|
1
|
|
|
2
|
|
|
3
|
- Government & Political Solutions
- versus
- Private Sector and Free Markets
- If one trusts government more than private sector (distrusts greedy
profit oriented health companies), then it seems natural to advocate
government controlled solutions (e.g. single payer, expanded Medicar=
e,
Canadian style)
- If one trusts the private sector more than government (distrusts
inefficient, wasteful, politically motivated lobbyist controlled
politics), then it seems natural to advocate free market solutions (=
e.g.
increased competition, individual ownership, personal responsibility,
lower taxes, tax credits)
|
|
4
|
- In a 21st Century Intelligent Health System, the individual has:
- accurate, timely knowledge of health needs;
- access to the best information about how to maintain personal health=
;
- knowledge of whom to s=
ee and
where to go for health services, and
- confidence that health providers are practicing medicine using the b=
est
practices based on the most up-to-date understanding of outcomes-bas=
ed
medicine.
- Most
importantly, the 21st Century Intelligent Health System must provide
access to affordable insurance coverage for those currently
uninsured. No one can =
be
left behind.
|
|
5
|
- Transformation to a 21st Century Intelligent Health System is much m=
ore
than employers implementing high deductible Consumer-Driven healthca=
re
(CDHC) plans with attached saving accounts.
- The future is about empowering individuals with information and
financial responsibility to support a position of ownership. It’s about supporting=
and
rewarding healthy behaviors regardless of plan design.
- It’s about engaging employees, employers, providers, carriers,=
and
other stakeholders in a new relationship that deals with health rath=
er
than sickness and disease.
|
|
6
|
- Healthcare seems to have two basic choices to control costs:
- 1. Managed care & HMOs - The “supply of care” is lim=
ited
by a third party who controls the access to medical services (e.g.
utilization reviews, medical necessity, gatekeepers, formularies,
scheduling, types of services allowed), or
- 2. Consumerism - The member controls their “demand for care=
221;
because of a direct and significant financial involvement in the cos=
t of
care, rewards for compliance, and the information to make wise health
and healthcare value driven decisions.
|
|
7
|
|
|
8
|
- 44,000 to 98,000 deat=
hs
annually from medical errors (Institute of Medicine)
- 7,391 deaths resulted=
from
medication errors (Institute of Medicine)
- 225,000 deaths annual=
ly
from medical errors including 106,000 deaths due to "nonerror
adverse events of medications" (Starfield)
- 180,000 deaths annual=
ly
from medication errors and adverse reactions (Holland)
- 20,000 annually to 88=
,000
deaths annually from nosocomial infections
- 2.9 to 3.7 percent of
hospitalizations leading to adverse medication reactions
- 2.4 to 3.6 percent of
hospital admissions were due to (prescription) medication events
(Australian study)
- 42% of people believe=
d they
had personally experienced a medical mistake (NPSF survey)
|
|
9
|
- 18,000 pe=
ople
die every year because they are uninsured.
- Uni=
nsured
adults have a 25% greater rate of dying than adults with insurance.<=
/li>
- Uninsured
trauma victims are less likely to be admitted to the hospital or rec=
eive
the full range of needed services. They are 37% more likely to die of
their injuries.
- Uni=
nsured
children are 70% more likely to go without care for common childhood
conditions such as asthma, ear infections, and sore throats.
- Uni=
nsured
children are five times more likely to have an unmet need for medical
care each year
|
|
10
|
- Uninsured women are 3=
6%
less likely to get a pap smear, and 60% less likely to get a mammogr=
am.
- Uninsured men are 40%=
less
likely to get a prostate examination.
- The ripple effects of=
being
uninsured and having poor health are felt throughout society. Uninsu=
red
children have impaired development and poor school performance.
Uninsured adults have more absences from work, more unscheduled sick
days, and greater rates of disability.
- The 2004 Kaiser Family
Foundation study found the societal costs of the uninsured to be $125
billion.
- Regardless of how one views the issue, the cost to society is high.
Without insurance - the health, lives, and financial security of
families are at extreme risk.
|
|
11
|
- The Center for Health Transformation endorses the goal of access to
insurance for all Americans with care provided in a 21st Century
Intelligent Health System.
- We can achieve 100% coverage through market-based solutions,
private/corporate efforts, tax incentives, direct public subsidies,
strong community support, and faith-based outreach programs.
- Personal responsibility, individual ownership, portability, and
healthcare consumerism are the hallmarks of such a system.
|
|
12
|
- Personal Responsibility
- Self-Help, Self-Care
- Individual Ownership
- Portability
- Transparency (the Right to Know)
- Consumerism (Empowerment)
|
|
13
|
- Healthcare Consumerism is about transforming a health benefit plan i=
nto
one that puts economic purchasing power—and
decision-making—in the hands of participants.
- It’s about supplying the information and decision support tools
they need, along with financial incentives, rewards, and other benef=
its
that encourage personal involvement in altering health and healthcare
purchasing behaviors.
|
|
14
|
- If Healthcare Consumerism is the basis for a new system of health and
healthcare, it MUST solve our country’s most difficult problem=
s.
- Healthcare Consumerism must improve ACCESS, QUALITY, and COST.
