1 / 15

Building a Sustainable Health Care System

Building a Sustainable Health Care System. Leslie A. Margolin President, Anthem Blue Cross UCI Health Care Forecast Conference February 20, 2009. What Defines Health Care Reform?. Insuring the Uninsured? Reducing Medical Inflation and Cost of Care? Improving Access to Care?

karli
Download Presentation

Building a Sustainable Health Care System

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Building a Sustainable Health Care System Leslie A. Margolin President, Anthem Blue Cross UCI Health Care Forecast Conference February 20, 2009

  2. What Defines Health Care Reform? • Insuring the Uninsured? • Reducing Medical Inflation and Cost of Care? • Improving Access to Care? • Improving Quality, Performance, Service? • Eliminating Waste? Improving Efficiency? • Better Communicating via Technology? • Reforming the Insurance Market? • Expanding (and Funding) Public Sector Programs? • Eliminating Health Disparities – ethnic, racial, gender- based, geographic? • Investing in Innovation?

  3. Clinical Outcomes Quality and Safety of Health Care Pharmaceutical Cost of Health Care Research Safety INTEGRATED RESEARCH NETWORK Sustainable Health Care System Accessible to All COLLABORATIVE OUTCOMES ARCHITECTURE Health Care Financing Insurance Market Reform Comparative Complex Clinical Effectiveness Cost - of - Care Building a Sustainable Health Care System When it comes to health care reform, we should get it right, not just get it done. • Quality & Safety: • Medical errors account for more than 32,000 deaths annually. • Antiquated, paper-based systems lead to inefficient and unnecessary care and expose patients to undue risk. • Need to promote evidence-based medicine, transparency initiatives and innovative health IT. • Cost: • 30% of health care spending goes toward redundant or inappropriate care. • Medical errors and drug safety events cost as much as $9B annually. • Need to encourage the right treatment at the right time in the right setting. • Insurance Market Reform: • Many Americans cannot obtain affordable coverage due to pre-existing conditions or cannot find coverage that meets their needs. • Need to promote innovative plans and products to meet the needs of consumers at every stage of life. • Financing • 46 million individuals, including over 6 million children, currently lack health insurance coverage. • Need to expand public programs, expand the employer-based system, and establish tax deductibility for individual coverage.

  4. Commitment to Physicians and HospitalsTotal Payments – WellPoint Significant increases in provider payments driving up premiums. * Source: WellPoint actuarial analysis of provider payments, December 2008. Due to data restrictions, population definitions vary by state, and in some states an element of reasonable approximation was used. * Note: NY, CO, NV data not currently available.

  5. Commitment to Physicians and HospitalsTotal Payments – Anthem Blue Cross Anthem Blue Cross Payment to CA Hospitals & Physicians

  6. Health Care Reform:Treating the Disease, Not the Symptoms As prices rise, private coverage decreases. Sources: WellPoint analysis of U.S. Census Bureau Current Population Survey statistics. (http://www.census.gov/hhes/www/cpstc/cps_table_creator.html). September 2008. Employer Benefits: 2008 Annual Survey. Kaiser Family Foundation. September 2008. (http://ehbs.kff.org/pdf/7790.pdf)

  7. Health Care Reform:Treating the disease, not the symptoms 7

  8. 2008 2007 2006 California Employment Status CA Employed Workforce • Unemployment 9.3% statewide; 9.9% in L.A. County, highest since 1994. • Nationally eliminated 3+ million jobs in 2008; January 2009 eliminated 600K more. • Particular weakness in construction, finance, real estate, and manufacturing. • LA and SF were the 2nd and 4th worst performing large cities in the US (June 08 YOY employment). • Lack of credit beginning to squeeze many small businesses; CA now has the lowest credit rating in the nation. • Consumer spending likely to slow further with continuing downturn in confidence. Loss of 246K jobs, or 1.4% of workforce Unemployment Rate: 5.0 5.3 5.6 5.9 6.2 7.0 7.4 7.7 4.9 The Conference Board announced that October 2008 consumer confidence dropped to 38, the lowest level on record (back to 1967), with the sharpest drop in 35 years.

  9. The Cornerstones • Quality & Safety: • Medical errors account for more than 32,000 deaths annually. • Antiquated, paper-based systems lead to inefficient and unnecessary care and expose patients to undue risk. • Need to promote evidence-based medicine, transparency initiatives and innovative health IT. • Insurance Market Reform: • Many Americans cannot obtain affordable coverage due to pre-existing conditions or cannot find coverage that meets their needs. • Need to promote innovative plans and products to meet the needs of consumers at every stage of life. • Cost: • 30% of health care spending goes toward redundant or inappropriate care. • Medical errors and drug safety events cost as much as $9B annually. • Need to encourage the right treatment at the right time in the right setting. • Financing • 46 million individuals, including over 6 million children, currently lack health insurance coverage. • Need to expand public programs, expand the employer-based system, and establish tax deductibility for individual coverage.

  10. Building a Sustainable Health Care System: Covering the Uninsured and Improving Coverage for All Americans • Improve and expand programs for the most needy • Provide a bridge to self-sufficiency through premium assistance • Expand the employer-based system • Equalize tax treatment for individuals purchasing coverage on their own • Increase funding for public-private partnerships Must enact financing strategies to place America on a sustainable path toward covering all of the uninsured:

  11. Building a Sustainable Health Care System • Plan to Address 45.7 M Uninsured Uninsured by Federal Poverty Level For the remaining 18% of uninsured who make over 300% FPL ($67k for family of 4), focus on expanding the employer-based system and designing attractive products Source: WellPoint analysis of U.S. Census Bureau Current Population Survey statistics. (http://www.census.gov/hhes/www/cpstc/cps_table_creator.html). September 2008.

  12. Participation in Public Programs Still need to correct this CIGNA.

  13. Plan Participation in High-Risk Graduate Program Tony/Ben: Can you give Leslie a sentence or two on the graduate program?

  14. Guaranteeing All Americans Access to Affordable Health Coverage • Approaches to Ensuring Everyone Can Access Affordable Coverage in the Individual Health Insurance Market

  15. Conclusion

More Related