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What We Really Need to Know about Economic Dynamics Affecting Healthcare Reform

Join expert panelists as they discuss the key economic factors affecting healthcare reform, including uninsured and underinsured populations, charity care and bad debt, emergency medicine, and managing population risk.

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What We Really Need to Know about Economic Dynamics Affecting Healthcare Reform

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  1. What We Really Need to Know about Economic Dynamics Affecting Healthcare Reform Panelists: Gerald Kominski, PhD, UCLA Center for Health Policy Research Tom Priselac, CEO, Cedars-Sinai Health System Walter Zelman, PhD, Chair, Department of Public Health, CSULA Moderator: Steven Blake, FHFMA, CPA, Executive VP & CFO Integrated Healthcare Holdings, Inc.

  2. Uninsured and Underinsured • Health Care Reform • Charity Care and Bad Debt • Emergency Medicine • Managing Population Risk • California Health Benefits Exchange • Funding for Undocumented Patients • Dual Eligible • Eligibility Assistance [MEP] • Bundled Payment Demonstration Projects • MediCal DRG Payments • Federal Medicaid Matching Program • IT-Meaningful Use

  3. Key Elements of Health Reform • Medicaid expansion: all up to 138% fpl • Exchanges and subsidies (to 400% fpl) • Requirements to purchase insurance • Insurance reforms • Pre-existing conditions; experience rating • Incentives to train Primary care doctors and pay them more • Incentives to move towards ACOs; payment reform; lower cost, higher quality

  4. System Integration: Projection

  5. FEE FOR SERVICE Insurance AdministrationProfits 20¢ Hospital 40¢ Specialists 30¢ Primary Care 10¢ The Politics of the IDSWho Gets What, When, Why and How?Redistributing the Premium Dollar FULL RISK IDS Insurance AdministrationProfits 20¢ ToInsurer /HMO or IDS Hospital 25¢ Specialists 15¢ Primary Care 15¢ ______?_____ 25¢ ? = Who Gets the 25¢ Adopted from Source: Jacque Sokolov, Inc.

  6. Value of Coordination Wide choice of MDs and less Of a team coordination approach 48% More limited selection of MDs and emphasis on team coordination between MDs 47%

  7. Physician Strategic OptionsSeeking Control • Form, join physician-sponsored HMO • Join, merge with larger primary care or multi-specialty group: seek capitation • Affiliate with organized delivery system • Large medical group • Health plan • Hospital system • Promote direct contracting: bypass insurer or form medical group capable of accepting risk

  8. Core Strategies in the New Marketplace • Enhance market power --Choose partners, consolidate • Increase capacity to accept capitation: Secure ties to primary care providers • Expand services, options, coverage area • Increase efficiency, lower costs • Secure access to capital • Improve clinical performance (and prove it)

  9. Volume of Information Available Rumor Isolated Event: Meaningful? Anecdote A Few Related Stories Rigorous Case Study Systematic Analysis Recent Modern Market Analysis (Health Care) Type of Analysis or Information

  10. Uninsured and Underinsured • Health Care Reform • Charity Care and Bad Debt • Emergency Medicine • Managing Population Risk • California Health Benefits Exchange • Funding for Undocumented Patients • Dual Eligible • Eligibility Assistance [MEP] • Bundled Payment Demonstration Projects • MediCal DRG Payments • Federal Medicaid Matching Program • IT-Meaningful Use

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