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Why Health Care Reform Should Matter to You

Why Health Care Reform Should Matter to You. Preparing for practice in an evolving health care system. The Status quo of the U.S. health care system. A Typical Month of Health Care in the United States.

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Why Health Care Reform Should Matter to You

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  1. Why Health Care Reform Should Matter to You Preparing for practice in an evolving health care system

  2. The Status quo of the U.S. health care system

  3. A Typical Month of Health Care in the United States Adapted from Green LA, Fryer GE, Yawn BP, Lanier D, Dovey SM. The ecology of medical care revisited. N Engl J Med 2001;344:2021-5.

  4. Current U.S. Health Care System • A non-system • Uncoordinated • Fragmented care • Emphasizes intervention, rather than prevention and comprehensive management of health • Unsustainable costs that are rapidly increasing • Access is declining • Quality is far from ideal Source: Health care for all: a framework for moving to a primary care-based health care system in the United States. American Academy of Family Physicians, 2008. Accessed August 30, 2013.

  5. What a “healthy” health care system would look like

  6. Triple Aim • Better patient experience of care • Better health outcomes • Lower Cost

  7. Health Insurance Coverage + Access to Usual Source of Care = Improved Health Outcomes

  8. “Right care, right time, right place, every time” Source: Nowak NA, Rimmasch H, Kirby A, Kellogg C. Right care, right time, right place, every time. HealthcFinancManage 2012 Apr;66(4):82-8.

  9. Key Elements of a High-functioning Health Care System • Health care coverage for all, including catastrophic protection • Patient-centered medical home for every patient • Health care a shared responsibility of: • Individual • Employers • Government • Private and public sectors Source: Health care for all: a framework for moving to a primary care-based health care system in the United States. American Academy of Family Physicians, 2008. Accessed August 30, 2013.

  10. What Does This Mean for Me As a Medical Student? • You are training at a pivotal time • You have a responsibility to be change agents for a system that will deliver better care • Your patients will look to you as a guide

  11. Health Insurance Coverage + Access to Usual Source of Care = Improved Health Outcomes DeVoe JE, Tillotson CJ, Lesko SE, Wallace LS, Angier H. The case for synergy between a usual source of care and health insurance coverage. J Gen Intern Med. 2011 Sep;26(9):1059-66. doi: 10.1007/s11606-011-1666-0. Epub 2011 Mar 16.

  12. 50 Million Uninsured • Approximately equals the population of OR, OK, PR, CT, IA, MS, AR, KS, UT, NV, NM, NE, WV, ID, HI, ME, NH, RI, MO, DE, SD, AK, ND, DC, VT, WY combined Or • The population of Sweden, Austria, Switzerland, Denmark, Finland, Norway, and Ireland combined

  13. Insurance Coverage Alone Is Only Part of the Solution • Giving people coverage alone is like giving everyone a bus ticket and not having enough buses. • Improved health outcomes must also address workforce needs

  14. Health Insurance Coverage + Access to Usual Source of Care = Improved Health Outcomes DeVoe JE, Tillotson CJ, Lesko SE, Wallace LS, Angier H. The case for synergy between a usual source of care and health insurance coverage. J Gen Intern Med. 2011 Sep;26(9):1059-66. doi: 10.1007/s11606-011-1666-0. Epub 2011 Mar 16.

  15. Primary Care Health Professional Shortage Areas Primary Care Health Professional Shortage Areas (2006) Primary Care Health Professional Shortage Areas, Family Physicians Removed (2006) Source: Interact For Health and the American Academy of Family Physicians. Health Landscape Primary Care Atlas (healthlandscape.org), 2006 – 2013.

  16. Improved Health Outcomes When the Usual Source of Care Is Primary Care • Increase accessibility • Promote prevention • Proactively support patients with chronic illness • Engage patients in self-management and decision-making Source: Health care for all: a framework for moving to a primary care-based health care system in the United States. American Academy of Family Physicians, 2008. Accessed August 30, 2013.

  17. States That Rely More On Primary Care Have… • Lower Medicare spending • Lower resource inputs • Lower utilization rates • Better quality of care Dartmouth Medical School Center for the Evaluative Clinical Sciences. The Care of Patients with Severe Chronic Illness. Trustees of Dartmouth College, 2006. Accessed August 30, 2013.

  18. Key Changes Needed • Reinvigorate the primary care infrastructure in the U.S. • Redesign the manner of primary care delivery • Re-emphasize the centrality of primary care Source: Health care for all: a framework for moving to a primary care-based health care system in the United States. American Academy of Family Physicians, 2008. Accessed August 30, 2013.

  19. What is the Patient Protection and Affordable Care Act and how does it address the equation?

  20. Health Insurance Coverage + Access to Usual Source of Care = Improved Health Outcomes DeVoe JE, Tillotson CJ, Lesko SE, Wallace LS, Angier H. The case for synergy between a usual source of care and health insurance coverage. J Gen Intern Med. 2011 Sep;26(9):1059-66. doi: 10.1007/s11606-011-1666-0. Epub 2011 Mar 16.

  21. What is the Patient Protection and Affordable Care Act? • Comprehensive health reform • Signed into law March 23, 2010 • Includes measures to: • Cover at least 30 million of the 60 million Americans projected to be uninsured by 2022 • Increase access to affordable care • Improve care quality and lower cost • Sound familiar? Echoes the three key elements of a high-functioning, primary care-based health system Source: Health care for all: a framework for moving to a primary care-based health care system in the United States. American Academy of Family Physicians, 2008. Accessed August 30, 2013.

