers, and employers—drive changes to the fundamentals of

the industry. Incentives based on volume must be replaced by incentives for doing

the right things that are evidence-based the first time. And the health system must

embrace accountability; adherence to evidence-based necessary care; mechanisms

to alter unhealthy behaviors; transparency for prices and quality; and technologies

that enable improved coordination, reduced error, and improved efficiency. To

embrace these changes, employers must understand the health system, not just

how their benefits are designed. There’s a difference.

The Affordable Care Act (ACA) is one of many legislative efforts to fix the system.

But transformation of the health system requires more than federal legislative

action: in most communities and states, employers are catalysts for meaningful

improvements.

Business leaders get it. They see a need to get the U.S. fiscal house in order. They

recognize the solution requires a combination of actions including tax reforms and

reduced government spending. And they understand health reform must be on the table

at the same time. Health costs impact corporate profits and global competitiveness for

large multi-nationals—that’s well documented. But even among smaller and mid-sized

companies, it’s about access to a productive workforce without being hampered by health

costs that defer growth and innovation. These findings from the National Center for the

Middle Market (NCMM) 3rd

quarter survey underscore the salience of health care to the

viability of mid-sized companies:

Source: NCMM Middle Market Indicator (MMI) 3Q 2012

Note: middle market companies have between $10 million and $1 billion in revenues.

As I reflect, it may have been the most challenging speech I’ve ever given, perhaps

because I followed Sammy, and perhaps because the topic is so delicate: employers have

a huge opportunity to impact reform of the health system, but they need to understand

health care—not just benefits design—and most don’t.

They know their costs are significant and growing: for single coverage, employers pay

83% of the $5,615 total premium and for family coverage, they invest 73% of the $15,745 total premium to get and keep a healthy, productive workforce (Source: Kaiser Family

Foundation, 2012 Employer Health Benefits Survey). They understand their employees

value health coverage as a benefit. Their issue is affordability: in the last decade, 10% of

employers dropped coverage due to costs, and in the decade ahead, we estimate 9%

more will drop simply due to costs (Source: 2012 Deloitte Survey of U.S. Employers).

They know it matters to their employees: only 20% of employees with employer-

sponsored coverage feel protected from health costs that might wipe out their household

financial security. But most don’t understand the health system—how it actually operates,

how clinical decisions are made, how necessary and unnecessary costs are incurred, or

how each of the system’s multiple sectors relate to each other or not.

I am going to download Sammy’s songs this week and learn the words to “I Can’t Drive

55” so I can sing along next time. I need to get out of my musical comfort zone.

And employers need to get out of their comfort zone and play an active role in fixing the

health system. They need to invest time in understanding the health system, not just its

costs, and become catalysts in its transformation.

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75%

77%

81%

86%

92%

79%

70%

85%

85%

90%

76%

77%

84%

89%

91%

0% 20% 40% 60% 80% 100%

Commodity costs

Talent management

Uncertainty of government actions

Ability to maintain margins

Health care costs

Top Middle Market Business Challenges

Q3

Q2

Q1

Implementation update

Study: premium rate review Per Section 10003 of the ACA, health insurers must justify increases in premium rates

above 10% to either state or federal reviewers. Kaiser Family Foundation researchers

analyzed 846 rate filings from 41 states that were reviewed by state regulators (798) or

the U.S. Department of Health and Human Services (HHS) (448): “As of August 1, 2012,

44 states and DC have rate review programs that have been deemed by HHS to be

effective in at least one insurance market, meaning that they meet such criteria as having

the authority under state law to determine the reasonableness of rate increases, having a

transparent process for making the information publicly available, and allowing public

comment on proposed rate changes.”