- In addition to expanding individual and employer-based insurance, th=
ere
must be a Consumer-centric Medicaid, Consumer-centric Medicare, a
solution to the uninsured.
|
|
15
|
|
|
16
|
- The Unifying Theme
- for a
- Health and Healthcare Strategy is:
- Behavioral Change
|
|
17
|
- Must work for the Sickest Members, as well as the healthy
- Must work for those not wanting to get involved in decision-making, =
as
well as the “techies”
|
|
18
|
|
|
19
|
|
|
20
|
|
|
21
|
|
|
22
|
|
|
23
|
- 1. Federal Support and Subsidies For HSAs & HDHPs
- 2. Major initiatives to address the 45 million uninsured problem in =
the
U.S.
- 3. Major initiatives to restructure the individual and small group
healthcare market place. Cross-state selling and new players entering
the market.
- 4. 45-50% Individual Policy ownership in 5-10 years (currently 5-7%)=
.
- 5. The development of Consumer-centric Medicaid and Consumer-centric
Medicare
|
|
24
|
- 1. Leveling the playing field by making the same tax relief availabl=
e to
individuals and employers. Americans who purchase HSA-qualified
insurance policies on their own should have the same tax advantages =
as
people who obtain insurance through their employer.
- 2. Eliminating all taxes on out-of-pocket spending through HSAs. Ame=
ricans
with HSAs should be able to pay for all of their care tax-free.
- 3. Making health insurance portable. Americans should be able to own=
the
insurance policy that goes along with their HSA, and keep it when th=
ey
change or lose their jobs without worrying about paying higher premi=
ums
if they become sick.
|
|
25
|
- 4. Strengthening the buying power of America’s small businesse=
s. Small
businesses should have the same access to price efficiencies as large
businesses when purchasing health insurance.
- 5. Passing medical liability reform. Limit costly and frivolous laws=
uits
that waste scarce resources, increase health care costs, and drive
doctors out of business.
- 6. Improving adoption of health information technology. Electronic
health records that reduce costs and improve the efficiency and
effectiveness of medical treatment should be widely used.
|
|
26
|
- 7. Empowering consumers through information. All Americans should be
able to obtain easy-to-understand information about the price and
quality of the health care they receive from their medical provider =
and
insurance carrier.
- 8. Providing affordable coverage for vulnerable Americans. Americans
with low incomes and persistently high medical expenses should recei=
ve
additional assistance.
- 9. Promoting prevention, wellness, and fitness. The President encour=
ages
all Americans to lead a healthy lifestyle to prevent disease and imp=
rove
their overall quality of life.
|
|
27
|
- Medicaid should be divided into three distinct sub-programs, each
administered separately with its own rules and structures. However, =
all
the sub-programs should be based on the following principles:
- 1. A 21st Century Medicaid System will focus on wellness,
- prevention, early detection, and independent living.
- 2. A 21st Century Medicaid System will integrate the family
- and community into the healthcare and the lives of loved ones.
- 3. A 21st Century Medicaid system will leverage innovations in
- science and technology, quality systems, and best practices in
- every aspect of providing care for its beneficiaries.
|
|
28
|
- To achieve real transformation in Medicaid:
- One program design cannot meet the needs of such distinct and
separate groups of beneficiaries –
- 1. the poor.
- 2. people with disabilities (Aged, Blind, Disabled), and
- 3. the frail elderly.
- Consumer-centric Medicaid as described in this presentation focuses =
on
the first group
|
|
29
|
- 1. Eligibility
- 2. Benefit Design
- 3. Cost Sharing
- 4. Premium Sharing
- 5. Service Costs
- 6. Utilization
- Consumer-centric Medicaid
- Graduation to Private Ownership
- Asset Accumulation
- Shared Savings-Pay 4 Compliance
- Income based
- Shared Savings-Pay 4 Performance
- Demand Controlled
|
|
30
|
|
|
31
|
|
|
32
|
- Add to Medicare a Health Opportunity Account (HOA). The account star=
ts
with a zero balance and would be funded through a number of sources
including employers offering post retirement healthcare supplements,=
tax
deductible individual contributions, and Medicare deposits based upon
voluntary patient participation in cost effective treatments, and
through compliance incentives programs.
- Like Health Savings Accounts, HOAs would be funded individual accoun=
ts
under the control of the Medicare beneficiary.
|
|
33
|
- 1. Employers could provide post retirement health insuirance
contributions directly into the HOA.
- 2. Medicare could establish incentive programs to reward compliance =
with
“best practices” medical care and treatments.
- 3. Medicare could reward patients that with HOA incentives if they u=
se
hospitals with proven cost effective programs for the diagnosis being
treated.
- 4. Medicare beneficiaries that use hospitals with recognized quality
standards would receive an HOA incentive bonus.
|
|
34
|
- 5. HOA incentives could be awarded to encourage using physicians with
better outcomes.
- 6. Medicare beneficiaries could be allowed to contribute to their HO=
As
with tax deductible contributions.
- 7. Medicare beneficiaries could be allowed to transfer (tax free) a
certain amount of life insurance cash value directly into their HOA.=
- 8. HOAs would accumulate tax-free. As with current HSAs, investments
would be through government approved financial investment vehicles.<=
/li>
|