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Understanding Health Reform

Understanding Health Reform. Health Care Foundation of Greater Kansas City. History of HCF Our Mission Target Population Area Served. HCF’s Grantmaking. $18 million in 2011 Funding Areas Safety Net Healthcare Healthy Lifestyles Mental Health Applicant Defined Grants Initiatives.

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Understanding Health Reform

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  1. Understanding Health Reform

  2. Health Care Foundation of Greater Kansas City • History of HCF • Our Mission • Target Population • Area Served

  3. HCF’s Grantmaking • $18 million in 2011 • Funding Areas • Safety Net Healthcare • Healthy Lifestyles • Mental Health • Applicant Defined Grants • Initiatives

  4. What is health insurance?

  5. Before Insurance • Medical care was purchased on an as-needed basis • Fees were based on services provided

  6. Started as a Way to Protect Workers • A firm arose in 1850 to offer accident protection to workers in particularly dangerous professions

  7. Evolution of a health system “Accident” insurance for those in dangerous professions

  8. Workers Began Organizing Themselves • In 1887, African-American workers at a coal plant in Iowa create a mutual protection society • $.50 per month for an individual or $1.00 per family

  9. Evolution of a health system Mutual Protection Societies “Accident” insurance for those in dangerous professions

  10. Companies Begin Offering Insurance to Employees • 1911: first employer-sponsored policy • Group disability policy

  11. Evolution of a health system Companies provide insurance Mutual Protection Societies “Accident” insurance for those in dangerous professions

  12. A Marketplace is Born! • In the late 1800s, commercial insurance companies are born

  13. Evolution of a health system Companies provide insurance Mutual Protection Societies Open marketplace “Accident” insurance for those in dangerous professions

  14. Everyone Wants In • Hospitals and physicians groups begin offering prepaid care plans in the early 1900s • Local hospitals (Blue Cross) and local physician groups (Blue Shield) offered services, rather than reimbursements

  15. Evolution of a health system Pre-paid plans Companies provide insurance Mutual Protection Societies Open marketplace “Accident” insurance for those in dangerous professions

  16. HMOs • Henry Kaiser ran a shipyard in California • He arranged a deal with local hospitals and clinics to provide care at reduced rates in exchange for being the sole source of care

  17. Evolution of a health system Pre-paid plans HMOs Companies provide insurance Mutual Protection Societies Open marketplace “Accident” insurance for those in dangerous professions

  18. World War II • Strict wage and price controls • Employer-sponsored insurance expanded dramatically • Benefits were taxable until 1954

  19. Evolution of a health system Pre-paid plans HMOs Companies provide insurance Mutual Protection Societies Open marketplace “Accident” insurance for those in dangerous professions

  20. Evolution of a health system Pre-paid plans HMOs Companies provide insurance Mutual Protection Societies Open marketplace “Accident” insurance for those in dangerous professions

  21. Evolution of a health system Pre-paid plans HMOs Companies provide insurance Uninsured Mutual Protection Societies Open marketplace “Accident” insurance for those in dangerous professions

  22. What do we think of this “system”? Pre-paid plans HMOs Companies provide insurance Uninsured Mutual Protection Societies Open marketplace “Accident” insurance for those in dangerous professions

  23. What is a “system”? • Interstate highway system • Named after Dwight D. Eisenhower • Largest public works program in history • Idea came from German autobahn

  24. What is a “system”? • Standards • Speed limits • Horizontal, vertical, and tunnel clearance • Bridge strength • Kansas was the first state to get started

  25. We don’t have a health system • No logical connection between components • No central manager, but also no true marketplace • No one is making sure we get our money’s worth • People aren’t getting the right care at the right time at the right place

  26. We need to turn this… Pre-paid plans HMOs Companies provide insurance Uninsured Mutual Protection Societies Open marketplace “Accident” insurance for those in dangerous professions

  27. Into this Uninsured Medicaid and Medicare for those who need it Well-regulated, affordable individual market Employer-sponsored insurance

  28. We spend a lot of money. Average spending on healthper capita ($US PPP) Total expenditures on healthas percent of GDP

  29. Health Care Expenditure per Capita by Source of Funding, 2007Adjusted for Differences in Cost of Living

  30. We spend a lot of money.

  31. We spend a lot of money.

  32. Mortality Amenable to Health Care And we don’t get enough in return. Deaths per 100,000 population*

  33. Mortality Amenable to Health Care Mortality Amendable to Health Care, by State Deaths per 100,000 population*

  34. Life Expectancy at Birth, 2007

  35. Total Spending for Health Care, as a % of GDP It’s Time to Deal with This Challenge

  36. We Need a Bargain Shopper • Without someone wrapping their arms around this “system,” we don’t get what we pay for. • Nothing is free

  37. U.S. Health System

  38. High Performance Health System

  39. Community Survey on Health Reform • Phone Survey • 403 registered voters in the Kansas City metropolitan area • Fielded in July 2010

  40. The Status Quo is Not Acceptable • Only 7% saw no need for change in the health care system.

  41. Initial Impressions of “Health Reform”

  42. But… • Many respondents were supportive of specific elements

  43. Change in Opinions After Brief Education • After being exposed to these elements of health reforms, respondents were again asked their opinion • Beginning of survey: 34% favorable • End of survey: 45% favorable • This is a 32% increase

  44. Patient Protection and Affordable Care Act • A platform for change • Seeks to move us toward a system • We can pay less and get more

  45. Current Source of Coverage, U.S. Medicare (12%) Employer Sponsored Insurance (49%) Individual (5%) Uninsured (17%) Medicaid (16%)

  46. Small business tax credits • Early retiree insurance • Wellness program grants • Employer mandate (exempts business < 50) Employer Sponsored Insurance (49%)

  47. Current Source of Coverage, U.S. Medicare (12%) Employer Sponsored Insurance (49%) Individual (5%) Uninsured (17%) Medicaid (16%)

  48. Review of Health Plan Premium Increases • Dependent Coverage to Age 26 • No Recissions Employer Sponsored Insurance (49%) Individual (5%) • Coverage of Preventive Benefits • Minimum Medical Loss Ratio for Insurers

  49. Current Source of Coverage, U.S. Medicare (12%) Employer Sponsored Insurance (49%) Individual (5%) Uninsured (17%) Medicaid (16%)

  50. Medicare (12%) • Changes in Provider Rates • Medicare Beneficiary Drug Rebate • Payments for Primary Care • Prevention Benefits • Medicare Advantage Payment Changes • Bonuses to High-Performing Medicare Advantage Plans • Value-Based Purchasing • Reduced Payments for Hospital Readmissions

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