health care reform & hospitals (aka the big squeeze) august 4, 2010
TRANSCRIPT
Health Care Reform Health Care Reform & &
HospitalsHospitals
(aka the Big Squeeze)(aka the Big Squeeze)
August 4, 2010August 4, 2010
HCR’s Overarching Goals HCR’s Overarching Goals
– Improve access: expand coverage, Improve access: expand coverage, prohibit pre-existing condition prohibit pre-existing condition denials, etc.denials, etc.
– Reduce the federal deficitReduce the federal deficit
– Improve access: expand coverage, Improve access: expand coverage, prohibit pre-existing condition prohibit pre-existing condition denials, etc.denials, etc.
– Reduce the federal deficitReduce the federal deficit
ApproachApproach– Phased: now through 2017+Phased: now through 2017+
– Medicaid expansion (Medi-Cal in CA, Medicaid expansion (Medi-Cal in CA, CalOptima in OC) serves as basis CalOptima in OC) serves as basis
– Individual/employer mandates with Individual/employer mandates with subsidies subsidies
– State-established exchangesState-established exchanges
– Consumer protectionsConsumer protections
– Phased: now through 2017+Phased: now through 2017+
– Medicaid expansion (Medi-Cal in CA, Medicaid expansion (Medi-Cal in CA, CalOptima in OC) serves as basis CalOptima in OC) serves as basis
– Individual/employer mandates with Individual/employer mandates with subsidies subsidies
– State-established exchangesState-established exchanges
– Consumer protectionsConsumer protections
Approach - 2Approach - 2
- Address “social determinants of health”Address “social determinants of health”
- Cost containment - Cost containment
(read: provider cuts)(read: provider cuts)
- Quality improvements/value-based - Quality improvements/value-based purchasing (more provider cuts)purchasing (more provider cuts)
- Workforce component- Workforce component
- Address “social determinants of health”Address “social determinants of health”
- Cost containment - Cost containment
(read: provider cuts)(read: provider cuts)
- Quality improvements/value-based - Quality improvements/value-based purchasing (more provider cuts)purchasing (more provider cuts)
- Workforce component- Workforce component
Approach - 3Approach - 3
– Standardized benefits, claims, Standardized benefits, claims, eligibility verificationeligibility verification
– Multi-state plansMulti-state plans
– Public option back on the table Public option back on the table overtly overtly andand covertly covertly
– Standardized benefits, claims, Standardized benefits, claims, eligibility verificationeligibility verification
– Multi-state plansMulti-state plans
– Public option back on the table Public option back on the table overtly overtly andand covertly covertly
Business IssuesBusiness Issues
– Employers w/50+ FTEs: play (provide Employers w/50+ FTEs: play (provide insurance) or payinsurance) or pay
– Employers w/200+ FTEs: auto-enroll Employers w/200+ FTEs: auto-enroll employees in a planemployees in a plan
– Starting in 2014, small companies Starting in 2014, small companies can procure coverage through can procure coverage through Exchange; larger companies starting Exchange; larger companies starting in 2017in 2017
– Employers w/50+ FTEs: play (provide Employers w/50+ FTEs: play (provide insurance) or payinsurance) or pay
– Employers w/200+ FTEs: auto-enroll Employers w/200+ FTEs: auto-enroll employees in a planemployees in a plan
– Starting in 2014, small companies Starting in 2014, small companies can procure coverage through can procure coverage through Exchange; larger companies starting Exchange; larger companies starting in 2017in 2017
ImplementationImplementation
- Waiver- Waiver
– Coverage InitiativeCoverage Initiative
- State/federal regulations- State/federal regulations
– ReinsuranceReinsurance
– ExchangeExchange
- Progress Reports- Progress Reports
- Waiver- Waiver
– Coverage InitiativeCoverage Initiative
- State/federal regulations- State/federal regulations
– ReinsuranceReinsurance
– ExchangeExchange
- Progress Reports- Progress Reports
Implementation - OCImplementation - OC
- 80% of County MSI clients will move - 80% of County MSI clients will move into Medi-Cal Managed Care (via into Medi-Cal Managed Care (via CalOptima) in 2014 or soonerCalOptima) in 2014 or sooner
