What Every Health Professional Should Know About National Health Reform

1. What Every Health Professional Should Know About National Health Reform Presented by: Allison Summerton, Research Analyst The Colorado Health Institute

2. Agenda • Welcome • Introduction to keypads • Demographic questions – Who is in the room? • What every Health Professional Should Know About National Health Reform • Questions • Next steps

3. Using your Keypads • Simply push the key that corresponds with your answer choice • It will turn on when you push a numbered key • Anonymous response

4. Using your Keypads • Simply push the key that corresponds with your answer choice • It will turn on when you push a numbered key • Anonymous response

5. Answer 2/B Polling Open Let’s say you press 2/B on your keypad: Your answer will be displayed on the keypad. Note: after your selection is displayed the screen will go blank The check mark indicates the answer was received properly.

6. Changing Your Answer Polling Open As long as Polling is Open, you can change your answer by pressing any other key.

7. Practice: What is your general view of the health care legislation Congress passed earlier this year? • Love it • Hate it • Mixed emotions • Need more information in order to understand it • Other

8. Demographic Questions Who’s in the room?

9. What is your race/ethnicity? • American Indian or Alaskan Native • Asian • Black or African American • Native Hawaiian or Other Pacific Islander • White • Hispanic • Unknown • More than one race • Other

10. What is your gender? • Male • Female

11. What is your age range? • <20 years old • 20 to 29 years old • 30 to 39 years old • 40 to 49 years old • 50 to 59 years old • >60 years old

12. I live in: Denver Metro Front Range Northeast Southeast Mountain San Luis Valley Western Slope Other

13. Are you a… Native of [this town/ county/region]? Native of Colorado? Native of another U.S. state? Native of another country?

14. What is the Colorado Health Institute? The mission of CHI is to advance the overall health of the people of Colorado by serving as an independent and impartial source of reliable and relevant health-related information for sound decision making.

15. Major components of the PPACA include: • Insurance market reforms • Coverage expansions • Payment reform and quality improvement initiatives • Public health promotion and disease prevention initiatives • Health professions workforce initiatives • Community health center expansions

16. Health insurance market reforms Insurance reforms provide consumer protections and establish minimum federal standards for the marketing of health insurance by prohibiting: • Lifetime dollar limits on coverage • Annual dollar limits on coverage • Insurers from rescinding coverage except in cases of fraud • Pre-existing condition exclusions for children <19 yrs (2010) • Pre-existing condition exclusions for adults (2014) • Coverage waiting periods in excess of 90 days, AND -- • Establishes a temporary national high-risk pool (2010-2013) • Requires employers who offer family coverage to offer coverage for adult children to age 26 (2010)

17. Establishes an essential health benefits package Essential health benefits package that must include: • Emergency services • Hospitalization • Maternity and newborn care • Mental health disorders and substance abuse services • Prescription drugs • US Preventive Services Task Force-recommended preventive services with no co-payments • Chronic disease management • Pediatric services including oral and vision care [Requires new plans to cover specified preventive services and immunizations with no co-payments effective for new plans in 2010, applies to all plans in 2018]

18. Individual responsibility Individuals and families are required to have health insurance (individual mandate) U.S citizens and legal residents without qualifying health coverage will pay tax penalty beginning in 2014: • 2014 - the greater of $95 or 1% of income • 2015 - the greater of $325 or 2% of income • 2016 - the greater of $695 or 2.5% of taxable income

19. Employer responsibility • No penalties for employers with fewer than 50 employees • Tax credits available to employers with no more than 25 employees • Employers not offering health insurance with at least one full-time employee receiving a premium tax credit will be assessed a fee of $2,000 per full-time employee • Employers offering insurance with at least one full-time employee receiving a premium tax credit will pay $3,000 for each employee receiving a subsidy or a $2,000 penalty for all full-time employees

20. A new health insurance marketplace: Health Insurance Exchanges

21. Federal premium subsidies in state-based Health Insurance Exchanges Individuals and families with incomes between 133-400% of FPL will be eligible for a tax refund or advance premium credit provided on a sliding scale in 2014

22. Medicaid eligibility expansions for low-income families and individuals • Childless adults (ages 18-64) with incomes up to 133% of FPL based on modified adjusted gross income (2014)   • Medicaid eligibility expanded for parents and children (ages 6-18) from 100% to133% of FPL (2014) AND-- • Physicians serving Medicaid patients reimbursed at 100% of Medicare for primary care in 2013 and 2014