  22. Year-by-Year: 2010 • New funding for scholarships and loan repayments for primary care physicians working in underserved areas • Tax incentives for primary care physicians working in underserved or health professional shortage areas • Increased payments for rural health care providers • New funding for community health centers • Creation of $15 billion Prevention and Public Health Fund Source: Key Features of the Affordable Care Act by Year. United States Department of Health and Human Services, 2010. Accessed August 30, 2013.

  23. Year-by-Year: 2010 Source: Key Features of the Affordable Care Act by Year. United States Department of Health and Human Services, 2010. Accessed August 30, 2013.

  24. Year-by-Year: 2011 • For seniors: • Prescription drug discounts • Free preventative care • Improved post-hospitilization care and coordination • Funding for home and community-based, rather than institutional, care for disabled covered through Medicaid Source: Key Features of the Affordable Care Act by Year. United States Department of Health and Human Services, 2010. Accessed August 30, 2013.

  25. Year-by-Year: 2011 • Testing of new care delivery models that highlight care quality, cost control, to propose a new national strategy • Regulations to control insurance premiums and overpayment Source: Key Features of the Affordable Care Act by Year. United States Department of Health and Human Services, 2010. Accessed August 30, 2013.

  26. Year-by-Year: 2012 • Payment linked to quality outcomes through the Value-Based Purchasing Program in Traditional Medicine. • Incentives for creation of Accountable Care Organizations (ACOs) to coordinate patient care. • Standards for billing and electronic health record (EHR) use • Increased information gathering on health disparities Source: Key Features of the Affordable Care Act by Year. United States Department of Health and Human Services, 2010. Accessed August 30, 2013.

  27. Year-by-Year: 2013 • Increased Medicaid payments for primary care doctors • Open enrollment in Health Insurance Marketplace begins • Payment bundling to incentivize provider coordination and improve quality of care • New funding for state Medicaid to cover preventative services Source: Key Features of the Affordable Care Act by Year. United States Department of Health and Human Services, 2010. Accessed August 30, 2013.

  28. Year-by-Year: 2014 • Establishment of the Health Insurance Marketplace • Expanded Medicaid (in states that choose) • Uninsured Americans who are not exempt pay a fee to help offset the costs of caring for uninsured Americans • Tax credits for middle class to afford insurance Source: Key Features of the Affordable Care Act by Year. United States Department of Health and Human Services, 2010. Accessed August 30, 2013.

  29. Year-by-Year: 2014 • Prohibit insurance discrimination due to pre-existing conditions or gender • Eliminate annual limits on insurance coverage • Ensure coverage for individuals participating in clinical trials Source: Key Features of the Affordable Care Act by Year. United States Department of Health and Human Services, 2010. Accessed August 30, 2013.

  30. Year-by-Year: 2015 • New provision to tie physician payments to care quality. Source: Key Features of the Affordable Care Act by Year. United States Department of Health and Human Services, 2010. Accessed August 30, 2013.

  31. What Are the Insurance Marketplaces (Exchanges)? • Federally run, state-run, or partnership exchanges. • Composed of private insurance plans and federal plans, including Medicaid and the Children’s Health Insurance Program. • Allow Americans to compare, find, and enroll for health insurance coverage in one place, with one application.

  32. Options for Saving • Based on income level and family size, patients can qualify for: • Reduced premiums or co-pays through a plan in the Marketplace • Expanded Medicaid programs for people who make up to 133% of the federal poverty level

  33. Gaps in Coverage • Some American’s won’t qualify for Medicaid or reduced-cost insurance through the Marketplaces • In states that chose not to expand Medicaid coverage • Income level too high for Medicaid coverage, but • Income level too low for Marketplace cost reductions • These patients can • Pay full price for coverage through the Marketplace, or • Go uninsured and qualify for exemption from the fee, fitting into the gap and remaining uninsured. Source: healthcare.gov

  34. Covering the Gap • Primary Care stepping up to the plate • Community health centers providing essential care in states that choose not to expand Medicaid to cover uninsured patients

  35. What does this mean for family medicine?

  36. More Patients Will Need Family Physicians • Insurance marketplaces and expanded coverage will create a new insured patient population • This is good for patients and for physicians (access and reimbursement) • Patients entering this population want a family doctor. They want a shepherd to navigate their personal health care and the system.

  37. Market Forces Will Drive Demand For Family Physicians • Demand for family physicians will increase steeply, highlighting undersupply of family physicians • Programs and policies both new and already in development will focus on producing more family doctors • Care will focus on prevention and disease management, saving cost

  38. Family Physicians in Demand • “Primary care physicians remain at the top of the wish list for most hospitals, medical groups and other health care organizations.” • The most recruited specialty in 2012; at the top of the list for 7 straight years Source: 2012 Review of physician recruiting incentives. An overview of the salaries, bonuses, and other incentives customarily used to recruit physicians. Merritt Hawkins, 2012. Irving, Texas.

  39. What Is the Future of Family Medicine? • Patient-centered medical home (PCMH) • Population health • E-visits and online appointments • Web-based patient education • Group visits • Team approach to care; systematic approach to care • Chronic disease management • Joy in practice through innovation

  40. Resources on Health Care Reform • Healthcare.gov • CMS.gov • HHS.gov/healthcare • Familydoctor.org • Health Care for All: A Framework for Moving to a Primary Care-Based Health Care System in the United States

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