Findings from 32 states and DC, which had publically available rate review data:

One in five resulted in a lower premium increase than the insurer initially requested

Individual group premium: 8.9% average rate increase requested, 6.3% average

rate increase approved

Small group premium: 5.2% average rate increase requested, 4.7% average rate

increase implemented

Findings in states where federal reviews were conducted:

The average premium rate request was 16%. Note: the average rate request is

higher for federal reviews because HHS can only review rate increases at or above

10%; states with rate review programs in place monitor all increases

77% of filings were determined unreasonable by HHS

19% were found to be “not unreasonable” by HHS

Background: prior to the passing of the ACA, many states had rate review programs in

place; Section 10003 set a floor of requirements. States with effective programs in place

began reviewing proposed increases in September 2011. HHS conducts reviews in states

without effective programs in place, but does not have the authority to deny rate

increases. HHS and states are required to make information publicly available for

requests at or above 10%.

(Source: Kaiser Family Foundation, “Quantifying the Effects of Health Insurance Rate

Review,” October 2012)

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CMS: 2.3 million Medicare beneficiaries saved an average of $657 on

prescription drugs Thursday, the Centers for Medicare & Medicaid Services (CMS) reported that in the first

nine months of 2012, 2.3 million beneficiaries in the Medicare prescription drug “donut

hole” saved an average of $657, and 20.7 million beneficiaries received at least one

preventive service with no deductible or co-payment as a result of Sections 3301, 4103,

4104, and 4105 of ACA. To date, CMS reports that 5.6 million beneficiaries have saved

$4.8 billion on prescription drugs since the enactment of these provisions.

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Physicians hesitant to participate in Medicare with looming SGR fix According to a Medical Group Management Association (MGMA) survey of physicians,

82% of practices would be likely to participate in accountable care organizations, patient-

centered medical homes, or bundled payment and shared savings pilots if Congress

passed legislation to override mandated sustainable growth rate (SGR) reductions for the

next five years. Key findings:

If the scheduled 27% reduction in Medicare reimbursement takes place on January

1, 2013: 45% of practices say they are very likely to reduce the number of

appointments for new Medicare patients, 27% say they probably would reduce the

number of appointments available for their current Medicare patients, 31% are very

likely to stop accepting new Medicare patients altogether.

More than half would likely reduce size of their staff; 75% say they would reduce

employee salaries or benefits.

In the past five years, 60% percent of practices reported reducing staff salaries,

benefits, or delaying buying new clinical equipment or facilities.

(Source: MGMA, “Performance and Practices of Successful Medical Groups: 2012 Report

Based on 2011 Data,” October 2012)

Note: stay tuned for an upcoming Issue Brief from the Deloitte Center for Health

Solutions—“Understanding the Sustainable Growth Rate: Analyzing the `Doc Fix.’”

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Study: safety net hospitals hurt by cuts in DSH payments, lower Medicaid

enrollment Thursday, the National Association of Public Hospitals and Health Systems (NAPH)

released its analysis of the Congressional Budget Office’s forecast of insurance coverage

for fiscal year (FY) 2014 to FY2019, concluding hospitals will spend $53.3 billion more on

uncompensated care by 2019 than estimated prior to the enactment of ACA. Two major

factors were cited for the increase: reductions in Medicaid disproportionate share hospital

(DSH) payments to safety net hospitals starting in FY2014, and lower participation in

Medicaid as a result of the June 28 Supreme Court ruling that disallowed mandatory

eligibility at 133% of the federal poverty level (FPL).

Background: beginning in FY2014, per Section 2551 of the ACA, CMS will reduce DSH

Medicaid allotments by a total of $18.1 million. States with a lower percentage of their

population uninsured will receive a 50% reduction, and states with a larger percentage of

uninsured will receive a 25% reduction. Per Section 3133 of ACA, CMS will reduce DSH

Medicare payments by a total of $22 billion over ten years. Initially CMS will reduce

Medicare DSH payments by 75% in FY2014, and subsequently increase payments based

on the percent of the population uninsured and the amount of uncompensated care.

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Legislative update

Class action lawsuit settled, Medicare enrollees with long-term medical

problems entitled to coverage Last Monday, the U.S. Department of Justice announced the proposed settlement of a

class action lawsuit brought on behalf of Medicare plaintiffs that, if approved by the U.S.

