Avalere Health LLC | The intersection of business strategy and public policy Medicare in 2008+: A Framework for Discussion November 2, 2005 Jon Glaudemans.

Slides:



Advertisements
Similar presentations
Medicare Reform Exhibit 12 New benefit administered exclusively by private insurers New benefit administered exclusively by private insurers New income-related.
Advertisements

Containing Health Care Costs: Market Forces and Regulation Paul B. Ginsburg, Ph.D. Center for Studying Health System Change and National Institute for.
What is an Accountable Care Organization?
DataBrief: Did you know… DataBrief Series ● February 2011 ● No. 12 Dual Eligibles Across the States In 2008, dual eligibles as a percent of the total Medicare.
Avalere Health LLC | The intersection of business strategy and public policy Long-Term Care Financing Reform: A Federal and Private Insurance Partnership.
Policy Proposals Health Care Coverage, Costs, and Financing.
THE COMMONWEALTH FUND Reforming the Health Care Delivery System – The Role of States Rachel Nuzum Vice President, Federal and State Health Policy The Commonwealth.
1 Wisconsin Partnership Program Steven J. Landkamer Program Manager Wisconsin Dept. of Health & Family Services July 14, 2004.
Changing the Conversation About Medicare Debra Whitman, EVP, Policy, Strategy & International Affairs Lina Walker, Director, Health Policy, Public Policy.
Truven Health Analytics State Exchanges - Data Collection & Analysis April 2014.
1 Controlling Costs in Medicare Jack Hoadley Research Professor Georgetown University Health Policy Institute Citizens’ Health Care Working Group Public.
Wednesday, December 17, :00pm-4:30pm EST National Coalition for Cancer Survivorship Post-Training Webinar ©2014 National Coalition for Cancer Survivorship.
Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 6 Health Care Economics.
Health Line of Business Revised Health Domains January 26, 2005 Outcomes / Domains have been revised.
The Health Care Industry Part 2 - Medical Insurance Karen F. Nichols, MSA School of Allied Health Professions University of Nebraska Medical Center.
SoonerCare and National Health Care Reform Oklahoma Health Care Authority Board Retreat August 26, 2010 Chad Shearer Senior Program Officer Center for.
Health care system innovation in the Netherlands - with a special focus on primary care André Knottnerus, MD, PhD Chair, Scientific Council for Government.
Building the Foundations for Better Health Health Services Organization.
Return to KaiserEDU Tutorials
Impact of ACA on the Health Insurance Industry. Agenda Impact of ACA on the Health Insurance Industry Planning for 2015 and Beyond Business Problems and.
CHCWG DRAFT March 2, 2006 Hearing from the American People: Preliminary Overview of Sources and Reports March 2006 Caution: Preliminary Data Do not cite.
Presented by: Kathleen Reynolds, LMSW, ACSW
U.S. Healthcare Policy. Project 4: One page summary of the project including comments on the student's contributions. Describe how the project contributed.
A Roadmap for Achievable Health Care Reform Karen Ignagni President and CEO America’s Health Insurance Plans November 13, 2007.
1 An Overview of the Evolving World of Health Insurance and the Role of Defined Contribution Jon B. Christianson James A. Hamilton Chair in Health Policy.
Affordable Care Act Aging Network Opportunities Judy Baker Regional Director Health and Human Services October 18, 2010.
Medicare’s Disease Management Activities Stuart Guterman Director, Office of Research, Development, and Information Centers for Medicare & Medicaid Services.
Lukas Steinmann Mexico 10. June 2008 To your health: diagnosing the state of healthcare and the global private medical insurance industry.
© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Health Care Reform and its Impact on Michigan Janet Olszewski, Director Michigan Department of Community Health Senate Health Policy Committee May 5, 2010.
1 HEALTH CARE REFORM – Changes in Delivery Systems Kenneth W. Kizer, MD, MPH Alaska State Hospital and Nursing Home Association Fairbanks, AK September.
A Presentation of the Colorado Health Institute 1576 Sherman Street, Suite 300 Denver, Colorado Hot Issues in.
CONNECTICUT HEALTH FOUNDATION: Update on Evaluation Planning for the Strategic Plan.
Health Care Facts and Guiding Principles for Health Care Reform Public Employees Union, Local #1.
Pharmaceutical system strengthening – Is there a need for a new paradigm? Andreas Seiter The World Bank ICIUM 2011, Antalya 1.
The Governor’s Plan for a Healthier Indiana
Peter B. Bloland, DVM, MPVM Director Division of Public Health Systems and Workforce Development Global Health Leadership Forum November 10, 2011 National.
Section 1115 Waiver Implementation Plan Stakeholder Advisory Committee May 13, 2010.
Academy Health Annual Meeting, Orlando, June 2007 What Accounts for the Rise in Medicare Spending? Kenneth E. Thorpe, Ph.D. Robert W. Woodruff Professor.
Consumer-focused Meeting September 27, 2011 Integrating Medicare and Medicaid for Individuals with Dual Eligibility.
J. James Rohack, MD, FACC President, AMA Director, Scott & White Center for Healthcare Policy Professor of Medicine and Humanities, TAMHSC Information.
Better, Smarter, Healthier: Delivery System Reform U.S. Department of Health and Human Services 1.
Avalere Health LLC | The intersection of business strategy and public policy Medicare Prescription Drug Payment Presented by Margaret Nowak September 24,
DataBrief: Did you know… DataBrief Series ● October 2011 ● No. 21 Dual Eligibles, Chronic Conditions, and Functional Impairment In 2006, 37% of seniors.
Covered California: Promoting Health Equity and Reducing Health Disparities Covered California Board Meeting March 21, 2013.
 Agreed upon fees paid for coverage of medical benefits for a defined benefit period. Premiums can be paid by employers, unions, employees, or shared.
Transition to Reform in Wisconsin Donna McDowell, Director Bureau of Aging & Disability Resources Department of Health Services D. McDowell1.
PACE: A Foundation for Serving People with Intellectual Disabilities? Peter Fitzgerald National PACE Association Alexandria, VA
The Health of the Nation. Judging the Health of a Nation Quality of its doctors and medical institutions Doctors from all over the world come to the U.S.
Avalere Health LLC | The intersection of business strategy and public policy Enrollment in the Medicare Drug Benefit Medicare Congress Audioconference.
Avalere Health LLC | The intersection of business strategy and public policy The Impact of Enrollment in the Medicare Prescription Drug Benefit on Premiums.
AFFORDABLE CARE ACT CONSUMER IMPACT. WHAT’S CHANGING WITH THE ACA? What’s not changing with the ACA? Will have broad impact that affects some population.
Health Reform: An Overview Unit 4 Seminar. The Decision The opinions spanned 193 pages, upholding the individual insurance mandate while reflecting a.
HEALTHCARE FINANCE Tracy Grant Viterbo University.
An Overview of Rural PACE 1 st Educational Series Conference Call – 2:00 PM, 1/26/04 Presented by: Rural PACE Technical Assistance Program.
August 16, 2011 MRT Managed Long Term Care Implementation and Waiver Redesign Work Group.
Our Healthcare System: Its Challenges Rising healthcare costs Growing numbers of uninsured Increasing shortages of caregivers Accelerating numbers of.
1. The Healthcare Economy in Transition/ An Overview of the Emerging ACO Imperative Erik Johnson Senior Vice President, Avalere Health 2.
Key Challenges in extending social security. Social Security: key Challenges   Social Security as a human right? Or is it individual responsibility?
Keith J. Mueller, PhD Director, RUPRI Center for Rural Health Policy Analysis Head, Department of Health Management and Policy College of Public Health.
22 nd Annual Rural Health Policy Institute Deputy Administrator, HRSA Marcia K. Brand, PhD January 24, 2011.
Brian C. Martin, Ph.D., MBA East Tennessee State University
Experiences with the Marketplace
Consumer-Directed Medicaid: An Overview Jon Blum June 14, 2007
The State of Healthcare Benefits
Lecture 9: PHC As a Strategy For HP Dr J. Sitali
Tit Albreht | Brussels | 7 November 2017
Communication Tools: Sample PowerPoint presentation
Communication Tools: Sample PowerPoint presentation
Presentation transcript:

