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1. HEALTHCARE.GOV Affordable Care ActPolicy and Implementation Briefing The Affordable Care Act and the Practice of Medicine Breakfast Forum October 25, 2012 Aryanna Abouzari, J.D. Affordable Care Act Outreach Specialist U.S. Department of Health & Human Services, Region III Pennsylvania, Delaware, District of Columbia, Maryland, Virginia, West Virginia

3. Critical Need for Health Reform 48.6 million uninsured Americans $2.6 trillion spent annually on healthcare 17.9 % of our economic output tied up in the health care system Without reform, by 2040, 1/3 of economic output tied up in health care

4. Affordable Care Act Overview • Creates Consumer Protections • Prevents denials of coverage for pre-existing conditions • Make health insurance affordable for middle class families and small businesses with tax credits • Expands access to care through Exchanges and Medicaid expansion

5. Affordable Care Act Overview • Expanded Medicaid Coverage • To include individuals with incomes up to 133 percent of the poverty level • 100% federally funded for first three years (2014-2016) • Federal funding gradually reduced to 90% in 2020

6. Highlights in 2010 • Establishment of State and National Temporary High Risk Pools • HHS Running Program • Extend coverage to young adults up to age 26 • 66,000 young adults in VA have benefited to date • Provide tax credits to small employers with 25 FTE employees and average annual wages less than $50k that purchase health insurance • 127,000 small businesses eligible in VA

7. Highlights in 2011 • Eliminate cost-sharing for Medicare covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force • 837,645 Medicare enrollees in VA received free preventive services last year • Require pharmaceutical manufacturers to provide a 50% discount on brand-name prescriptions and a 14% discount on generic prescriptions for those who hit the Medicare Part D donut hole • 86,007 Medicare enrollees in VA received discounts.

8. Highlights in 2011 • Independent Payment Advisory Board • Recommend ways to target waste in the Medicare program, reduce costs, improve health outcomes for patients, and expand access to high-quality care

9. Highlights in 2011 • Holds Insurance Companies Accountable for Unreasonable Rate Hikes – Requires health insurance companies to submit justification for all requested premium increases over 10% • Ensures value for premium payments – Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent

10. Highlights in 2011 • Increases the number of Primary Care Practitioners – Provides new investments to increase the number of primary care practitioners, including doctors, nurses, nurse practitioners, and physician assistants • Projected to place more than 16,000 health professionals over next 5 years • Community Health Centers - Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years • 231 community health centers in VA eligible for funding • 671,646 patients treated in 2010 at federally supported health centers in VA

11. Highlights in 2011 • Center for Medicare & Medicaid Innovation - developing important payment and delivery system reforms, focused on: • Expanding team-based care coordination • Rewarding clinicians for care outside of traditional face-to-face visits • Focusing on aggressive management of chronically ill patients • Expanding access to home-based care • Ensuring clinicians have seamless, secure ways to share patients’ medical records • $10 Billion in funding for 2011-2019 • Opportunity to scale up: authority to expand successful models to the national level

12. Partnership for Patients • New nationwide public-private partnership to make care safer, more reliable, and less costly. Goals: • 40% Reduction in Preventable Hospital Acquired Conditions over three years • 1.8 Million Fewer Injuries • 60,000 Lives Saves • 20% Reduction in 30-Day Readmissions in Three Years • 1.6 Million Patients Recover Without Readmission • Potential to Save $35 Billion in Three Years

13. Bundled Payments for Care Improvement Improve the care for beneficiaries who are admitted to the hospital, both during and following the hospitalization Reduce the escalating costs including costs born by beneficiaries Eliminate waste by improving the coordination and continuity of care across providers and settings Provide a first step towards accountable care and an effective tool for established ACOs Create flexibility in payment arrangements that support the redesign of care and increase alignment across providers and settings

14. Hospital Value-Based Purchasing Program • 3,500 hospitals nationwide will be paid based on care quality, not just quantity of services provided • Some of the quality measures include: • Ensure that patients who may have had a heart attack receive care within 90 minutes • Provide care within a 24-hour window to surgery patients to prevent blood clots • Communicate discharge instructions to heart failure patients • Hospitals that meet quality measures will receive bonuses based on overall performance

15. Highlights for Providers • 10% Medicare bonus payment to primary care physicians and general surgeons practicing in shortage areas (2011-2015) • Increased Medicaid payments to family and internal medicine providers to 100% of Medicare rates (2013-2014) • Increased loan repayment and funding for the National Health Services Corps • Award five-year demonstration grants to states to develop, implement, and evaluate alternatives to current tort litigations

16. Supreme Court Opinion On June 28, 2012, the United States Supreme Court upheld the law as constitutional The Supreme Court ruled that the Medicaid expansion provision is optional for states

17. Moving Forward • Exchange Implementation • Exchange certified by January 1, 2013 • Three models available • HHS will operate exchange for States that do not elect to operate or do not receive approval to do so by January 1, 2013

18. Moving Forward • Essential Health Benefits • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services/devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care

19. Affordable Care Act website –www.healthcare.gov Health IT website – www.healthit.gov Center for Consumer Information & Insurance Oversight website – http://cciio.cms.gov Affordable Care Act Spanish website – www.cuidadodesalud.gov Resources:

20. Thank you! Contact: aryanna.abouzari@hhs.gov