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Executive Briefing Health Reform Implementation: What’s Ahead Scottsdale Institute Spring Conference April 27, 2011 Paul H. Keckley, Ph.D. Executive Director Deloitte Center for Health Solutions Washington DC . Health Reform: Executive Briefing Guy Carpenter Client Summit

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paul h keckley ph d executive director deloitte center for health solutions washington dc

Executive Briefing

Health Reform Implementation: What’s Ahead

Scottsdale Institute Spring Conference

April 27, 2011

Paul H. Keckley, Ph.D.

Executive Director

Deloitte Center for Health Solutions

Washington DC

Health Reform: Executive Briefing

Guy Carpenter Client Summit

Las Vegas, Nevada

April 14, 2011

Paul H. Keckley, Ph.D., Executive Director

Deloitte Center for Health Solutions

Washington, DC

ppaca timeline
PPACA timeline

Its implementation will span 5 election cycles and occur simultaneous with efforts to reduce the federal deficit, restore economic growth, and reduce unemployment

Economic recovery, Clinical Innovation, Demand

2010 - 2013

2017 +

2014 - 2016

Rules, Regulations & New Funding

Mandates, Pilots & Exchanges

“New Normal”

Insurance compliance: MLR, premiums, coverage

Coordination: state-federal governments, agencies

Rules, guidelines, task forces, agencies

Excise taxes—insurance, medical devices, drug companies

  • Individual mandate
  • Health exchanges
  • Employer pay or play
  • Demonstration/pilot programs:
  • Accountable care organizations
  • Value-based purchasing: FY 2013
  • Episode based payments: Jan. 2012
  • Medical home: Jan. 2011

Physician-hospital alignment

Industry convergence

Convergence: Public health & delivery system

Volume to value

ICD-10, Electronic Medical Record, Comparative Effectiveness implementation

structure intended delivery payment system changes
Structure: intended delivery, payment system changes
  • Delivery system changes
  • Increased linkage between performance (outcomes, costs) and payments/incentives
  • Increase integration of physicians, hospitals and long term care providers
  • Increased access to health services by under-served populations
  • Increased alignment of coverage with evidence
  • Insurance system changes
  • Elimination of pre-existing condition, lifetime and annual limits for insurance plans
  • Required coverage of preventive health services without co-payments
  • Creation of health insurance exchanges in each state to facilitate access to affordable insurance and manage subsidized purchases by individuals and employers
  • Federal-state regulation of insurance plan coverage, premiums, and medical expenditures

Consumerism

Preventive health, individual insurance, PHR

Primary Care 2.0

Home monitoring, retail medicine, LTC, medical homes, scope of practice expansion, health coaching

Comparative Effectiveness/EBM

Personalized medicine, bundled payments, provider adherence/performance-based payments liability reforms

Health Information Technology

EHR (HiTech), health information exchanges, fraud detectionadministrative simplification, clinical data ware-housing, ICD-10, direct to consumer e-medicine

implementation three boards will play key role lightning rods

CMS Center for Medicare and Medicaid Payment Innovation

Independent Payment Advisory Board (IPAB)

Patient-Centered Outcomes Research Institute (PCORI)

Implementation: three boards will play key role, lightning rods
  • Test innovative payment and service delivery models
  • Broad authority to determine what models will be tested, in what populations, and for how long, with a preference for models that address deficits in care leading to poor clinical outcomes or potentially avoidable expenditures
  • The purpose is to reduce the per capita rate of growth in Medicare spending
  • Operates independently of MedPAC
  • Recommendations take effect absent Congressional action
  • May recommend changes to Part D to generate required savings
  • Broad scope of research (drugs, devices, procedures, delivery system) with a focus on clinical effectiveness research
  • Findings are not coverage/ payment recommendations, but can be used by HHS to inform coverage

Patient-Centered Outcomes Research Trust Fund Created

CMS Payment Innovation Center Established

IPAB Begins to Propose Changes to Limit Medicare Spending

2010

2012

2013

2014

2011

the four big bets in health reform
The "four big bets" in health reform
  • Individual mandate: Will the uninsured and newly eligible for Medicaid enroll? Will the insured increase by 32 million as targeted? Or will only sicker, costlier enroll? Or the mandate thrown out??
  • Employer pay or play: Will employers drop health benefits after 2016 to facilitate direct consumer engagement and their reduce operating costs? Will their employees purchase through the exchanges, or go without?
  • State solvency: Will states be able to manage their expansion new responsibilities and obligations?
  • Delivery system consolidation: Will delivery system reforms-accountable care organizations, value-based purchasing, medical homes, bundled payments, comparative effectiveness-- reduce costs over time?
important themes
Important themes
  • Optics of error: transparency, valid and reliable metrics substantially accessible
  • Market structure:consolidation in provider, plan sectors driving
  • Margin pressures pervasive: quest for sustainability might drive bad behavior
  • Data granularity: clinical-administrative clinical data warehousing and applied analytics
  • Integrated connectivity:crosswalks to LTC, ambulatory add complexity
  • Climate of fairness:public disaffection for "excess profit" in health care
contact information
Contact information
  • For more information, please contact:
  • Paul H. Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutionspkeckley@deloitte.com202-220-2150
  • And visit our website to subscribe to our content:www.deloitte.com/CenterforHealthSolutions/subscribe