District Court judge, will change a long-standing policy toward payments for certain home,

skilled, and long-term care services for Medicare enrollees whose health status was not

deemed to be “improved” as a result of the services. The proposed settlement agreement

requires that CMS re-write the Medicare manual for nursing and therapy services to make

clear that provision of these services no longer requires evidence that their provision is directly linked to health status improvement. Note: the settlement will be most meaningful

to patients and family members with Alzheimer’s/Parkinson’s, stroke, spinal cord and

traumatic brain injuries, and others. The settlement stemmed from a case where an 81-

year-old woman was denied home health services through Medicare because her multiple

sclerosis was not improving.

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Study: Medicaid block grants could cut $1.7 trillion in Medicaid Block grants to states for Medicaid could cut $1.7 trillion from the Medicaid program over

the next ten years ($932 billion from repealing the ACA and $810 billion from transitioning

to a block grant), per an analysis by the Urban Institute and the Kaiser Commission on

Medicaid and the Uninsured. Key findings:

Hospitals payments could be reduced $363.8 billion and nursing home payments

$220.2 billion from 2013-2022 under a block grant scenario

Medicaid enrollment could be reduced by 17 million if the ACA is repealed

77% increase in state spending with no efficiency gains; 46% if Medicaid spending

per enrollee was held to the rate of growth in GDP per capita under a block grant

scenario

(Source: Kaiser Commission on Medicaid and the Uninsured and the Urban Institute,

“National and State-by-State Impact of the 2012 House Republican Budget Plan for

Medicaid,” October 2012)

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Compounding update: compounding pharmacy license revoked, CDC finds

facility contaminated The fallout continued last week for the Massachusetts compounding pharmacy linked to

the multi-state fungal meningitis outbreak responsible for 294 known cases of fungal

meningitis and 24 deaths. Tuesday, the Massachusetts Board of Pharmacy permanently

revoked the New England Compounding Center’s (NECC) license after several health and

safety violations were discovered. An inspection conducted by the Massachusetts

Department of Public Health and U.S. Food and Drug Administration (FDA) found that

black fungus particles were visible in sealed vials of the recalled steroid, NECC distributed

products on 13 separate occasions before receiving sterility test results, large batches of

compounded sterile product were distributed directly to facilities for general use without

requiring a prescription for an individual patient, and sterilization procedures were not

followed properly.

Related: members of the U.S. House Energy and Commerce Committee sent a letter to

NECC’s owner and former owner seeking documents related to the recent outbreak as

well as the history of investigations and operations of the NECC and associated entities

dating back to 2002. NECC’s owner declined to comply with the Committee’s earlier

request for a briefing on the outbreak. The letter highlighted that prior to the meningitis

investigation, joint federal and state inspections of the NECC facility occurred in 2002,

2003, and 2004 in response to an adverse event reported to the FDA. Public Citizen’s

Health Research Group issued a letter to HHS Secretary Kathleen Sebelius requesting

that the HHS Office of Inspector General (OIG) investigate whether the FDA exerted full

use of its legal authority to regulate NECC after prior inspections discovered violations.

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House GOP claims HHS improperly using tax dollars in promoting ACA Last week, GOP Chairmen of the House Subcommittee on Oversight Dave Camp (R-MI)

and Charles Boustany (R-LA) sent HHS Secretary Kathleen Sebelius a letter inquiring

about the status of materials requested in May 2012 regarding the use of taxpayer dollars

on the promotion of the ACA. The Subcommittee claims HHS is improperly using taxpayer

dollars to promote “Obamacare.” The information is requested by October 31, 2012.

