A New Landscape for Health CareBoulder County Business Report
PULSE: What’s Next? Health Care Reform in the Boulder Valley November 12, 2013
Jandel T. Allen-Davis, MD
Vice President, Government and External RelationsKaiser Permanente, Colorado Region
Since the passage of the Affordable Care Act (ACA), America has been on a trajectory that will result in significant changes in how health care in America is delivered, experienced and financed. Even if none, some or all of the landmark legislation is changed or delayed in
implementation, we will not retreat to the health care system of old.
In this discussion, after reviewing many of the changes that have taken place in United States with the passage of the ACA, we will take a speculative look into the future, based on the current
status of health care in the US and in Colorado.
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Objectives
Name key components of the national health care reform that have some basis in current United States health care reform initiatives.
Identify 4 key strategies to control costs in the US health care system.
Articulate one potential scenario, should the public policy debate regarding health carereform change.
Fifth Agenda
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Health Care in America:
Since March 2010 the United States has been on a path to enact the Affordable Care Act. In this section, we will lay out the current status of health care in America: the cost, the coverage and the outcomes.
Perfect storm or perfect opportunity?
Economic Status
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United States economy
Unemployment: 7.2% (Colorado 7.0%) Living in Poverty: 46.5 million people
(15% of US population) Uninsured: 14.8% (National Health
Interview Survey Jan.-March 2013)
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Health Insurance Coverage, by type, 2010
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http://www.kff.org/insurance/snapshot/Employer-Health-Insurance-Costs-and-Worker-Compensation.cfm
Health Status
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Adult Obesity
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Childhood Obesity
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Diabetes
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Heart Disease Deaths
Health Care Costs
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Health Care Costs: Contributors
Aging of the population Changes in third party payment Personal income growth Health sector prices Administrative costs Defensive medicine and supplier-
induced demand Technology related changes in medical
practice
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Payment Reform Activity
Whether through insurance reforms, increasing access to coverage, or changing how care is delivered and by whom, many feel that the pace of increase in the cost of health care will not decelerate until we change how the system is organized and how providers are paid.
Insurance reforms help, changing care delivery cures!
Payment Reform Activity
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Payment Reform
Fee for service problems Modified arrangements Risk sharing arrangements and gain
sharing arrangements Global caps Bundled payments Quality bonuses
So, where are we headed?
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The Future of Health Care in America
In this section, we will explore some likely outcomes that will define how care and coverage will play out in the coming decades. We will cover topics such as Medicaid, Medicare, Health Insurance Exchanges, health insurance benefit design, health care status of Americans, delivery systems of the future and the role of information technology.
Some Likely Scenarios
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Looking Ahead
Medicaid Medicare Insurance Market
Limit coverage and benefits
More managed care
Accountable Care Organizations
Means testing: higher income people will have less access
Set the standards for care across the nation
Financial pressures
Fewer small players: mergers, acquisitions
Creative benefit designs
Explosion in individual coverage
Health Insurance Marketplaces (Exchanges): the bet
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Looking Ahead
Delivery System Providers Communities
Coordination of care, venue management, integration
Proliferation of electronic health records
More interoperability and transparency
Value equation: quality and efficiency
Larger multispecialty groups, fewer physician owned practices
Shift back to primary care as payment reform takes hold
Pay for value
Health status will continue to decline
Focus on community health
Built environment, disparities, “place matters”
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Looking Ahead
Patients Hospitals Employers
Self-efficacy
Self-care
Consumerism
Higher out of pocket expenses
Quality improvement activity
Physician-owned practices
Self-funding
Less Employer Sponsored Insurance
Focus on wellness
Productivity measurement will take hold
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Looking Ahead
Brokers/Consultants PPACA States
Will play increasing role in the individual market
Consolidation among the players
Navigators, Assisters, Health Coverage Guides
More delays in implementation possible
“The end of the beginning of health care reform.”
Continue to be learning labs
Exchanges will look more similar over time
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Looking Ahead
Federal and State Government
Financing health care coverage challenges will continue
New rules establish incentives to get most of the US population into the risk pool, standardize benefit design and pricing
State and federal regulators better positioned as referees over a leveled playing field
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We are at the beginning…
— The Lord of the RingsThe Old Walking Song sung by Bilbo Baggins, Chapter 'A
Long-Expected Party'.
The Road goes ever on and onDown from the door where it began,Now far ahead the Road has gone,
And I must follow if I can,Pursuing it with eager feet,
Until it joins some larger wayWhere many path and errands meet.
And whither then? I cannot say.
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We are at the beginning…
— The Lord of the RingsA Walking Song sung by Frodo, Sam and Pippin, as they
set off for Buckland, Chapter 'Three is Company'.
Still round the corner there may waitA new road or a secret gate,
And though we pass them by today,Tomorrow we may come this way
And take the hidden paths that runTowards the Moon or to the Sun.
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Thank you!
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