1. October 13, 2010 1:45 – 3:00 pm Opening Plenary: Perspectives on Reform Richard J. Umbdenstock, FACHE, President and Chief Executive Officer, American Hospital Association Lead Sponsor Supporting Sponsor Riddell Williams, P.S

2. Washington State Hospital Association 78 th Annual Meeting “Perspectives on Reform” October 13, 2010

3. Washington State Hospital Association - AHA Partnership AHAPAC – 100% of goal or more since 1996! Three quarters of Washington state hospitals are AHA members! National Leadership: Dr. Mark C. Adams – AHA Board of Trustees Douglas Conrad PhD – Committee on Research Kimberly McNally – Committee on Governance RPBs, Councils, Committees, and Task Forces Partnership

4. Overview Health care reform 2010 mid-term elections A look ahead – strategic direction

5. Health For Life

6. Health for Life Framework and the New Health Care Reform Law $12.9 billion prevention and public health fund Increases access to preventive services Zero cost sharing for recommended preventive services (public & private insurance) Annual Medicare wellness visits Grants for workplace wellness programs Creates a national public health council with advisory groups $12.9 billion prevention and public health fund Increases access to preventive services Zero cost sharing for recommended preventive services (public & private insurance) Annual Medicare wellness visits Grants for workplace wellness programs Creates a national public health council with advisory groups Public/Private comparative effectiveness institute with steady funding Hospital Value-Based Purchasing (VBP) Enhanced public reporting Numerous provisions to reduce health disparities National quality center Public/Private comparative effectiveness institute with steady funding Hospital Value-Based Purchasing (VBP) Enhanced public reporting Numerous provisions to reduce health disparities National quality center Pilot programs on payment bundling Accountable Care Organizations (ACOs) Center for Medicare and Medicaid Innovation (CMI) Independent Payment Advisory Board (IPAB) Administrative Simplification Pilot programs on payment bundling Accountable Care Organizations (ACOs) Center for Medicare and Medicaid Innovation (CMI) Independent Payment Advisory Board (IPAB) Administrative Simplification HIT Medicare/ Medicaid Incentive programs (ARRA) Expansion of broadband technology (ARRA) Funding for HIT infrastructure (ARRA) HIT Medicare/ Medicaid Incentive programs (ARRA) Expansion of broadband technology (ARRA) Funding for HIT infrastructure (ARRA) 32 million more people with health insurance Shared responsibility - Individual mandate, employer “play or pay,” government subsidies Expands public programs 32 million more people with health insurance Shared responsibility - Individual mandate, employer “play or pay,” government subsidies Expands public programs

7. A Good Start! Initiating major insurance reforms Setting in motion future payment and delivery system reforms Increasing the focus on wellness and prevention Coverage for 32M Americans The bill creates a good reform foundation by:

8. Key Dates For Hospitals: 2010 Insurance market reforms Payment – Geographic variation:  IOM studies  Summit – 340 B expansion – Medicare extenders

9. Delivery system reform –Center for Medicare and Medicaid Innovation Payment –Hospital payment update: market-basket minus 0.25 percentage point –Geographic variation: $150 million in funding –Redistribute GME slots Key Dates For Hospitals: 2011

10. Delivery system reform –ACO program –Readmission data verification Payment –Hospital payment update: market-basket minus 1.5% (productivity), minus 0.1* percentage point –Geographic variation: $250 million in funding *This extra % exempts hospitals from IPAB Key Dates For Hospitals: 2012

11. Delivery system reform –Bundling pilots –Readmission penalties –Value-based purchasing program Payment –Hospital payment update: market-basket minus productivity; minus 0.1* percentage point *This extra % exempts hospitals from IPAB Key Dates For Hospitals: 2013

12. Three Weeks And Counting… November 2, 2010! ? What will the mid-term election mean to health care reform implementation?

13. Ask Your Candidate – Post Election Advocacy Effort

14. Mid-term Elections Republicans need to flip 39 seats to take back control 49 districts held by Democrats in which John McCain beat Barack Obama Over on the House side

15. GOP Control of Congress New players on key committees Hearings, investigations and subpoenas Stake in governance Focus on deficit reduction Implications

16. Marginal Control by Democrats No working majority Blue Dogs key swing vote No actions possible without bipartisan support Focus on deficit reduction Implications

17. Deficit Reduction Commission BBA (Ten Year Impact) Health Reform Savings (Ten Year Impact) Commission Target (3 years) Spending reductions $ 836 billion$ 539 billion Medicare component of spending reductions $ 385 billion$ 155 billion Tax cuts$ 242 billion$ 38.6 billion Tax increases0$ 561 billion Net deficit reduction$ 594 billion$ 135 billion$ 440 billion +

18. Commission must report by December 1, 2010…after the election 18 members / bi-partisan 14 votes for recommendations Congressional leaders have pledged “to have a floor vote” on the recommendations…but: −Senate needs 60 votes to consider −Speaker Pelosi has said that House will not vote unless Senate passes recommendations Congressional Consideration

19. Key Implementation Areas for Hospitals Insurance reforms and exchanges Medicaid expansion and payment adequacy Program integrity and recovery audit contractor (RAC) expansion to Medicaid Tax-exempt hospital requirements Administrative simplification Workforce State- Based

20. Key Implementation Areas for Hospitals (Cont.) Integrated care models of delivery system reform (ACOs, bundling, medical home, CMS Center for Innovation) Major hospital payment changes (update reductions, Value Based Purchasing, readmissions, hospital-acquired conditions, variation) Reducing health disparities Delivery System Reforms

21. Strategic Directions and Take-Aways More INTEGRATION across the “silos” More AT-RISK FUNDING More PUBLIC ACCOUNTABILITY and reporting Increased coverage Delivery system reforms Payment reforms Increased transparency Adoption of health IT

22. Developing a Truly “Integrated System” Common Admin Systems Common Clinical Systems Continuum of Care Seamless Info & Hand-offs Goal: ONE… Registration Medical Record Patient Bill

23. CORE PERFORMANCE! (Quality/Safety/Efficiency/Clinical Integration/HIT/Etc) VALUE ADDED? (Geography/Population/Physicians/Continuum/Public Health/Etc) INFO EXCHANGE CAPABILITY? (Interoperable/Regional Exchange/Etc) INSURANCE RISK CAPABILITY? (Stratification/Allocation/Real Time Info/Etc) MAKE?BUY? MOST FEWESTINTEGRATED NOT COLLABORATE? SPECIALIZE/RE-PURPOSE STRATEGIC QUESTIONS

24. Thank you!