Transcript New Models of Care

Patient Protection and Affordable
Care Act (ACA)
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Individual mandate (2014)
State insurance exchanges
Expansion of Medicaid program
Changes to private insurance
Employer requirements mandates
Medicare changes
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Untruthful Assertions
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Cuts Medicare by $1000 per person
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Both ACA and the Ryan plan reduce increases in
spending in the future by over $700 billion over
10 years
Establishes death panels
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Payment to physicians for holding advance care
planning discussions was cut from the Act
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U.S. spending much more for older ages
Source: Fischbeck, Paul. “US-Europe Comparisons of Health Risk for
Specific Gender-Age Groups.” Carnegie Mellon University; September,
2009.
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Medicare
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Reduce payments to Medicare Advantage
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MA plans were paid 113% of FFS
Some bonuses for high quality programs
Balance payments to high/low areas
Establishes an “Independent Payment
Advisory Board”
Early donut hole relief – eventual elimination
Coverage for prevention services
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Independent Payment Advisory Board
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Recommend cost savings
Produce public reports – access, quality, costs
Make recommendations to President and
Congress
Prohibited from “rationing” or “changing
benefits or eligibility” or “Medicare
premiums”
Hospitals and hospices not subject to
recommendations until 2019
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Donut Hole Relief 2011
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$250 rebate
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255, 996 FL seniors received the rebate
Total amount to FL seniors - $63,999,000
Part D coverage gap discounts
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252,989
Ave. per senior - $600
Total amount - $151, 807,700
Kff.org, 1/7/13
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Prevention & Wellness in FL
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Free preventive services
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1,662,014 FL seniors received free services
70% of FL Part B enrollees (65.5% US)
Annual wellness visit
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151,133 FL seniors had an annual wellness visit
6.9% of FL Part B enrollees (5.4% US)
Kff.org, 1/7/13
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Older Adult Workforce
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Funds Geriatric Education Centers
Expand Geriatric Academic Career Award to
other disciplines (nursing, pharmacy, etc.)
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New Geriatrics Career Incentive Award
Advanced training opportunities
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Professionals
Direct care workers
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Elder Justice
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Create an Elder Justice Coordinating Council
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Report published in May 2013
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http://www.aoa.gov/AoA_programs/Elder_Rights/EJCC/
Meetings/docs/2013_05_13_EJCC-Proposals.pdf
$400 million for Adult Protective Services
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$100 million for state demonstration grants
$26 million to create Elder Abuse, Neglect
and Exploitation Forensic Centers
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New Models of Care
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Innovation Center at CMS
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Foster patient-centered care & coordination
Models
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Accountable Care Organizations
Bundled payments
Medicare Coordinated Care
Partnerships for patients
Comprehensive Primary Care
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Problems with Medical Payments
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Fee-for-service
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Provider (not the consumer) decides what is
needed
Insurance (not the consumer) pays the fees
Provider is incentivized to do more
Capitation (“by the head”)
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Insurer decides what is needed
Insurer pays provider regardless of use
Provider is incentivized to do less
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Accountable Care Organizations (ACO)
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An organization of physicians and hospitals
that agree to cost and quality targets
Strong primary care base
Payment is linked to quality (instead of
volume)
Savings are achieved through improvements
in care
Savings are shared between providers and
CMS
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Bundled Payments
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“Bundling” expenses that used to be separate
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Hospital admission and after care
Surgery and a “warranty”
Considerations
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Hard to predict costs
Difficult cases may be avoided
Doesn’t discourage unnecessary care
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Medicare Coordinated Care
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Funds coordinated care for people with
chronic conditions
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Face-to-face meetings with client
Helped with medications
Facilitated communications (“hub”)
Helped with transitions
8%-33% reduction in hospitalizations
Cost neutral
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Comprehensive Primary Care
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4 states (OR, CO, AK, NY)
Components
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Risk adjustment
Access and continuity
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Non-visit services & fees
Planned care for chronic conditions
Patient and caregiver engagement
Coordination od care
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Partnerships for Patients
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Reduce hospital-acquired conditions and
readmissions
Elements
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Hospital Engagement Networks (TMH)
Care Transitions (5 sites in FL)
Patient and family engagement
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Provides resources to health care providers to better
educate staff and patients/families
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Elephant in the Room - LTC
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Nursing homes - $100,000/year
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Low satisfaction
CLASS act – (part of ACA) – would have
established a national LTC insurance
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Many become impoverished and go on Medicaid
Dropped by Democrats
Are some interesting new models
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Eden Alternative, Greenhouse Model
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1 – Affordability & Access - 35
2 – Choice of setting & provider - 41
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4 – Support of family caregivers - 40
5 – Effective transitions - 14
3 – Quality of life & quality of care - 43
State Scorecard on LTSS Commonwealth/AARP 2014
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Few Good Things in LTSS in ACA
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National panel of LTC experts
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Report issued Sept. 2013
Funding for LTC Ombudsman Program
Funding for LTC training and recruitment
Nursing home transparency
Some financing options
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Money follows the person
Home health and HCBS
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Nursing Home Transparency
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Disclose ownership, financers, etc.
Take steps to reduce violations
Establish quality assurance programs
Provide dementia care training
Data collection requirements
Pilot program – extend to all states a national
criminal background check system
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Good Resources
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Kaiser Family Foundation
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CMS Innovation Center
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http://www.edenalt.org
Greenhouse Project
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http://innovation.cms.gov/initiatives/#views=models
Eden Alternative
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http://kff.org
http://thegreenhouseproject.org
Autumn Blossoms
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http://autumnblossoms.org
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