Health Reform: An Environmental Overview

Jon Fishpaw, VP, Advocacy & Government Relations Catholic Health Partners May 18, 2011

An Important First Step While not perfect, the legislation represents an important first step in helping ensure Americans have access to quality healthcare, and we are encouraged by the inclusion of numerous global provisions in the legislation that: • Covers 32 million uninsured and prohibits denials for pre-existing conditions; • Provides funding for workforce development and related job training; • Implements a series of insurance and delivery system reforms; and • Provides incentives for health and wellness.

More Work Needed for Systemic Reform CHP believes much work remains to be done on reforming the reimbursement model in order to incentivize hospitals and others that are consistently providing high quality care at the greatest value to payers. We are also disappointed that lawmakers didn't seize this historic opportunity to align payment incentives, and we'll continue to lead by example and advocate for aligned incentives so that we can control the growing costs of healthcare.

Implementation and Changes Over Time

States

Attorneys General have filed suit against federal government on Constitutionality, and potential Supreme Court decision. Added fiscal pressures due to one-half of newly insured on Medicaid & 133% of FPL new floor for Medicaid eligibility.

Federal Bureaucracy

HHS Secretary is central actor to rule-making and regulatory oversight new federal legislation to follow.

Elections

2012, 2014 mid-terms, and 2016 Presidential elections.

Healthcare Reform Implementation Timeline

Healthcare Reform Implementation Timeline

Healthcare Reform Implementation Timeline

Healthcare Reform Implementation Timeline

Healthcare Reform Implementation Timeline

Barriers to Overcome In addition to new rule-making authority and regulatory oversight for providers and employers, there are issues that remain unaddressed … • Numerous sections of ACA are authorized, but not appropriated.

• CBO projects 22M+ Americans will remain without coverage by 2019.

• Beginning in 2014, 16 of 32 million newly insured to be covered by Medicaid, placing further constraints on state budgets.

• Systemic program payment reform, including physician payment.

Opportunities & Challenges

Opportunities

Expanded coverage to 32 million uninsured Linking payment to quality Greater physician alignment & integration Pilot Programs & innovative care solutions Limitations on specialty hospitals

Challenges

Cuts before Coverage Planning Cost containment Employer health insurance provisions Increased regulation

The Road Ahead An incremental, collaborative approach will help address provider, employer and community provisions… Title I.

Title II. Title III.

Title IV.

Title V.

Title VI.

Title VII. Title VIII. Title IX.

Quality, Affordable Health Care for All Americans Role of Public Programs Improving the Quality and Efficiency of Healthcare Chronic Disease Prevention / Improving Public Health Health Care Work Force Transparency and Program Integrity Improving Access to Innovative Medical Therapies Community Living Assistance Services and Supports Revenue Provisions

Four Steps to Considering the Elements

Preparation

Establishment of clear stakeholder groups to understand timing and impact of provisions.

Pilot / Demonstrations / Grant Funding

Identifying the universe of opportunities.

Rule Making

Shifting external federal focus to executive branch of government.

Strategy

Linking reform provisions to current and tangible initiatives.

Integrating Reform with Top Priorities 1. Ambulatory Transformation: • ACOs • Medical Homes • Physician Employment and Alignment 2. Inpatient Transformation: • Increase Quality • Lower Cost • Full Transparency 3. Clinical Information Transformation: • Epic (EMR) • Health Information Exchanges

Medical Home: One Example of Reform Integration Source: Advisory Board

Questions?

Jon Fishpaw VP, Advocacy & Government Relations Catholic Health Partners [email protected]

513.639.0136