Avalere Health LLC | The intersection of business strategy and public policy Medicare in 2008+: A Framework for Discussion November 2, 2005 Jon Glaudemans Avalere Health LLC

© Avalere Health LLC Page 2 Medicare in 2008+:Trends, Challenges, and Choices  Consumerism  Demographics  Technology  Genomics  Participation  Partnership  Enrollment  Solvency  Price Setting  Care Management

© Avalere Health LLC Page 3 Societal Trends Consumerism  Demographics   Will beneficiaries’ ability to manage more of their own coverage and care decisions keep pace with nuanced Medicare plan differences and more complex medical decisions?  What role will consumers’ perceptions about care play in determining payment levels at the practitioner level?  How will Medicare adapt to the bifurcated Medicare population and the varying preferences and needs of the healthy aged vs. the frail elderly?  How will Medicare and Medicaid coordinate their support of condition-appropriate care to the low-income, frail elderly population?

© Avalere Health LLC Page 4 Medical Trends Innovative Technologies  Genomic Advances   How will Medicare use emerging data on new and existing treatments in determining coverage and payment?  How will Medicare promote and/or respond to the increased information and evidence that might enable customized care for individual conditions and illnesses?  As our ability to assess individual-level risk factors increases, how will Medicare use this data while retaining its social insurance function and preventing discrimination?  As our ability to fashion personalized Rx treatments increases, how will Medicare adapt?

© Avalere Health LLC Page 5 Financial Challenges Part D Enrollment  Trust Fund Solvency   If enrollment lags projections and premiums rise in 2008+, what choices are available to Medicare and its beneficiaries?  What can and should Medicare do in 2006/7 to assure a broad and representative risk pool for Part D enrollees into the future?  As Medicare’s solvency deteriorates, what will be the impact on Part D’s benefit structure and progressiveness?  How will Medicare balance beneficiaries’ view of Medicare as a “defined benefit” with the statute’s “defined contribution” approach?

© Avalere Health LLC Page 6 Relationship Challenges Provider Participation  Business Partnership   As Medicare expands its reliance on primary care physicians, are market forces sufficient to assure an adequate supply?  How will Medicare exert its market power in areas of e-technology and evidence- based medicine without jeopardizing physicians’ willingness to participate?  Will Medicare prove to be a sufficiently reliable “partner” with private plans in terms of transparency and predictability?  How will private “partners” be held publicly accountable?  How will Medicare address below-average performers in pay-for-performance?

© Avalere Health LLC Page 7 Policy Choices Price Setting  Care Manager   Can Medicare continue to rely on private entities (MACs, PDPs, MA-PDs) to establish market-based price/coverage policies?  If Medicare continues its move to capitated payment systems, will its fee-for-service policies follow – and not lead – private sector decisions?  What will be the respective roles of the Medicare program and its beneficiaries in playing a more aggressive role in “managing” care?  Will efforts to manage elements and/or episodes of care (e.g., radiology, diabetes) perpetuate artificial boundaries of care?

© Avalere Health LLC Page 8 Medicare in 2008+: Trends, Challenges, and Choices  Consumerism  Demographics  Technology  Genomics  Participation  Partnership  Enrollment  Solvency  Price Setting  Care Management