Healthcare Reform: Implications for Health Delivery. Discussion Notes June 2010. EXECUTIVE SUMMARY. The healthcare reform law – summary. The CBO estimates roughly 32 million additional Americans will have health insurance by 2019.
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Public program expansion
Waste, fraud & abuse
U.S. citizens will be required to be enrolled in “minimum essential coverage” starting in January 2014.
Health reform establishes a minimum standard for health insurance coverage in 2014 to address the needs of the individual and small group market segments.
The law makes changes to provider reimbursement and establishes programs under Medicare and Medicaid to encourage new payment models that stress accountability across the spectrum of care.
Starting in October 2012, a portion of a hospital’s Medicare reimbursement will now be tied to actual performance on quality and efficiency measures.
The government has specifically targeted spending on preventable hospital readmissions and hospital acquired conditions as key areas for payment reductions.
Reductions to DRG payment amounts will add up quickly.
1Between .99 and 1.00 in FY13; between .98 and 1.00 in FY14; between .97 and 1.00 in FY15 and beyond
21% in FY13; 1.25% in FY14; 1.5% in FY15; 1.75% in FY16; 2% in FY17 and beyond
3Based on hospital’ performance score under VBP program
The CBO estimates that the individual mandate and expansion in Medicaid eligibility will result in roughly 18 million newly-insured Americans in 2014 alone -- and an additional 11 million in 2015 and 2016.
Projected Number of Non-Elderly Adults Without Health Insurance in the U.S., 2011-2019
Source: CBO.gov, March 20, 2010
Combating Waste, Fraud, and Abuse (WFA)
The law includes provisions to fight fraud and improve the program integrity of Medicare, Medicaid, and CHIP.
Health reform will standardize administrative transactions and the implementation of operating rules in an effort to improve interoperability.
Other Provisions to Improve Quality and Access to Care
The Massachusetts Plan
The national health reform law is very similar to the one passed by Massachusetts in 2006.
Key Findings from Massachusetts
Although almost all residents in Massachusetts now have health insurance, the increase in demand has strained capacity.
For more information on the Massachusetts experience : http://assets1.csc.com/health_services/downloads/CSC_Health_Insurance_Reform_in_Massachusetts.pdf
Implications/Advice to Clients: Health Delivery OrganizationsHealth Delivery Implications
The most obvious impact of health reform is 32 million more people seeking care
Implications/Advice to Clients: Health Delivery Organizations
Health Delivery Implications“Savings” in Medicare = cuts in reimbursement
Implications/Advice to Clients: Health Delivery OrganizationsQuality performance has a potentially much larger impact on reimbursement than the market basket and productivity adjustments.
Health Delivery Implications
Implications/Advice to Clients: Health Delivery OrganizationsThe net for health delivery
Health Delivery Implications
Implications/Advice to Clients: Health Delivery OrganizationsAdvice to Health Delivery Organizations-Immediate Actions
Implications/Advice to Clients: Health Delivery OrganizationsExpand your thinking of your role for the longer term
Advice to Health Delivery Organizations