A Presentation of the Colorado Health Institute 303 E. 17 th Avenue, Suite 930 Denver, Colorado (Twitter) What Every Health Professional Should Know About National Health Reform Presented by: Allison Summerton, Research Analyst The Colorado Health Institute

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

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

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

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

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

Practice: What is your general view of the health care legislation Congress passed earlier this year? 1.Love it 2.Hate it 3.Mixed emotions 4.Need more information in order to understand it 5.Other

A Presentation of the Colorado Health Institute 303 E. 17 th Avenue, Suite 930 Denver, Colorado (Twitter) Demographic Questions Who’s in the room?

What is your race/ethnicity? 1.American Indian or Alaskan Native 2.Asian 3.Black or African American 4.Native Hawaiian or Other Pacific Islander 5.White 6.Hispanic 7.Unknown 8.More than one race 9.Other

What is your gender? 1.Male 2.Female

What is your age range? 1.<20 years old 2.20 to 29 years old 3.30 to 39 years old 4.40 to 49 years old 5.50 to 59 years old 6.>60 years old

I live in: 1.Denver Metro 2.Front Range 3.Northeast 4.Southeast 5.Mountain 6.San Luis Valley 7.Western Slope 8.Other

Are you a… 1.Native of [this town/ county/region]? 2.Native of Colorado? 3.Native of another U.S. state? 4.Native of another country?

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. 14

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 15

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 ( ) Requires employers who offer family coverage to offer coverage for adult children to age 26 (2010) 16

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] 17

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: 1) the greater of $95 or 1% of income 2) the greater of $325 or 2% of income 3) the greater of $695 or 2.5% of taxable income 18

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 19

A new health insurance marketplace: Health Insurance Exchanges 20

Federal premium subsidies in state-based Health Insurance Exchanges Individuals and families with incomes between % of FPL will be eligible for a tax refund or advance premium credit provided on a sliding scale in Individual/family income as % of federal poverty level (FPL) Premium contributions limited to % of annual income Individual contribution as % of FPL (2009) Family of 3 contribution as % of FPL (2009) 133%2%$288$ %4%$650$1, %6.3%$1,365$2, %8.05%$2,180$3, %9.5%$3,076$5, %9.5%$4,105$6,940

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

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

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 24

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 25 Health care workforce: Assessment and planning

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 26

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. 27

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

Population health improvement Establishes the Prevention and Public Health Fund to provide a funding source for prevention and public health programs ($5 billion FY ) 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 29

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 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 30

Quality improvement initiatives A multi-faceted approach to promote clinical quality improvement 1)Expand use of quality metrics and use of quality data 2)Quality improvement and patient safety 3)Care coordination and health services delivery reforms 4)Quality improvement reforms across all payers, private insurers, Medicare and Medicaid 31

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 32

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 33

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 34

“My top three priority issues/concerns regarding the impact of Healthcare reform for continued dialogue are:” 35 1.The Underinsured in Colorado and Issues of Health Insurance Affordability 2.Profile of Colorado’s Health Workforce: Implications of Reform-Induced Demand for Health Services (includes oral and mental) 3.Colorado's Health Care Safety Net: What is it, who uses it and how is it funded? 4.Cost Drivers in Health Care and Models of Payment Reform Colorado Household Survey: Health Care Utilization and 3 Things That Will Change Under Health Reform

Contact Information My contact information: Allison Summerton, MSW Research Analyst x