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Senate HELP Committee seeks feedback on track and trace system policy

change The Senate Committee on Health, Education, Labor, and Pensions (HELP) released a

draft proposal on drug distribution security, referred to as a “track and trace” system, last

week requesting comments from stakeholders on the policy options proposed in the

report. Comments are due November 7, 2012, the day after the election, and

policymakers hope to draft and pass legislation by the end of the year. Congress

attempted to address drug distribution safety earlier this year, but efforts were stalled due

to disagreements on the requirements and implementation of a track and trace system.

Background: “track and trace” language was included in the re-authorization of the

Prescription Drug User Fee Act (PDUFA) of 2012 this summer, but was removed due to

industry opposition. Manufacturers oppose the use of individual identifiers that require

tracking of single packages of drugs but favor tracking at the lot level.

A federal track and trace system would allow the FDA to track a drug from its origination,

through the manufacturing process, to the point of sale. If a counterfeit, diverted, stolen, or

otherwise damaged product is reported, the FDA would be able to ensure timely

intervention to prevent the damaged product from being distributed widely. Currently,

some states have laws in place to enhance drug security, but a federal system would

standardize processes across state lines. In 2015, California will require unique identifiers

to be placed on all drugs.

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State update

State employee health costs State government workers have richer health benefits than the private sector, but the gap

has narrowed from $1,523 in 2007 to $891 in 2012 while the numbers of state workers not

paying a co-payment or premium has shrunk from 39% in 2007 to 30% in 2012 with an average of $425/month out-of-pocket (vs. 17% in the private sector). (Source: Bureau of

Labor Statistics [BLS] National Compensation Survey)

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Massachusetts health department officials issued warnings to

compounding center Massachusetts Department of Health officials notified the NECC of safety and quality

improvements dating back to 1999. Per the Department’s records, each citation was

resolved. To date, nearly 300 cases of fungal meningitis and 24 deaths have been linked

to the tainted injectable from NECC.

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State round-up Tuesday, an Indiana law preventing Planned Parenthood from obtaining

reimbursement from the state Medicaid program because it provides abortion

services was overturned by the Seventh Circuit U.S. Court of Appeals. The ruling

differs from a Fifth Circuit U.S. Court of Appeals decision to uphold legislation that

refuses state funding to Planned Parenthood and other abortion providers in Texas.

A settlement between legal advocates and the state of Pennsylvania's public

welfare office acknowledges up to 100,000 individuals may have been wrongly

terminated from the state’s Medicaid program due to eligibility. The state agreed to

increase use of electronic databases to more accurately verify Medicaid eligibility. If

re-enrolled, beneficiaries may submit receipts for reimbursement for any cost

incurred for Medicaid covered expenses during the period they were without

coverage.

Enrollees in California's Major Risk Medical Insurance Program will see reduced

premium rates in 2013 matching the Pre-Existing Condition Insurance Plan (PCIP),

the federal program established per Section 1101 of the ACA for individuals with

pre-existing health conditions unable to access affordable coverage. This measure

will serve as a stopgap until 2014 when high-risk subscribers may purchase

coverage through the state Health Benefit Exchange.

Mississippi estimates more than 300,000 residents could be added to its Medicaid

program by 2025 with projected cumulative state costs (2014-2025) of $1.07 billion.

The cost to state government will be just under $100 million in 2017 when the

federal match is reduced to 95%.

In a letter to Governor Mary Fallin (R-OK), Senator Tom Coburn (R-OK)

recommended Oklahoma not expand Medicaid to 133% of the FPL and instead

work on improving public programs already in place.

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Industry news

Report: decline in the number of employers offering retiree health benefits The number of private businesses offering retiree health benefits decreased significantly

between 1997 and 2010, and employers that still offer retiree health benefits have

generally adapted benefit packages resulting in increased retiree premiums, decreased

eligibility, or reduced coverage features. Notable findings:

Private firms offering retiree health benefits decreased from 29% to 17% resulting in

a net 4% decrease in the percentage of retirees over age 65 with health benefits.

Most employers (78%) are very or somewhat likely to increase retiree contributions

to premiums in the future.