- The state-established Exchange will - The state-established Exchange will initially serve those without employer initially serve those without employer coverage; MCMC entities (CalOptima) coverage; MCMC entities (CalOptima) seeking to serve general public seeking to serve general public (public option)(public option)
- 80% of County MSI clients will move - 80% of County MSI clients will move into Medi-Cal Managed Care (via into Medi-Cal Managed Care (via CalOptima) in 2014 or soonerCalOptima) in 2014 or sooner
- The state-established Exchange will - The state-established Exchange will initially serve those without employer initially serve those without employer coverage; MCMC entities (CalOptima) coverage; MCMC entities (CalOptima) seeking to serve general public seeking to serve general public (public option)(public option)
Implementation - OCImplementation - OC
- Hospitals - Hospitals
– Payment cuts Payment cuts
– ““Quality”, “value-based purchasing”, Quality”, “value-based purchasing”, hospital readmissions (devil in hospital readmissions (devil in details)details)
– Fewer uninsured but hospitals will Fewer uninsured but hospitals will also lose payment supplementsalso lose payment supplements
- Hospitals - Hospitals
– Payment cuts Payment cuts
– ““Quality”, “value-based purchasing”, Quality”, “value-based purchasing”, hospital readmissions (devil in hospital readmissions (devil in details)details)
– Fewer uninsured but hospitals will Fewer uninsured but hospitals will also lose payment supplementsalso lose payment supplements
Trends and PredictionsTrends and Predictions
- By 2016, a larger portion of the population - By 2016, a larger portion of the population will move into public plans: public option will move into public plans: public option and single payerand single payer
- Traditional physician private practice will - Traditional physician private practice will change: more, larger groups, hospital change: more, larger groups, hospital systems, mega health planssystems, mega health plans
- Cost controls: rate regulation, price - Cost controls: rate regulation, price controls, certificates of need, rationing of controls, certificates of need, rationing of servicesservices
- By 2016, a larger portion of the population - By 2016, a larger portion of the population will move into public plans: public option will move into public plans: public option and single payerand single payer
- Traditional physician private practice will - Traditional physician private practice will change: more, larger groups, hospital change: more, larger groups, hospital systems, mega health planssystems, mega health plans
- Cost controls: rate regulation, price - Cost controls: rate regulation, price controls, certificates of need, rationing of controls, certificates of need, rationing of servicesservices
Trends and Predictions - 2Trends and Predictions - 2
- Alliances: ACOs, hospital-physician - Alliances: ACOs, hospital-physician alignment, integrated delivery systemsalignment, integrated delivery systems
- Tiered future for hospitals- Tiered future for hospitals
– ““Must haves” in health plans/ACOsMust haves” in health plans/ACOs
– Physician alignment, high quality, low costPhysician alignment, high quality, low cost
– Unable to achieve above; able to survive Unable to achieve above; able to survive low-cost low-cost
- Alliances: ACOs, hospital-physician - Alliances: ACOs, hospital-physician alignment, integrated delivery systemsalignment, integrated delivery systems
- Tiered future for hospitals- Tiered future for hospitals
– ““Must haves” in health plans/ACOsMust haves” in health plans/ACOs
– Physician alignment, high quality, low costPhysician alignment, high quality, low cost
– Unable to achieve above; able to survive Unable to achieve above; able to survive low-cost low-cost
ConclusionConclusion
This is sea change!This is sea change!
- - For the delivery of health careFor the delivery of health care
- For the health care - For the health care marketplacemarketplace
This is sea change!This is sea change!
- - For the delivery of health careFor the delivery of health care
- For the health care - For the health care marketplacemarketplace
Questions?Questions?
Julie PuentesJulie Puentes
Regional VPRegional VP
Hospital Association of Southern Hospital Association of Southern California (HASC)California (HASC)
[email protected]@hasc.org
Julie PuentesJulie Puentes
Regional VPRegional VP
Hospital Association of Southern Hospital Association of Southern California (HASC)California (HASC)
[email protected]@hasc.org