23. Medicare payment reforms • Medicare will pay for and will not require co-payments or deductibles for specified preventive care in 2011 • Part D prescription “donut hole” closed by 2020 by reducing coinsurance to 25% of cost on brand name and generic drugs • Restructure payments to private insurance companies participating in Medicare Advantage Plans • Primary care providers will receive a 10% Medicare bonus for primary care services through 2016

24. Improving access to health care services • Reauthorizes/increases federally qualified health centers (FQHCs) grants to $11 billion (FY2011-FY2015) • Review of criteria for designating medically underserved areas/populations (MUAs/MUPs) and health professions shortage areas (HPSAs) • Authorizes a grant program for the development and operation of school-based health centers • Grants for demonstration programs co-locating primary and specialty care into community-based mental and behavioral health settings

25. Health care workforce: Assessment and planning • National Health Care Workforce Commission to undertake comprehensive and coordinated workforce planning • National Center for Health Care Workforce Analysis and State and Regional Centers for Health Workforce Analysis to collect and analyze data on workforce supply, demand and distribution • State Health Care Workforce Development Grants to support state partnerships for comprehensive workforce development strategies

26. Primary care workforce • Appropriates $1.5 billion to National Health Service Corps to recruit primary care providers into health shortage areas • Awards grants to expand primary care training programs • Awards grants to train physicians to serve in underserved rural communities • Awards grants to Teaching Health Centers to expand primary care residency programs in community and rural health clinics • Redistributes unused Medicare-funded residency slots for primary care and general surgery

27. Expansion of training programs for health care workforce • Grants for training programs in generalist, pediatric and public health dentistry • Demonstration grant to train or employ alternative dental health care providers • Grants for training programs in geriatrics, chronic care management and long-term care • Grants for recruitment and training of mental and behavioral health providers for children and adolescents • Loan repayment program for public health and allied health professionals working in public health.

28. Nursing workforce • Awards grants to develop and operate nurse-managed health clinics • Increases nursing student loan program • Expands education and retention programs for nurses • Awards grants to train more advanced practice nurses • Expands loan repayment and scholarships to increase nursing faculty

29. Population health improvement • Establishes the Prevention and Public Health Fund to provide a funding source for prevention and public health programs ($5 billion FY2010-2014) • Directs the Secretary of DHHS to coordinate a public-private campaign for health promotion education • Expands coverage of preventive services under Medicare, Medicaid and private health insurance • Encourages the development of wellness programs by employers and insurers

30. Population health improvement (cont.) • Community Transformation grants to promote individual and community health and chronic disease prevention • Grants to states to conduct pilot programs for chronic disease prevention targeted at 55-64 year olds • Requires nutrition labeling of standard menu items at chain restaurants • Enhanced collection and reporting of data by race, ethnicity and primary language to better understand health disparities • Continued funding for childhood obesity demonstration project

31. Quality improvement initiatives A multi-faceted approach to promote clinical quality improvement • Expand use of quality metrics and use of quality data • Quality improvement and patient safety • Care coordination and health services delivery reforms • Quality improvement reforms across all payers, private insurers, Medicare and Medicaid

32. Quality improvement and patient safety • AHRQ Health Care Quality Improvement Programs to identify, develop, evaluate and disseminate innovative and best practices in healthcare • Demonstration project grants for curriculum development to integrate quality improvement and patient safety into clinical education programs

33. Care coordination initiatives • Grants to promote community health teams to support patient-centered medical homes. • Grants to develop medication management programs for chronic disease patients • Grants to facilitate shared decision-making in treatment planning between patients, caregivers and clinicians • Re-authorized demonstration programs for community patient navigator programs • Grants to states for Primary Care Extension Program to provide technical assistance to practicing primary care providers

34. Quality improvement and delivery reforms in Medicaid and Medicare programs • Medicaid state option to provide coordinated care through health homes for individuals with chronic conditions • Demonstration programs to evaluate use of bundled payments for Medicaid and Medicare enrollees • Medical Global Payment System Demonstration Project • Pediatric Accountable Care Organization Demonstration Project • Medicare Community-Based Care Transitions Program

35. “My top three priority issues/concerns regarding the impact of Healthcare reform for continued dialogue are:” • The Underinsured in Colorado and Issues of Health Insurance Affordability • Profile of Colorado’s Health Workforce: Implications of Reform-Induced Demand for Health Services (includes oral and mental) • Colorado's Health Care Safety Net: What is it, who uses it and how is it funded? • Cost Drivers in Health Care and Models of Payment Reform • 2008-2009 Colorado Household Survey: Health Care Utilization and 3 Things That Will Change Under Health Reform

36. Contact Information My contact information: Allison Summerton, MSW Research Analyst 303.831.4200 x 222 summertona@ColoradoHealthInstitute.org