BIOTECH

1. The U.S. health system today: fragmented, expensive, complicated, disconnected ($7,681 per capita, NHE 2008) Administrators/Watchdogs Regulators Media Professional Societies/ Special Interests BIOTECH Insurers Innovators Academic Medicine Pharma BioTech Accrediting Agencies Employers HCIT Device Service Providers Disruptors Hospitals Outpatient Facilities Long Term Care Allied Health Professionals Disease Management CAM Physicians Consumers

2. Health Reform Legislation Insurance Delivery System Revenue & Government Markets & Effectiveness Subsidies Programs Clinical Additional Small Taxes , Fees Transparency Comparative Enabling Subsidies & Coverage Coverage Operational & Public Health Payment & Effectiveness / Group & Effectiveness & & Consumer Oversight Transparency & Penalties Expansion Requirements Administrative & Access Eligibility Individual Market Technology Rebates Pay for Evidence Based Engagement Requirements Changes Medicine Performance Life sciences / Premium tax HITECH Quality & patient Tax rules around State medical Individual Dependent HIPAA 5010 / pharmaceutical ICD - 10 Individual credits and comparative Education & Wellness & satisfaction ratings FSAs , HRAs , etc . malpractice reform mandate coverage to age 26 ICD - 10 “sunshine” requirements mandate & penalty subsidies to 400 % effectiveness Access published for plans changed demonstrations provisions Awareness Prevention FPL grants Increased Hospitals pricing EMR adoption Small business tax Administrative Nursing home Unearned income Temporary high - Prohibitions on Patient Centered investigation of publishing subsidies and credits ( < 50 simplification of “Compare” tax ( extension of Preventive health Workforce Indian Health risk pools rescissions Outcomes tax requirements penalties employees ) fraud and abuse in all provider / plan website Medicare payroll co - pays eliminated development Service changes Research Institute Medicare and transactions tax ) ( Medicare & program Medicaid Medicaid ) improvements Physician NFP hospitals $ 250 Medicare “Meaningful use” Maternal & child Automatic State ombudsman Penalties for “Compare” required to Part D rebate for Prohibition on guidelines Medicare payroll No lifetime benefit health funding enrollment of programs New office & employers whose website conduct beneficiaries using CE research stipulate greater maximums tax increase on Coverage for employees Residency programs created employees obtain community needs reaching the donut as the basis for data collection high - income health risk positions to better manage subsidized assessment hole ( 2010 ) coverage decisions over time earners Biologic data assessments & Standard reallocated dual eligibles coverage exclusivity annual prevention electronic Temporary No pre - existing plan ( Medicare ) enrollment forms reinsurance condition Health insurance AHRQ expansion Restaurants & program for early exclusions for Health information Payment Quality tax to fund Patient Medicare Medicaid vending machines retirees children Biosimilar access exchanges National Reform Improvement Centered must publish Participation Prevention , Health Outcomes nutritional standards & Promotion and Research Institute Limits on annual information reporting Funding for Co - Op Public Health NIH funding Medicare National strategy Medicare benefit maximums requirements for Minimum community health development Regional Part D “donut Council created payments for for health care Innovation Center to 2014 ; no annual participating plans eligibility set to centers subsidies hole” elimination extension centers preventable quality in CMS limits starting 133 % FPL hospitalizations improvement Health insurance 2014 Prevention and reduced industry excise tax Scope of practice public health fund PBM transparency Medicare Medicaid expansions CLASS Act – Medicare for prevention & Limits on pre - Advantage Disproportionate “Health home” LTC insurance Advantage quality Episode - based wellness , etc . existing condition program payment Share payment pilot ( Medicaid ) bonus payments payments established exclusions to changes reductions Medical device ( Medicare & 2014 ; exclusions Plan Design Exchanges Rating / Pricing sales tax Medicaid ) starting 2014 Independence @ Medicare Medicare Payments to Wellness grants Home Independent Disproportionate primary care for small Hospital Value - demonstration Payment Advisory Share payment physicians employers OPM contracts Rating restrictions American Health Based Purchasing project ( Medicare ) Board reductions increased Rx manufacturer Minimum MLRs with 2 national ( age , geography , Benefit Exchanges Program fees and rebates plans to be offered family size & for individuals & ( Medicare ) Employer wellness on each exchange smoking ) small groups up to CHIP expansion & ACOs that meet Medicare market program – pilots , Medicare annual 100 employees eligibility quality standards basket update programs , etc . Medicare enrollment maintained until can share in Prohibition of self - State option to reductions Internal & external payments for 2019 savings referral to create a “State Premium increase appeals processes hospital acquired Groups over 100 ( Medicare & physician owned Basic Plan” for rate reviews required infections reduced can join exchanges Medicaid ) hospitals those at 133 % - Changes & Bonus payments to DME competitive starting in 2017 200 % FPL increases to primary care & bidding No Federal match Medicaid drug gen . surgeons in for Medicaid Guaranteed issue Health Care Retiree Part D rebate percentages medically payments for and renewal Choice Compacts deduction for Website to underserved areas hospital acquired allow sales of Essential benefits employer subsidy compare plan CMS systems infections insurance products Medicaid LTC & package defined eliminated options – with modernization across - state lines community based standard ways of Coverage for care programs & describing benefits clinical trials NFP hospitals pilots created participation must charge low Risk adjustment 10 % tanning bed Create 4 benefit income patients for individual and tax categories + Medicaid the standard small - group plans catastrophic plan enrollment Limitations on reimbursement simplification cost sharing for amount preventive Reduce OOP services minimums for Connecting health those up to 400 % and human FPL services programs Health Reform Map: Simplifying Complexity