1 Patient Protection and Affordable Care Act (ACA) Individual mandate (2014) State insurance...
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Transcript of 1 Patient Protection and Affordable Care Act (ACA) Individual mandate (2014) State insurance...
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Patient Protection and Affordable Care Act (ACA)
Individual mandate (2014) State insurance exchanges Expansion of Medicaid program Changes to private insurance Employer requirements mandates Medicare changes
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Untruthful Assertions Cuts Medicare by $1000 per person
Both ACA and the Ryan plan reduce increases in spending in the future by over $700 billion over 10 years
Establishes death panels Payment to physicians for holding advance care
planning discussions was cut from the Act
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U.S. spending much more for older ages
Source: Fischbeck, Paul. “US-Europe Comparisons of Health Risk for Specific Gender-Age Groups.” Carnegie Mellon University; September, 2009.
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Medicare Reduce payments to Medicare Advantage
MA plans were paid 113% of FFS Some bonuses for high quality programs
Balance payments to high/low areas Establishes an “Independent Payment
Advisory Board” Early donut hole relief – eventual elimination Coverage for prevention services
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Independent Payment Advisory Board Recommend cost savings Produce public reports – access, quality, costs Make recommendations to President and
Congress Prohibited from “rationing” or “changing
benefits or eligibility” or “Medicare premiums” Hospitals and hospices not subject to
recommendations until 2019
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Donut Hole Relief 2011 $250 rebate
255, 996 FL seniors received the rebate Total amount to FL seniors - $63,999,000
Part D coverage gap discounts 252,989 Ave. per senior - $600 Total amount - $151, 807,700
Kff.org, 1/7/13
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Prevention & Wellness in FL Free preventive services
1,662,014 FL seniors received free services 70% of FL Part B enrollees (65.5% US)
Annual wellness visit 151,133 FL seniors had an annual wellness visit 6.9% of FL Part B enrollees (5.4% US)
Kff.org, 1/7/13
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Older Adult Workforce Funds Geriatric Education Centers Expand Geriatric Academic Career Award to
other disciplines (nursing, pharmacy, etc.) New Geriatrics Career Incentive Award
Advanced training opportunities Professionals Direct care workers
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Elder Justice Create an Elder Justice Coordinating Council
Report published in May 2013 http://www.aoa.gov/AoA_programs/Elder_Rights/
EJCC/Meetings/docs/2013_05_13_EJCC-Proposals.pdf
$400 million for Adult Protective Services $100 million for state demonstration grants
$26 million to create Elder Abuse, Neglect and Exploitation Forensic Centers
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New Models of Care Innovation Center at CMS
Foster patient-centered care & coordination Models
Accountable Care Organizations Bundled payments Medicare Coordinated Care Partnerships for patients Comprehensive Primary Care
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Problems with Medical Payments Fee-for-service
Provider (not the consumer) decides what is needed Insurance (not the consumer) pays the fees Provider is incentivized to do more
Capitation (“by the head”) Insurer decides what is needed Insurer pays provider regardless of use Provider is incentivized to do less
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Accountable Care Organizations (ACO) An organization of physicians and hospitals that
agree to cost and quality targets Strong primary care base Payment is linked to quality (instead of volume) Savings are achieved through improvements in
care Savings are shared between providers and CMS
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Bundled Payments “Bundling” expenses that used to be separate
Hospital admission and after care Surgery and a “warranty”
Considerations Hard to predict costs Difficult cases may be avoided Doesn’t discourage unnecessary care
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Medicare Coordinated Care Funds coordinated care for people with chronic
conditions 15 programs
Face-to-face meetings with client Helped with medications Facilitated communications (“hub”) Helped with transitions
8%-33% reduction in hospitalizations Cost neutral
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Comprehensive Primary Care 4 states (OR, CO, AK, NY) Components
Risk adjustment Access and continuity
Non-visit services & fees
Planned care for chronic conditions Patient and caregiver engagement Coordination od care
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Partnerships for Patients Reduce hospital-acquired conditions and
readmissions Elements
Hospital Engagement Networks (TMH) Care Transitions (5 sites in FL) Patient and family engagement
Provides resources to health care providers to better educate staff and patients/families
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Elephant in the Room - LTC Nursing homes - $100,000/year
Many become impoverished and go on Medicaid Low satisfaction CLASS act – (part of ACA) – would have
established a national LTC insurance Dropped by Democrats
Are some interesting new models Eden Alternative, Greenhouse Model
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1 2 3 4 5
1 – Affordability & Access - 35
2 – Choice of setting & provider - 41
3 – Quality of life & quality of care - 43
4 – Support of family caregivers - 40
5 – Effective transitions - 14
State Scorecard on LTSS Commonwealth/AARP 2014
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Few Good Things in LTSS in ACA National panel of LTC experts
Report issued Sept. 2013 Funding for LTC Ombudsman Program Funding for LTC training and recruitment Nursing home transparency Some financing options
Money follows the person Home health and HCBS
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Nursing Home Transparency Disclose ownership, financers, etc. Take steps to reduce violations Establish quality assurance programs Provide dementia care training Data collection requirements Pilot program – extend to all states a national
criminal background check system