Presentation made by Dr. Carolyn A. (Cindy) Watts on the 5th of November, 2012 during the live webinar hosted by VCU Department of Gerontology (discussion moderated by Dr E. Ayn Welleford) - review recording of webinar at http://www.alzpossible.org/wordpress-3.1.4/wordpress/alliedhealth/
1. Looking into the
Crystal Ball of Health Care Reform:
Patient Protection and Affordable
Care Act (PPACA)
and the Allied Health Professions
Carolyn Watts, Ph.D.
Professor and Chair
Department of Health Administration, Virginia Commonwealth University
3. Primary Question:
Is Health Care a “Social Good”?
YES for elderly, certain
YES for most
low income
Americans
NO individuals, disabled
1965 2014
4. Financing Context
$8300/person
Mixed public/private
50%
17%
of GDP (in 2009)
Medicare Medicaid Employers Uninsured
15% 20% 67% 18%
of population of population of non-elderly of population
Up to 2/3 of all births
5. Delivery System Context
Volume-
based
payment
Illness
– not
health –
based care
Decades
of
profession
al control
6. Proposed
by 6
presidents
Crowd-out of
Rising un-
other public
programs employment
Pressure
for
Reform
Rising
Increasing enrollment in
expenditures public
programs
Fragile state
of delivery
system
7. Cost as % of
income at all Global
time high business
• 12.6% in 1996 disadvantage
• 23.2% in 2010
Approaching
Changing
national debt
demographics
cliff
More
Pressures
10. Health Care Reform: PPACA
Individual Employer
mandates responsibility
• Subsidies • Tax credits
• Fines • Fines
11. PPACA
• Limits on underwriting and exclusions
• Older dependent children coverage
Insurance
rules • 2018: tax on first dollar coverage
• “Expedia” for private insurance
Exchanges
• States or federal government (default)
12. PPACA
• Eliminate categories; 133% FPL
• Federal government pays 100% for 3
Medicaid years
expansion
• “Donut Hole”
• Preventive services
Medicare • Provider payment reductions
payment cuts;
benefit increases • Increases in Medicare payroll tax
13. PPACA
• Accountable Care Organizations
Delivery and
• Bundled payment
payment
demonstrations
• Innovation Center
• Incentives for employers
Wellness
• Mandated coverage of prevention
14. PPACA: Myths
All Americans must have
coverage
Exemptions for:
• Very low income
• Insurance costs > 8% of income
• Religious
beliefs, incarceration, Native
Americans
15. PPACA: Myths
Everyone must have the
same coverage
• Essential benefit package as floor
• Choices through
employer/exchange
16. PPACA: More Myths
All businesses must provide
coverage
• Small businesses (< 50 employees) exempt
• = 96% of 6M businesses
• 96% of other businesses already do
• 10,000 businesses (.2%) will be affected
17. …and More Myths
Government will take over
insurance
• MUST contract with at least 2
private insurance companies in
every US market
18. …and More Myths
Medicare benefits will be
drastically cut
• Increases for traditional Medicare
• Drug coverage
• Preventive services
• Reduced payments for Medicare
HMOs
19. …Still More Myths
“Death Panels” will limit care
provided
• Funding of new evidence base, but CMS
prohibited from using it
• Pres. G.W. Bush-era legislation allows
coverage of integrated advance planning
• Independent coverage of advance planning
taken out of PPACA
20. So Far….
54M Saved $3.7B on
3M
Young adults
$321M
Insurance rebates to small
54M
People got newly
drugs
seniors new dependent businesses (more to big free preventive
coverage business) services
21. Evolving government
role
Evolving employer role
Future
Evolving insurance
markets
Evolving delivery
system
Evolving consumer role
Evolving technology
22. Future
Evolving
government role
Impact of States and Medicare
elections Medicaid payment/rules
23. Future
Evolving employer
role
Insurance
What if they Wellness
coverage and
drop coverage? programs
benefit changes
Harvard study: $3.72 HC
Value-based insurance So savings, $2.73 absenteeism
design what? savings from $1 wellness
program
24. Future
Evolving insurance
markets
Provider
Integration Impact of
Consolidation payment
with providers exchanges
changes
25. Future
Evolving delivery
system
Consolidation
Physician Scope of Retail
and Transparency
employment practice medicine
integration
27. Future
Evolving
technology
Genetic New
Robotics Telemedicine E-medicine
medicine pharmaceuticals
28. What are the Opportunities for Allied Health?
Greater
demand
Different
Expanding
payment
Medicaid (?)
models
OPPORTUNITIES
for ALLIED
HEALTH
More Evolving
consumer scope of
engagement practice
Team-based
medicine
29. What are the Challenges for Allied Health?
Different
Lower
payment
payment rates
models
More
concentrated
Shrinking
interests
Medicaid (?)
(payers, syste
ms)
CHALLENGES
