1. ACA 2010 and Seniors 2011 Annual Conference Maryland Gerontological Association Chad Boult, MD, MPH, MBA Professor of Public Health, Nursing and Medicine Johns Hopkins University

2. “We simply cannot afford to postpone health care reform any longer. We must attack the root causes of the inflation in health care.” Barack Obama June 2, 2009

3. 2011 ANNUAL REPORT OF THE BOARDS OF TRUSTEES OF THE FEDERAL HOSPITAL INSURANCE (Part A) AND FEDERAL SUPPLEMENTARY MEDICAL INSURANCE (Parts B and D) TRUST FUNDS “Total benefits paid in 2010 were $516 billion.” “Income was $486 billion.” “Part A trust fund is estimated to be exhausted in 2024, 5 years earlier than was shown in last year's report. ”

4. Medicare 5% Sample, 2001 The ¼ of Beneficiaries Who Have 4+ Chronic Conditions Account for 80% of Medicare Spending * * $516 billion in 2010

5. For the chronically ill, the U.S. health care system is Fragmented Discontinuous Difficult to access Inefficient Unsafe Expensive “A nightmare to navigate” Institute of Medicine, Crossing the Quality Chasm, 2001

6. What Does the ACA Do? It tries to save money for the Medicare and Medicaid programs by: Moving payment from FFS to VBP (value-based purchasing) - to incent providers to operate more efficiently. Promoting greater collaboration between the federal and state Medicaid programs.

7. Moving payment from FFS to VBP VBP is paying for value rather than volume: Accountable care organizations (ACOs) Transitional Care Independence at Home Medical/health homes: MAPCP, FQHC, HH demos

8. Promoting collaboration between the federal and state Medicaid programs Federal Coordinated Health Care (“Duals”) Office: 15 state contracts Nationwide program for providing technical assistance, eg., to assess, certify and develop health homes within states.