Health Care Reform and GHS

1. Health Care Reform and GHS

2. GHS Overview Health Care Reform Impact of the State and Local Economy GHS Strategy Leadership Framework Questions / Discussion AGENDA 2

3. Our Vision Transform health care for the benefit of the people and communities we serve. Our Mission Heal compassionately. Teach innovatively. Improve constantly.

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5. 2. Health Care Reform A lengthy and highly charged national debate.

6. Health Care Reform Choices 6

7. Policy Decisions Have Left a Gap in Coverage for SC 2.2 million have employer-based health insurance 1.2 million rely on a government-sponsored program for coverage 178,000 have coverage purchased in the individual market 760,000 South Carolinians have no coverage *Source: Kaiser Family and Robert Wood Johnson Foundations

8. A Closer Look at South Carolina�s 760,000 Uninsured 557,000 live in working families that pay taxes to support government coverage for others 357,000 live at or below 133% of the federal poverty level SC has no program to help childless adults *Source: Kaiser Family Foundation

9. What Happens When the Uninsured Need Care? Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 Last year, SC hospitals provided more than $1 billion worth of care for which they received no direct payment. Those financial losses were passed along to insured patients and their employers. This may be a good place to highlight your community benefit numbers.This may be a good place to highlight your community benefit numbers.

10. Premiums Are Growing Faster Than Paychecks Hospitals do have to cover all of our costs, and our revenue source is the insured patient. So as hospitals provide care for which we are not reimbursed, we pass that along to our paying patients and their employers. This pushes insurance premiums higher and puts existing insurance coverage at risk as employers have to make tough decisions about dropping or decreasing coverage, or even reducing their workforce. Hospitals do have to cover all of our costs, and our revenue source is the insured patient. So as hospitals provide care for which we are not reimbursed, we pass that along to our paying patients and their employers. This pushes insurance premiums higher and puts existing insurance coverage at risk as employers have to make tough decisions about dropping or decreasing coverage, or even reducing their workforce.

11. Some of the Myths about the Legislation You�ll have no choice in what health benefits you receive; a �health choices commissioner� will decide what benefits you get. Death panels will decide who lives. Illegal immigrants will get free health insurance. Federal funding of abortions will increase. Care will be rationed. Patient Protection and Affordable Care Act One myth is that you�ll have no choice in what health benefits you receive�a �health choices commissioner� will decide what benefits you get. The legislation does create an essential health benefits package that provides a comprehensive set of services, covers at least 60% of actuarial value, and limits annual cost sharing. Effective Jan 1, 2014, all qualified health benefit plans, including those offered through the Exchanges and those offered in individual and small group markets outside the Exchanges, will have to include at least the essential health benefits package. Requirements will be floors, not ceilings�feds will have no say in how generous private insurance can be. � Another popular myth designed to scare people is that death panels will decide who lives. In truth, the legislation expands Medicare coverage to include optional counseling on end-of-life care for any senior who requests it. � Another myth is that Illegal immigrants will get free health insurance. � The reality is that access to coverage through state-based exchanges is restricted to U.S. citizens and legal immigrants who are not incarcerated. � Federal funding of abortions will increase, the critics say. � The legislation prohibits abortion coverage from being required as part of essential health benefits package. It also requires insurers participating in Exchanges who wish to offer coverage for abortions to calculate and collect separate premiums for that coverage. � Finally, we have all heard that care will be rationed under health-care reform.� � Under the current system neither public programs nor private insurance plans cover everything. And that will not change. The essential benefit package will help limit what can be deemed uncovered and the legislation does establish a non-profit institute to conduct, with assistance by expert advisory panels, research that compares clinical effectiveness of medical treatments. As a result, health care consumers will be able to get comparative information about health care treatments just like they currently get from Consumer Reports when they buy a television or a car. �One myth is that you�ll have no choice in what health benefits you receive�a �health choices commissioner� will decide what benefits you get. The legislation does create an essential health benefits package that provides a comprehensive set of services, covers at least 60% of actuarial value, and limits annual cost sharing. Effective Jan 1, 2014, all qualified health benefit plans, including those offered through the Exchanges and those offered in individual and small group markets outside the Exchanges, will have to include at least the essential health benefits package. Requirements will be floors, not ceilings�feds will have no say in how generous private insurance can be. � Another popular myth designed to scare people is that death panels will decide who lives. In truth, the legislation expands Medicare coverage to include optional counseling on end-of-life care for any senior who requests it. � Another myth is that Illegal immigrants will get free health insurance. � The reality is that access to coverage through state-based exchanges is restricted to U.S. citizens and legal immigrants who are not incarcerated. � Federal funding of abortions will increase, the critics say. � The legislation prohibits abortion coverage from being required as part of essential health benefits package. It also requires insurers participating in Exchanges who wish to offer coverage for abortions to calculate and collect separate premiums for that coverage. � Finally, we have all heard that care will be rationed under health-care reform.� � Under the current system neither public programs nor private insurance plans cover everything. And that will not change. The essential benefit package will help limit what can be deemed uncovered and the legislation does establish a non-profit institute to conduct, with assistance by expert advisory panels, research that compares clinical effectiveness of medical treatments. As a result, health care consumers will be able to get comparative information about health care treatments just like they currently get from Consumer Reports when they buy a television or a car. �

