Cancer Care Delivery System Transformation Kenda K. Klotz, MPA,RN 12/29/2018

Impact of the Affordable Care Act Health Care Insurance Exchanges will be set up and ready for accrual by October 1st, 2013. Private Insurers as well as non-profit federal insurers will be part of the exchange. The plans will range from bronze to gold. Bronze plans will have a high deductible but lower monthly costs. Gold plans will have a much lower deductible but higher monthly costs. Outcome: An increase in insured patients Uncompensated care in hospitals should be reduced 12/29/2018

Changes in Reimbursement Structure Medicaid Expansion –Supreme Court upheld the ACA, but they determined that states could opt out of the expansion. Michigan: Governor Snyder pledged support in February 2013 and has retitled the expansion to Healthy Michigan. Eligibility will be based on the following criteria: 19 to 64 years of age 138% above the poverty level ($32k for family of 4) The Federal government will provide 100% of the premium for 3 years 2014-2016. 12/29/2018 3

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Changes in Care Delivery System Expectation for the health care community will be to provide high quality care at reasonable cost. Payment will change from fee for service to values based payment. (Quality, Cost, Outcomes) Population Health, Accountable Care Organizations, Medical Home models are all ways to attempt to decrease cost, manage patients across the care continuum and provide stellar outcomes. 12/29/2018 5

Changes in Care Delivery System What will be the value proposition for consumers of health care? For commercial payers? For employers? Employers expectations: Cost Demands Transparency with quality metrics Predictability Manageability Quality Demands Timely Access Clinical Excellence Employee Productivity Choice of Provider How will employers drive value? Benefit design, contracting strategy, cost sharing and wellness 12/29/2018 6

Changes in Care Delivery System What will be the value proposition for consumers of health care? For commercial payers? For employers? Commercial payer’s expectations: Cost Demands Predictability Appropriate Utilization Optimal Site of Care Quality Demands Patient Satisfaction Accessibility Evidence-based Practice How will commercial payers drive value? Narrow Networks Comparative Effectiveness Payment Pilots 12/29/2018 7

Changes in Care Delivery System What will be the value proposition for consumers of health care? For commercial payers? For employers? Patient’s expectations: Cost Demands Transparency Predictability Managability Exclusion as a factor in treatment decision Quality Demands Timely Access Clinical Excellence Choice of Provider Clear and Compassionate Communication How will patients drive value? By using their voice and executing their choice. Value Based Purchasing: payments increasingly tied to patients’ experience. Cancer specific Patient Experience Survey will be initiated. 12/29/2018 8

Thank You 12/29/2018 9