Healthcare Reform. North Carolina Dietetic Association September 12, Duke Medicine

Transcription

1 Healthcare Reform North Carolina Dietetic Association September 12, 2014

2 Take home messages Healthcare [and health insurance] is transforming at an accelerating pace Key metrics of concern relate to quality, consumers experience/engagement, access, and cost If you re not at the table, you re on the menu. -Michael Enzi

3 Key features of the ACA [health insurance reform] Guaranteed issue everyone who applies must be accepted Individual mandate, with weak penalty Modified community rating with limited rating factors (age, gender) No health underwriting/no pre-existing Established Exchanges/Marketplace Premium and cost-sharing subsidies (for individual coverage only and only on Exchange) State option for Medicaid expansion (SCOTUS)

4 Key features of the ACA [health insurance reform] (2) Preventive care coverage USPSTF Grade A or B recommendations Offer or refer to intensive behavioral counselling interventions to promote a healthful diet and physical activity. Grade: B Kaiser Family Foundation, April, 2013 USPSTF, August 2014

5 Medicaid Expansion, March 2014 WA VT NH ME AK HI OR CA NV ID UT AZ MT WY CO NM ND SD NE KS OK MN IA MO AR WI IL MS NY MI PA OH IN WV VA KY NC TN SC GA AL NJ DE MD DC MA RI CT TX LA Expanding (22 states + D.C.) FL Expanding with variation (4 states) Options under discussion (5 states) Not expanding (19 states) Note: The Centers for Medicare and Medicaid Services (CMS) has approved waivers for expansion with variation in Arkansas, Iowa, and Michigan. Pennsylvania s waiver is currently under review by CMS. Source: Avalere State Reform Insights; Center of Budget and Policy Priorities; Politico.com; Commonwealth Fund analysis.

6 Use, prior affordability of care with ACA plans Have you used your new health insurance plan to visit a doctor, hospital, or other health care provider, or to pay for prescription drugs? Prior to getting your new health insurance plan, would you have been able to access and/or afford this care? No 34% Yes 60% No 62% Yes 36% Plan has not yet gone into effect 6% Adults ages who selected a private plan or enrolled in Medicaid through the marketplace or have had Medicaid for less than 1 year Note: Segments may not sum to 100 percent because of rounding. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, April June Don t know or refused 2% Adults ages who have used new health insurance plan

7 Health Risks of New Enrollees (Early Indications) More chronic conditions than non-aca customers Enrollees with chronic conditions diabetes, depression, asthma, arthritis, cancers, heart disease cost six times more than enrollees of similar age without chronic conditions Significant, because insurers can no longer rate a person differently because of health status Higher use of health care services than non-aca customer population More Primary Care and Specialist visits More In-Patient Admissions and requests for Advanced Imaging Seeking prescription drugs for chronic conditions Diabetes, mental health and mood disorders, Multiple Sclerosis, HIV, infectious hepatitis Source: Blue Cross and Blue Shield of North Carolina, July

8 Where we are: U.S. health care spending at 18% of GDP and climbing 75% of healthcare costs related to chronic conditions Life expectancy 38 th in the world-70% of deaths due to chronic conditions Nearly half of US adults live with at least one chronic condition Only 55% of needed care is delivered SOURCES: Health Affairs; United Nations World Population Prospects; CDC; McGlynn 8

9 Obesity Rates, 2013 NC= 29.4% Trust for America s Health, 2014

10 Healthcare Reform- Emerging approaches [payers] Bridging from current fee-for-service to value-based payment Patient-centered medical homes Accountable care organizations (ACOs)/ population health Episodic bundled payments, outpatient prospective payments Limited and/or tiered networks [and formularies] Transparency, consumerism and self-management On-line and digital care Alternative providers of care Joint ventures with providers 10

11 NCQA-recognized PCMH Practices in North Carolina April, 2013 CCNC, April 2013

12 Proportion of lives in ACOs 2014

13 Transparency and consumerism in healthcare o People seeking health information online and on mobile devices has more than doubled in the past decade- 80% have a cell phone o o o o check provider reviews, costs, or ratings validate doctor recommendations Find a provider, e.g. urgent care Prescription drug information o Benefits and claims status 13

14 *Pre-visit data sharing, risk stratification with payer *Wi-fi home monitoring of weight, activity, blood glucose, blood pressure *E-visits *Video consultations *Point of decision finger stick lab *Automated quality and performance reporting * MD, PA, RDN, MSW, CSP team care

15 Expanding horizons

16 Take home messages Healthcare [and health insurance] is transforming at an accelerating pace Key metrics of concern relate to quality, consumers experience/engagement, access, and cost If you re not at the table, you re on the menu. -Michael Enzi

17 References Healthcare Reform Summary- Kaiser Family Foundation, April 23, / pdf USPSTF, August nutrition recommendation dhighrisk/cvdhighrisksumm.pdf CCNC, April 2013 PCMH growth /