12. Patient Protection and Affordable Care Act Some Facts about the New Law The new law will expand coverage to almost 500,000 of the 760,000 uninsured South Carolinians. No government-run, public option included. The new law includes health insurance reforms intended to protect consumers. The new law includes delivery system reforms that hold promise for improving care.

13. Consumers Expanded access to insurance coverage and protections from denial Supports individual responsibility for improving personal health status Employers Tax credits to small businesses Play-or-Pay for larger employers Major Themes

14. Health Care Providers A greater focus on coordinated care, health outcomes, and evidence-based practices Additional efforts directed toward improving quality Increasing access to primary care Supports training of health care professionals Major Themes

15. 3. Impact of State and Local Economy

16. S.C. Economics 101 �Circa 2007 16

17. SC Unemployment Rate (%)

18. SC Unemployment (#)

19. SC Single-Family Building Permits

20. SC General Fund Revenue

21. S.C. Economics 101 � 2010 21

22. Future Implications Need to adopt a new mindset Expectations may be slow to change� Community Employees Elected Officials �but our reality will be very different.

23. 4. GHS Strategy 23

24. GHS Multi-Year Organizational Goals (3-5 Year Horizon) Become a Total Health Organization Transform core organization structures and processes into a Highly Integrated Delivery System Become an Accountable Care Organization Improve care delivery and work force development through Innovation in Academics Ensure a sustainable financial model that supports our Vision and Mission

25. Pillar Frameworkfor FY 2011

26. Pillar Frameworkfor FY 2011

27. 5. Leadership Framework  Four Ways of Being in the World;Shifts to Authentic Community;Creating a Culture of Curiosity and Engagement 27

29. Health Care Reform�USC School of Medicine-Greenville�Economy� 29

31. Examples of Tools Used at GHS Quarterly Town Hall Meetings Annual Employee Opinion Surveys �and Quarterly pulse surveys at Town Hall Meetings Rounding for Outcomes Intranet Site � CEO Corner Ask the CEO Creating a Culture of Engagement an Curiosity 31

32. Issues Clearing Model The facts are� Here�s what happened� My emotion is�. When this happens I feel� My interpretation (story) is� What I make this to mean is� My part in this is� I see my responsibility as.. And what I want is� Listener mirrors back Let me see if I have this� Do I have that right? Is there more? Are you clear about this? Do you feel understood?

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35. US News2010-2011 America�s Best Hospitals GMH programs ranked among thenation�s top 50 hospitals in threespecialties. Diabetes and Endocrine Disorders (#25) Gastroenterology (#39) Heart & Heart Surgery (#45) We also ranked #5 in the country for lowestreadmissions and received a 2010 SilverAchievement Award for Coronary ArteryDisease/Congestive Heart Failure/Stroke. These results reflect on the entire GHS team. All elements of our integrated delivery system working together to deliver high quality care and services for our patients and families.

36. Questions / Discussion mriordan@ghs.org 36