Employees expecting health benefits upon retirement have decreased, from 45% to

32% of workers.

While 35% of current employees age 45 to 64 expected to receive health benefits

upon retirement, 25% of early retirees and 16% of Medicare-eligible retirees actually

received them in 2010.

(Source: Employee Benefit Research Institute, “Employment-Based Retiree Health

Benefits: Trends in Access and Coverage, 1997‒2010,” October 2012)

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Updated recommendations for cervical cancer screening and hormone

therapy Last Monday, the American College of Obstetricians and Gynecologists (ACOG) issued

new guidelines recommending that most women should be screened for cervical cancer

(Pap test) once every three to five years, instead of annually. The new guidelines also

recommend that women over the age of 30 receive the Pap test and the human

papillomavirus (HPV) test simultaneously every five years.

Related: the U.S. Preventive Services Task Force (USPSTF) recommended against the

use of combined estrogen and progestin hormone therapy treatments for the prevention of

chronic conditions in postmenopausal women, and the use of estrogen for the prevention

of chronic conditions in postmenopausal women who have had a hysterectomy. Both

treatments received a grade “D” rating from the Task Force based on the evidence of both

the benefits and harms of the service.

Background: per Section 2713 of ACA any group health plan or insurer in the group or

individual market must provide preventive health services rated grade “A” or “B” by

USPSTF with no cost sharing or co-payment beginning August 1, 2012.

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Report: medical devices spending up almost 1% In 2010, medical device spending was 6% ($156 billion) of the $2.6 trillion the nation

spent on health care, representing an increase of 0.7% from 1989 to 2010. During this

time, the Health Care Consumer Price Index (MC-CPI) increased 4.7%, and the Medical

Care Services Consumer Price Index (MCS-CPI) increased 5%

(Source: Gerald Donahoe, Guy King, “Estimates of Medical Device Spending in the

United States,” October 2012)

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Study: declines in U.S. biomedical and health R&D funding threaten global

competition A Research!America analysis of biomedical and health research and development (R&D)

spending in the U.S. revealed that R&D declined 3% ($4 billion) in FY2011, the first

spending decline since 2002. The report noted that much of this decline comes from the

expiration of $10.4 billion in funding designated to the National Institutes of Health (NIH)

by the American Recovery and Reinvestment Act. Per the report, sequestration might

threaten the nation’s biomedical and health research capacity and ability to compete

globally by reducing federal biomedical and health research funding by 8-10%. Notable

findings:

Federal funding for research declined 14% in FY11, totaling $39.5 billion in 2011

Overall industry investment in R&D increased 1.4% from 2010, $77.6 billion in 2011

Pharmaceutical industry investment in R&D increased 3% from 2010, $38.5 billion

in 2011

Biotechnology investment in R&D declined 3% ($800 billion) from 2010, $29.2

billion in 2011

Medical device industry investment in R&D increased 7.4% from 2010, $9.8 billion

in 2011

(Source: Research!America, “2011 U.S. Investment in Health Research,” October 2012)

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Quotable “Congress needs to grant the FDA whatever additional powers it deems necessary to

inspect the pharmacies, monitor their sales and judge the safety or effectiveness of their

products. The problems need to be addressed on a nationwide basis, not just through states, which often have limited resources and expertise.”—The New York Times,

Editorial Page, “Deeper Concerns about Drug Compounding,” October 26, 2012

“I was always confident that the Affordable Care Act, a.k.a. Obamacare, was

constitutional. It was interesting to see them, or Justice Roberts in particular, take the

approach that this was constitutional under the taxing power. The truth is that if you look

at the precedents dating back to the 1930s, this was clearly constitutional under the

Commerce Clause. I think Justice Roberts made a decision that allowed him to preserve

the law but allowed him to keep in reserve the desire, maybe, to scale back Congress’

power under the Commerce Clause in future cases.”—President Barack Obama, Rolling

