quality/cost imperative
DESCRIPTION
Healthcare 2015 ACA Implementation – Divided Congress – More Litigation – Federal Subsidies Origination Clause – Continued Changes in the Law – More Litigation – Federal Medicaid Expansion – Payment Reforms – Cost Containment – Coverage Expa sion – Above $200 Billion in Healthcare Costs– Exchanges– Policy Implications KL: Needs more balance, the smaller photos should be bigger Full speed ahead on implementation, which will be daunting Divided Congress = few/no significant changes Likely more litigation Contraception, Federal exchange subsidies, Origination clause, Others? Continual tweaking to the law Major action (Medicaid expansion, payment reforms, exchanges, cost containment…) at the state level Coverage expansion continues to be an area of change: Delay in implementation? Changes in subsidies, Medicaid expansion, etc… Healthcare is even more central to Federal activity – more than $200 billion Policy has enormous impact and ongoing regulatory and payment reformsTRANSCRIPT
Quality/Cost Imperative Healthcare 2015 ACA Implementation
Divided Congress More Litigation Federal Subsidies Origination
Clause Continued Changes in the Law More Litigation Federal
Medicaid Expansion Payment Reforms Cost Containment Coverage Expa
sion Above $200 Billion in Healthcare Costs Exchanges Policy
Implications KL:Needs more balance, the smaller photos should be
bigger Full speed ahead on implementation, which will be daunting
Divided Congress = few/no significant changes Likely more
litigation Contraception, Federal exchange subsidies, Origination
clause, Others? Continual tweaking to the law Major action
(Medicaid expansion, payment reforms, exchanges, cost
containment)at the state level Coverage expansion continues to be
an area of change: Delay in implementation? Changes in subsidies,
Medicaid expansion, etc Healthcare is even more central to Federal
activity more than $200 billion Policy has enormous impact and
ongoing regulatory and payment reforms Financial imperative
Unsustainable Healthcare Spending
Based on projections by Peter Orzag at the Office of Management and
Budget (OMB), we are on an unsustainable path for healthcare
spending. Based on a study by the Congressional Budget Office, if
we continue on this path tax rates will have to increase for the
top bracket (around 35%) to 92% in 2050 in order to solely fund
healthcare spending. Source: CBO Financial imperative 1%
KL:Redo this take the text off the top. Recolor this too. Here is
another outlook. As you can see, currently the revenues from taxes
cover all non-discretionary spending. 1% SOURCE: Data from the
Government Accountability Office The Federal Governments Long-Term
Fiscal Outlook: January 2010 Update, alternative simulation using
Congressional Budget Office assumptions. Compiled by PGPF. NOTE:
Baseline interest rate is assumed to be 5.0 percent. Peter G.
Peterson Foundation Future of Medicare To further compound the
issue. Enrollment in Medicare is going to boom. With the baby
boomers coming into the system, CMS estimates it will receive on
average 10,000 new beneficiaries a day. Source: 2012 Annual Report
of the Boards of Trustees for the Federal Hospital Insurance and
Federal Supplementary Medical Insurance Trust Funds Digitization of
health care Operating from a source of truth
Disparate systems Accurate data Analyze, trend, insight Affect
change Visual of optimal world, you have to get to one, drop of
water visual Data Challenges How Many Ways Can You Say 3M?
THREEMis my Favorite Discovery with confidence
Identifying potential opportunities Price parity Contract
compliance Benchmarking Validation Engaging key stakeholders
Driving decisions Visual uncover, discover, analyze THEN validation
affecting change, providing context, data to back it up =
magnifying glass or better Art of managing the middle game
Volume-based Value-based Cuts to ExistingFFS System Cuts to
Medicare 30 Day readmissions penalty Market basket reductions Bad
debt cuts Nonpayment for anything preventable or unnecessary
Disrupt Existing System Bundled payments Innovation Center
Demonstrations ACOs KL:Volume and Value and the picture need to be
bigger, everything else in the background DL: Text from original
slide: Cuts to Existing FFS System Market basket reductions Bad
debt cuts Nonpayment for anything preventable or unnecessary
Disrupt Existing System Bundled Payments Innovation Center
Demonstrations ACOs Congress hedged its bets in crafting the reform
legislation. Created opportunity to experiment with models that
would disrupt the existing system such a bundled payments across
clinical conditions as well as ACOs that could be led by hospitals,
payers, or providers. But if these experiments are not sufficient
to bend cost curve, then legislation has mechanisms to continue to
cut payments in the existing system, including the creation of an
Independent Payment Advisory Board. This means our providers will
have a foot in both camps. They are going to live in a fee for
service world while they also try to innovate and reinvent the care
delivery model. DG from original slide: Track 1 Cuts to Medicare
FFS System 30 day readmissions penalty Penalty = 5x readmissions
payment Value based purchasing FY-15 - Efficiency measure: total
spending 3 days prior/30 days post Care coordination measures
Private Payors and Medicaid Bundled payment: 2016? Track 2 MSSP
Pioneer Flexible design; retro & prospective attribution
State/Federal duals demo State partnership; eased enrolling Medical
home demo; new CMMI Primary Care Initiative Reducing readmissions
from nursing homes demo Bundled payment demos 10 Key questions to
ask Right stuff, right price, right quantity,
Payment Transparency Resource Utilization EBP Leading Practices
Right stuff, right price, right quantity, right place, right way,
right time? Can you operate on Medicare margins? Are you tracking
and reporting, by DRG? Are your physicians and clinicians
accustomed to making data driven decisions based on evidence based
practice? Do you have real time data and resources to understand
how you map industry leading practice? Payment Question
Transperency Resource Utilization Evidence Based Practice Leading
Practices DG:Kathy I need a little more to go on to add photos
here. What are M/C margins? Are the questions correct? How do you
navigate the quality/cost maze?
Or I can use the graphic from the strategic initiatives deck I like
the coloring of this one better. Still looking for a better
graphic. Also need a bit more info on what text should be added.
Carole Gilroy, RN, MSN, MBA
Contact us Carole Gilroy, RN, MSN, MBA VP, Service Lead Cost
Management