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Positive Aspects of the Affordable Care Act

Positive Aspects of the Affordable Care Act. By: Vickie Delaney Karen Lishinski Heather Smith LDR 614 – Contemporary Issues in Health Care Administration August 14, 2013. Affordable, quality driven, accessible. Cost has been increasing 18% of GDP (Fuchs, 2013) Quality is lacking

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Positive Aspects of the Affordable Care Act

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  1. Positive Aspects of the Affordable Care Act By: Vickie Delaney Karen Lishinski Heather Smith LDR 614 – Contemporary Issues in Health Care Administration August 14, 2013

  2. Affordable, quality driven, accessible • Cost has been increasing • 18% of GDP (Fuchs, 2013) • Quality is lacking • “More than half of American adults surveyed (55%) barely give the quality of American health care a passing grade—a C or D on a standard report card scale.”(Harvard, 2013) • Access needs to improve • 62 million in rural areas Health Care for all Vickie Delaney

  3. Cost of Health Care Income • ACA insures that people with incomes of 100-400% of poverty won’t pay more than 9.5% of income • Tax Credits to Employers • Extended Medicaid coverage-up to 28 million more covered Karen Lishinski Collins, 2013

  4. Cost of Health Care • Insurers- no longer allowed to deny coverage for pre existing conditions • No lifetime dollar limits will be allowed • All premiums will remain the same for men, women and health status • Insurers banned from cancelling policies due to illness and hospitalization Restrictions Karen Lishinski Whitehouse, 2013

  5. Cost of Health Care Medical Loss Ratio • Mark up on premiums restricted • Ratio- no less than 80% for small business • Must spend up to 85 cents of every dollar on care for large markets Karen Lishinski Tate, 2013

  6. Cost of Health Care • ACA will make premiums affordable to those within 400% of poverty • ACA will provide more resources to combat waste and fraud • Caps imposed on non-medical expenses, overhead and profits of insurers Affordability Karen Lishinski

  7. Quality Health Care To improve quality and efficiency • Quality Provisions in Effect • Comparative effectiveness research • National quality strategy • Medicaid payments for hospital-acquired infections • Data collection to reduce health care disparities • Medicare value-based purchasing • Reduced Medicare payments for hospital readmissions • Quality Provisions for 2013-14 • Financial disclosure • Medicare payments for hospital-acquired infections Heather Smith Kaiser Family Foundation (2013)

  8. Quality Health Care ACA emphasizes quality through… • Clinically integrated, systems-based care PROS • Shares electronic health records & clinical guidelines • Unifies practice management techniques • Builds collaborative team-based relationships • Aligns hospitals and provider offices • Raises the bar for higher quality across the delivery of patient care Heather Smith Belmont, et al. (2011)

  9. Quality Health Care Improving the value of health care… • Medicare’s value-based purchasing program • Designed to improve the health status of patients • Uses EMR’s & IT to off-set communication issues • Pushes for data transparency • Provider’s paid on performance and quality measures • Requires hospitals to publicly report outcomes • Key to health and wellness is prevention Heather Smith Bozic, (2012); Cudney, (2002)

  10. Quality Health Care Enhancing the quality of care… • Bundled payment for care improvement initiative • Mandates providers to meet quality benchmarks to receive payments • Places value on improving health outcomes • Pays providers per episode of care • Organizations can choose between four models • Develops community partnerships • “The objective of this initiative is to improve the quality of care delivery for Medicare beneficiaries, while reducing program expenditures, by aligning the financial incentives for all providers” –Marilyn Tavenner, Administrator for CMS Heather Smith Bozic, (2012); CMS, (2013); Japsen, (2013)

  11. Access to Health Care Health equity and a better quality of life • Through affordable insurance • Through patient education • Reduction in preventable disease • Better treatment of chronic diseases Vickie Delaney

  12. Access to Health Care Insurance • Affordable health insurance • Decrease the uninsured rate in Michigan • Increase in coverage • Young people • Children • Women • Health care professionals • School loan repayment Vickie Delaney

  13. Access to Health Care Healthy Living • Employer sponsored wellness • Fitness centers • Health screenings • Educational programs • Better, healthier living through access to insurance and education Vickie Delaney

  14. Access to Health Care TECHNOLOGY • Telehealth • Underserved rural areas • 62 million people • Increase in number insured • Mobile Medicine (mHealth) • Monitoring patients Vickie Delaney

  15. The Affordable Care Act Affordable, quality driven, accessible • Affordable • For most Americans • Stop gaps to control costs • Quality Driven • Value based reimbursement • Patient outcomes • Accessible • Health equity • Reduction in disease • Mobile medicine Vickie Delaney

  16. References • Belmont, et al. (2011). A new quality compass: hospital boards’ increased role under the affordable care act. Health Affairs 30 (7), pp. 1282- 1289. DOI: 10.1377/hithaff.2010.1317 • Boston, R. & Clifford, B. (2013). Laws affecting wellness programs and some things they make you do. Employee Relations Law Journal, 39.1, p.30. Retrieved from: http://go.galegroup.com.ezproxy.sienaheights.edu:2048/ps/retrieve.do?sgHitCountType=None&sort=DAS ORT&inPS=true&prodId=HRCA&userGroupName=lom_sienahul&tabID=T002&searchId=R2&resultListTy e=RESULT_LIST&contentSegment=&searchType=BasicSearchForm&currentPosition=1&contentSet=GALE 7CA331806642&&docId=GALE|A331806642&docType=GALE&role= • Bozic, K.J. (2013). Improving value in healthcare. Clinical Orthopedics and related research 471, pp. 368-370. DOI: 10.1007/s11999-012- 2712-x • Collins, S., Robertson, R., Garber, T., Doty, M., (2013). Insuring the future: Current trends in health care and the effects of implementing the affordable care act. The Commonwealth Trend, April, 2013 • Fuchs, V. (2013). The gross domestic product and health care spending N Engl J Med 2013; 369:107-109 DOI: 10.1056/NEJMp1305298 • Greene, J. (2010, June). Report: Health care reform will cut uninsured in Michigan from 11 percent to 1.5 percent. Crain’s Detroit Business. Retrieved from: www.crainsdetroit.com/print/article/20100621/HEALTH/ • Harvard Business. (2013). When it comes to quality, new poll shows Americans give U.S. health care low grades. Retrieved from: http://www.hsph.harvard.edu/news/press-releases/poll-us-health-care-quality/ • Kaiser Family Foundation. (2013). Health Reform Implementation Timeline. Retrieved from: http://kff.org/interactive/implementation- timeline • Lee, E. O. (2013, March ). Only 3 years old, the affordable care act is already having a big impact. Retrieved from: http://www.americanprogress.org/issues/healthcare/news/2013/03/25/57946/only-3-years-old- the- affordable-care-act-is-already-having-a-big-impact/ • Office of Rural Health (2013). Office of rural health policy. Retrieved from: http://www.hrsa.gov/ruralhealth/index.html • Tate, N. (2013). Obamacare survival guide. Humanix Books. West Palm Beach • US Dept of Health and Human Services. (2013, April). Access to health services. Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=1 • Wasden, C. (2013). MHealth and the future of healthcare. Futurescan 2013, pp.30-34. United States of America: Society for Healthcare Strategy & Market Development  of the American Hospital Association. Vickie Delaney

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