Stone, October 2012

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Fact file Economic outlook: the GDP is expected to grow 2.3% next year, up from 1.65%

in first half of 2012; unemployment is expected to end 2013 at 7.6% vs. 7.8% in

2012; job growth is expected to average 175,000/month. (Source: USA Today

survey of 48 economists, October 15-18, 2012)

Obesity and school food: kids consume 30-50% of their calories at school; one in

three is overweight or obese. (Source: U.S. Department of Agriculture [USDA])

High caffeine sports drinks: emergency room (ER) visits attributable to sports

drinks increased ten times from 1,128 in 2005 to 13,114 in 2009. (Source:

Substance Abuse and Mental Health Services Administration [SAMHSA],

November 22, 2011)

Debate viewership: October 3 (domestic policy)—67.2 million, October 11

(domestic and foreign policy)—51.4 million, October 22 (foreign policy)—65.6

million. (Source: Nielsen)

College tuition: average cost for tuition, room, and board after financial aid is

$12,110 vs. sticker price of $17,860 for public four-year schools and $23,840 for

private four-year school sticker price of $39,520; represents a sticker price increase of 3% and actual price increase of 4.8% over prior year. (Source: The College

Board)

Multigenerational homes: 4.3 million U.S. households—5.6% of total—have three

or more generations—up from 3.7% in 2000. (Source: U.S. Census Bureau 2009-

2011 American Community Survey)

Campaign 2012 polling: 31.6% of the samples used in polling in this cycle are on

mobile devices. (Source: Real Clear Politics average of the eight polls it follows)

Medicare appeals: Part A hospitals: 14.1 million Medicare claims were denied,

295,000 were appealed, 40% of the appeals were successful; Part B physicians:

93 million claims denied, 2.4 million appealed, 53% reversed. (Source: CMS)

Lower income household consumption: households with incomes in the bottom

fifth account for 8.7% of total consumption—unchanged since 2000; 47.7% have

personal computers vs. 19.8% in 2000, households with six or more rooms increased from 21.9% to 30%, 75.5% have cell phones. (Source: American

Enterprise Institute, BLS Consumer Expenditure Survey)

Medicaid enrollment: Medicaid spending increased 2% in FY2012 with a 3.2%

increase in enrollment compared to a 9.7% increase in spending and a 4.4%

increase in enrollment in FY2011. (Source: Kaiser Commission on Medicaid and

the Uninsured, October 2012)

Medical school applicants: 45,266 applicants for 2012 school year, a 3.1%

increase from 2011. Total enrollment is projected to increase by 30% within the

next three to four years. In 2013, four new medical schools are scheduled to open.

(Source: Association of American Medical Colleges [AAMC], “Medical School

Enrollment Continues to Climb with New Diversity Gains,” October 2012)

Medical cost burden: the recession did not increase the percentage of individual

discretionary spending for health care over 10% because individuals decreased

out-of-pocket spending overall to adjust to their lower compensation; 19% of

people under age 65 spend more than 10% of their discretionary income on health

care. (Source: Health Affairs, “Despite the Recession’s Effects on Incomes and

Jobs, the Share of People With High Medical Costs Was Mostly Unchanged,”

October 2012)

Adverse birthing events: on average 52,000 women experience severe maternal

morbidity per year; 114% increase in 2009 from 1998 for postpartum

hospitalizations. (Source: Obstetrics & Gynecology, “Severe Maternal Morbidity

Among Delivery and Postpartum Hospitalizations in the United States,” November

2012)

Health insurance coverage: in 2011, 92.5% of children had access to health

insurance. Significant drop in health insurance coverage for kids occurred in 20

states, down from 34 states between 2009 and 2010. (Source: Georgetown

University Health Policy Institute Center for Children and Families, “Uninsured

Children 2009-2011: Charting the Nation’s Progress,” October 2012)

