Health Reform is More Than “Obamacare”

Getting Hit From All Sides

Senate Could Turn

Name of The Game

• Employer Mandates

• Minimum Essential Benefits

• ICD-10

• Meaningful Use Stage 2

• Physician Payment (SGR) Cuts

SGR Permanent Fix Proposal

• Rates Steady 2014 – 2023• Budget Neutral VBP model for providers

starting in 2017– 4% in 2017– 6% in 2018– 8% in 2019– 10% in 2020– Capped at 12% in 2021 and beyond

SGR Permanent Fix Proposal (Cont.)

• Professionals participating in APMs will receive 2% updates (2023), not subject to VBP and will receive 5% bonus each year (2017-2022)

• Current Law program penalties would end– 2% PQRS Penalty– 3-5% EMR MU Penalty

How Did Obamacare Enrollment Go?

LocationMarketplace

Type

Number of Individuals who have Selected a

Marketplace Plan

Estimated Number of Potential

Marketplace Enrollees

Percent of Potential

Marketplace Population

Enrolled

1. Vermont State-based 38,048 45,000 85.2%

2. California State-based 1,405,102 3,291,000 42.7%

3. Rhode Island State-based 28,485 70,000 40.6%

4. Florida Federally-facilitated 983,775 2,545,000 38.7%

5. Idaho State-based 76,061 202,000 37.7%

6. Michigan Partnership 272,539 725,000 37.6%

7. Connecticut State-based 79,192 216,000 36.7%

8. Maine Federally-facilitated 44,258 122,000 36.3%

9. North Carolina Federally-facilitated 357,584 1,073,000 33.3%

10. Washington State-based 163,207 507,000 32.2%

How Did Obamacare Enrollment Go?

NC Short Session… Living Up to Name

Thom Tillis (R) Kay Hagan (D)

Medicaid ACOs

Medicaid ACOs

• Benefits• Provider led• Creates budget certainty for

state government• Aligns incentives to get to

value-based care

• Negatives• Shifts risk• Moves very fast

Senate Budget is Bad News

• Stops work on Medicaid ACOs

• Makes permanent 3% “Withold” on all Medicaid payments

• Explores the idea of a provider assessment on physicians

Questions?