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Health Care Reform: An Interactive Policy Discussion and Dialogue

Health Care Reform: An Interactive Policy Discussion and Dialogue. Thomas S. Campanella Professor of Health Economics & Director of Health Care MBA Baldwin-Wallace College Of-counsel, Baker Hostetler LLP.

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Health Care Reform: An Interactive Policy Discussion and Dialogue

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  1. Health Care Reform: An Interactive Policy Discussion and Dialogue Thomas S. Campanella Professor of Health Economics & Director of Health Care MBA Baldwin-Wallace College Of-counsel, Baker Hostetler LLP NEO HFMA GHALI 2011 May 18, 2011 NEO HFMA 2011

  2. Unlimited financial demands placed on the finiteresourcesavailable to society Medical care must be placed within the context of other goals considered important by society To a large extent these are competing priorities Setting the Stage: The Financial Challenge Facing Healthcare Stakeholders

  3. Setting the Stage: The Financial Challenge Facing Healthcare Stakeholders The culmination of healthcare cost, quality and access to care issues: 1. Negative impact on employers 2. Negative impact on Medicare/Medicaid 3. Negative impact on both the “haves and have nots” 4. Which will in turn negatively impact healthcare stakeholders – no longer business as usual

  4. Financing Healthcare Reform: Follow the Money Our healthcare system is shaped by how we pay for services and what we pay for as well as consumer expectations Medicare, the primary architect of our healthcare system Will there be “real payment” reform of Medicare? Remember, healthcare cost is revenue to the healthcare stakeholders Overlaying the financial impact of Healthcare Reform

  5. How will Healthcare Reform Impact the Stakeholders? • Hospitals • Physicians • Managed care organizations • Free-standing Ambulatory Provider Facilities

  6. Healthcare Reform –Hospitals ACOs(the Silver Bullet?) Aligning stakeholder incentives Consumer engagement Risk/reward reimbursement The return of the HMO model? The impact of transparency Make or buy? The future of the full service hospital Winners and losers – house of cards? Your thoughts?

  7. Healthcare Reform –Physicians • Medicare payment policy • The focus on primary care • Financing of medical education • The future of the independent group • Third party financing (venture capital, etc.) • Hospital collaboration • Physician leadership • Consumer engagement • Winners & losers • Your thoughts? (see next slide)

  8. Healthcare Reform –Physicians Percentages of Practices Owned by … Source: Medical Group Management Association

  9. Healthcare Reform –Insurance Industry • Insurance reform/medical loss caps • Health insurance exchanges • The ACO threat? • A new role for MCOs? • Risk arrangements • Increased consolidation? • The Kaiser model • Consumer engagement • Winner & losers • Your thoughts?

  10. Healthcare Reform –Free-standing Ambulatory Provider Facilities Transparency + prudent purchasers of healthcare services = financial success Medicare payment policies Independent physician collaboration Collaboration with Hospitals/MCOs Third-party financing Impact on full-service hospitals Winner & losers Your thoughts?

  11. The Healthcare Stakeholders’ Challenges/Opportunities • Major national public policy issues still need to be addressed: 1. End of life care 2. Inappropriate use of high cost of technology 3. Consumer life-style choices 4. Malpractice reform • Both challenges and opportunities for health care stakeholders • Those stakeholders that are proactive in addressing these challenges and pursuing value-oriented opportunities will have the best chance for short and long-term success

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