Access to orthopedic surgeons for Medicaid enrollees: in the past six years

the number of orthopedic surgeons accepting children enrolled in Medicaid with a

broken arm dropped 40%; access to orthopedic surgeons for children with private

insurance decreased 10% since 1996. (Source: American Academy of Pediatrics,

“Fewer Orthopedic Surgeons Accepting Pediatric Medicaid Patients,” October

2012)

Consumer reaction to health information exchange: 86% want personal health

information (PHI) to be protected, 86% want to be continually informed about who

has seen their health information, and 78% want to control what information is shared. (Source: Annals of Family Medicine, “Health Care Consumers’ Preferences

Around Health Information Exchange,” October 2012)

Global comparisons: the U.S. spends 2.5 times more than the average health

expenditure per person of the 34 Organisation for Economic Co-operation and

Development (OECD) countries. Notable comparisons: physicians/1,000: U.S. 2.4

vs. OECD 3.1; hospital beds/1,000: U.S. 2.6 vs. OECD 3.4; life expectancy at birth:

U.S. 78.7 vs. OECD 79.8. (Source: OECD Health Data 2012)

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Press (www.DUPress.com).

Coming soon: Understanding the Sustainable Growth Rate: Analyzing the “Doc Fix”

2012 Survey of U.S. Health Care Consumers – INFOBrief series and Five-year report

Currently available: Impact of Health Care Reform on Insurance Coverage: Projection Scenarios Over

10 Years – Update 2012—October 2012. Available online at

www.deloitte.com/us/2012coveragemodel

State Medicaid Program Management: Update and considerations—September 2012.

Available online at www.deloitte.com/us/2012statemedicaid

Meeting the Challenge: Maximizing the value of employer-sponsored health care—

August 2012. Available online at www.deloitte.com/us/meetingthechallenge

2012 Deloitte Survey of U.S. Employers: Opinions about the U.S. health care system

and plans for employee health benefits—July 2012. Available online at

www.deloitte.com/us/2012employersurvey

Deloitte 2012 Survey of U.S. Health Care Consumers: The performance of the health

care system and health care reform—June 2012. Available online at

www.deloitte.com/us/2012consumerism

Health Care Reform: Center Stage 2012 Perspectives from consumers, physicians

and employers—June 2012. Available online at

www.deloitte.com/us/healthcarecenterstage2012

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Upcoming life sciences and health care Dbrief webcasts Anticipating tomorrow's complex issues and new strategies is a challenge. Stay fresh with

Dbriefs – live webcasts that give you valuable insights on important developments

affecting your business.

November 13: Market Forces at Work: Life Sciences Implications of Changes in Health

Care Delivery, Access, and Coverage

December 11: What's Around the Corner for Health Care Organizations and

Policymakers?

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Deloitte contacts

Paul H. Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutions

(pkeckley@deloitte.com)

Jessica Blume, U.S. Public Sector National Industry Leader, Deloitte LLP

(jblume@deloitte.com)

Bill Copeland, U.S. Life Sciences and Health Care National Industry Leader, Deloitte LLP

(bcopeland@deloitte.com)

Jason Girzadas, National Managing Director, Life Sciences & Health Care, Deloitte

Consulting LLP (jgirzadas@deloitte.com)

Harry Greenspun, M.D., Senior Advisor, Health Care Transformation and Technology,

Deloitte Center for Health Solutions (hgreenspun@deloitte.com)

Mitch Morris, M.D., National Leader, Health Information Technology, Deloitte Consulting

LLP (mitchmorris@deloitte.com)

George Serafin, Managing Director, Health Sciences Governance Regulatory & Risk

Strategies, Deloitte & Touche LLP (gserafin@deloitte.com)

Rick Wald, Director, Human Capital, Deloitte Consulting LLP (rwald@deloitte.com)

To receive email alerts when new research is published by the Deloitte Center for Health Solutions, please register at www.deloitte.com/centerforhealthsolutions/subscribe.

To access Center research online, please visit www.deloitte.com/centerforhealthsolutions.

To arrange a briefing for your team, contact Jennifer Bohn (jebohn@deloitte.com).

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