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Achieving Affordable and Effective Health Care Reform

Achieving Affordable and Effective Health Care Reform. Karen Ignagni President & CEO April 27, 2009. National Expectations: What does the public want?. Increased affordability, especially for working families and small businesses

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Achieving Affordable and Effective Health Care Reform

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  1. Achieving Affordable and Effective Health Care Reform Karen Ignagni President & CEO April 27, 2009

  2. National Expectations:What does the public want? • Increased affordability, especially for working families and small businesses • Guaranteed access to coverage, especially for those with pre-existing conditions • Improved quality, safety and effectiveness

  3. Committing to Reform:What health plans have proposed Bending the cost curve Covering everyone Keeping everyone covered Providing predictability, security, and transparency Improving quality and value • Establish goal of reducing future trend by 1.5 percentage points per year • Blueprint for meaningful change established by stakeholder group • Series of reforms to promote value & affordability • Guarantee issue (Eliminate pre-existing condition exclusions) • Eliminate medical underwriting (No health status rating) • Personal coverage requirement • Portability • Continuity of coverage • Expand safety net programs • Targeted assistance to low and moderate income individuals, families and small businesses • Essential benefits plan available nationwide for individuals and small businesses • Create a standard platform for consumers in each state to compare coverage options • Build on health plans’ strategies to reward value not volume • Ensure patients get the right care at the right time in the right setting • Promote consumer decision making w/ clear concise information about safety and effectiveness • Administrative simplification

  4. Determining Which Architecture Meets the Public’s Objectives • What is the best blend of public and private sector responsibilities? • Can comprehensive market reforms and consumer protections solve the problem? • What can we learn from FEHBP? • What can we learn from European models? • What are true administrative costs?

  5. Comparing Design Choices Government-run plan added to the offerings Market reforms and fundamental regulatory changes ? ?

  6. Impact of a government-run plan Employer provided coverage (small and large) Individual market 100 million + people moved 120 million people moved into government-run plan Providers ? Federal Budget ? Families/ Individuals ?

  7. Assessing the Potential to Achieve 21st Century Reforms • Private Sector Today • Infrastructure to identify health risk, coordinate outreach and track outcomes • Encourage healthy behaviors: health coaching/wellness, smoking cessation, physical fitness • Access to health information & performance transparency • Nurse call lines – trouble shooting, respond with timely information • Flexibility to tailor DM programs to meet individual needs • Nurse case managers to monitor patient adherence, complications and provide tools and support to manage care • Use information technology to improve care coordination (PHRs, registries) • Hi-touch tools: phone/web based innovations, state of the art interactive voice response to support self management • Assess/reduce social and home factors that contribute to poor health care • Alerts to physicians and patients, re: drug interactions and missed opportunities • Training in cultural competency and translation services • High quality service facilities (e.g. radiology) and Centers of Excellence • Payment models that incentivize value not volume • “At-risk” and “pay for performance” type arrangements with manufacturers and providers of specialty services • Public Sector Today • Administered pricing • Fee-for-service platform • Volume vs. value • Rejection of SGR cap • Political aspect to demos, and difficulty moving to market adoption • Political impact on coverage decisions • Inability to assess high risk patients and target supportive programs

  8. Assessing Private-Sector PerformanceMA HMO Performance Relative to FFS

  9. Assessing Private-Sector PerformanceMA HMO Performance Relative to FFS

  10. True Administrative Costs If a government-run plan were to perform functions of health plans… $?

  11. Cost ContainmentPotential associated with bending the cost curve

  12. Cost ContainmentPotential associated with bending the cost curve

  13. Achieving Affordable and Effective Health Care Reform Karen Ignagni President & CEO April 27, 2009

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