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Health Reform and New Jersey

Health Reform and New Jersey. Sally Roslow 609-275-4224 sroslow@njha.com. Agenda. Political Outlook National Healthcare Reform State Update. GOP Challenges. Unlikely to have two-thirds vote necessary to override presidential vetoes Law responds to genuine needs

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Health Reform and New Jersey

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  1. Health Reform and New Jersey Sally Roslow 609-275-4224 sroslow@njha.com

  2. Agenda • Political Outlook • National Healthcare Reform • State Update

  3. GOP Challenges • Unlikely to have two-thirds vote necessary to override presidential vetoes • Law responds to genuine needs • Law saves government money…repealing provisions could be “spenders” • Many provisions “connected”

  4. National Healthcare Reform

  5. Key Items in Reform 32 million covered (expansion begins 2014) 923,000 New Jerseyans 300,000 Medicaid 600,000 Exchange Insurance mandate (2014) Large employers pay $2000/employee fee Insurance market reforms No lifetime caps Children up to age 26 Can’t deny coverage for pre-existing conditions

  6. Key Items in Reform cont’d • Medicaid expansion – 133% of FPL • Tax on Cadillac Plans (2018) • Closes Medicare prescription drug “donut hole” • Geographic variation • $400 million carrot for low cost / high quality states • IOM study

  7. Key Items in Reform cont’d • Readmissions – imposes penalties for “excess” readmissions (heart attack, heart failure & pneumonia) • $7.1 billion over 10 years (2013)

  8. Healthcare Reform 2010-2019 • Cost – $1 trillion/10 years • Coverage – 32 million • How – Individual and employer mandates – Medicaid expansion – Insurance exchanges • NJ Specifics – 923,000 of 1.3 million uninsured covered – Hospitals will contribute $4.5 billion/ 10 years

  9. Strategic Directions • Movement away from fee-for-service toward integration • Emphasis on value versus volume • Emphasis on quality versus quantity

  10. “The Secretary shall…” • “The Secretary Shall”

  11. Accountable Care Organizations Rethinking the Organization of Care Where is your place? What is realistic? What is achievable? Primary Care Physicians Specialty Care Physicians Outpatient Hospital Care and ASCs Inpatient Hospital Acute Care Long Term Acute Hospital Care Inpatient Rehab Hospital Care Skilled Nursing Facility Care Home Health Care Post Acute Care (PAC) Episode Bundling Acute Care Episode with PAC Bundling Acute Care Bundling Medical Home Source: The American Hospital Association (AHA)

  12. Strategic Issues for Hospital / Healthcare Leaders • Reinvent ourselves as we continue to provide quality care, largely under old system (volume and procedures) even as we shift to P4P • Anticipate impact of reduced payments from Medicare • Get ready to jump to new way of doing business • But don’t jump too soon or too late • Many advise acute care hospitals to plan to reduce costs to maintain profitability at Medicare rates

  13. Strategic Areas to Focus Upon • Enhance efforts to improve quality and patient safety (Focus on outcomes, care coordination, evidence based medicine & comparative effectiveness) • Reduce variation in care in your organization (then region, then state… county) • Increase clinical and operational efficiencies • Reduce avoidable readmissions

  14. Strategic Areas to Focus Uponcont’d • Conduct community needs assessment (req’d for tax-exempt hospitals) • Assess/strengthen plan for HIT and EHR. Move to doctor/patient/hospital connectivity • Examine readiness for episodic payment, care redesign and ability to manage care across continuum • Foster better alignment with physicians

  15. Making Delivery System Reform a Success Three Keys to Delivery System Reform

  16. NJHA Healthcare Reform Resource Center • http://www.njha.com/Reform • Implementation schedule • Grant opportunities • Regulations • News and updates • Resources and links

  17. FY12 State Budget • The state is projecting a $10.5 billion budget shortfall on an approximately $30 billion budget • Cuts and reductions in governmental spending are highly anticipated • DHSS looking at consolidating funding • CMS approval of current budget plan still pending • Increased assessment moving forward

  18. Healthcare Reform :State Implementation • NJ Protect • High Risk Pool - Initiated August 2010 • Administered by Horizon Blue Cross Blue Shield • Coverage to approximately 21,000 individuals • Insurance Exchange • Must be operational by Jan. 1, 2014 • NJ DOBI recently awarded $1 million grant to review exchange creation

  19. Healthcare Reform :State Implementation • Insurance Reform • August 16, 2010, NJ receives $1 million grant to conduct premium reviews of health insurance companies • Medicaid Expansion • Beginning Jan. 1, 2014, Medicaid coverage will be expanded to 133% of the federal poverty level for non-elderly individuals

  20. Questions?

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