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Colorado Health Care 2014 Legislative Agenda

Colorado Health Care 2014 Legislative Agenda. Senator Irene Aguilar, MD. IOM: Best Care at Lower Cost. 7.2%. 9.8%. INSTITUTE OF MEDICINE 2012: US Health Care Annual Waste $ 765 Billion. 27.5%. 24.8%. 17%. 13.7%. Variations Among Academic Medical Centers. Senate Bill 16: Context.

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Colorado Health Care 2014 Legislative Agenda

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  1. Colorado Health Care 2014 Legislative Agenda Senator Irene Aguilar, MD

  2. IOM: Best Care at Lower Cost 7.2% 9.8% INSTITUTE OF MEDICINE 2012: US Health Care Annual Waste $ 765 Billion 27.5% 24.8% 17% 13.7%

  3. Variations Among Academic Medical Centers

  4. Senate Bill 16: Context • EMTALA: Emergency Medical Treatment & Labor Act • CMS: Center for Medicaid and Medicare Services • Emergency Medical Care: ambulances, surgeons, cardiologists, operating rooms, hospitalization • Facility Fee: Supplemental payment to support the full spectrum of emergency medical care • Cost shifting inpatient costs to consumers of the ED • Medicaid, Medicare & TriCare do not pay this to FSEDs

  5. A tale of two business models Panorama Orthopedics, Golden, CO First Choice Emergency Center Arvada, CO

  6. Market Principles and Health Care • Consumers bear the cost of what they consume • Only 20% of Coloradans have high deductible plans • 80% pay Copayment only for Emergency Care • Consumers have transparent information and make an informed choice on the purchased service • Most consumers do not recognize the difference between urgent care and emergency care facilities • Insurers do not have a choice – must pay emergency bills • Limited financial or regulatory barriers that prevent new suppliers from entering the market

  7. Cost of Insurance • Based on actuarial analysis of the health of the population, the cost of the services provided and frequency of use • Oregon Experiment: 40% more ER visits • Geographic Region 11: Higher costs of services October 2012 – September 2013 One Insurer’s Data

  8. EMERGENCY or URGENT ? • 59% of visits were for non-emergency care: • Allergic reactions including dermatitis and Hives • Headaches, Back Pain, Sciatica • Viral Infections, Strep Throat, Nausea • 16% of visits were for conditions that might have needed immediate access to specialists • Require transfer by ambulance to a hospital FSED Testimony on Patient Visits

  9. Freestanding Emergency Rooms H O 2 U 0 S 0 T 4 O N

  10. Freestanding Emergency Rooms H O 2 U 0 S 1 T 4 O N

  11. CO SPRINGS: Freestanding Emergency Room

  12. ARVADA: Freestanding Emergency Room

  13. Which would you choose?

  14. Which would you choose? Jaguar XF Starting Price: $46,975 Hyundai Elantra Starting Price: $17,200

  15. Determinants of Health 2011 U.S. Healthcare Spending: $2.7 Trillion

  16. Table 2: Estimate of ACA Effect, 2016 → → → Source: Dr. Jonathan Gruber’s analysis for the Colorado Health Benefit Exchange, 2011

  17. 22% 39% 29% 10% Dr. Jonathan Gruber 9/16/11

  18. Figure 4. Share of Colorado population without health insurance coverage, alternative funding programs, 2015-24.

  19. Cooperative would put Colorado on sustainable path: Spending growing no faster than the GSP Savings grow by “bending the cost curve” by reducing administrative share and restraining drug price inflation

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