Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association Health Reform and New Jersey Sally Roslow 609-275-4224 [email protected]

Source: New Jersey Hospital AssociationCopyright 2010, New Jersey Hospital Association

Health Reform and New Jersey

Sally Roslow

609-275-4224

[email protected]


Agenda

Political Outlook

National Healthcare Reform

State Update

http://z.about.com/d/politicalhumor/1/0/K/K/3/Obama-Sings-HCR.jpg




GOP Challenges• Unlikely to have two-thirds vote

necessary to override presidential vetoes

• Law responds to genuine needs

• Law saves government money…repealing provisions could be “spenders”

• Many provisions “connected”


National Healthcare Reform


Key Items in Reform

32 million covered (expansion begins 2014) 923,000 New Jerseyans

300,000 Medicaid 600,000 Exchange

Insurance mandate (2014) Large employers pay $2000/employee fee

Insurance market reforms No lifetime caps Children up to age 26 Can’t deny coverage for pre-existing conditions


Medicaid expansion – 133% of FPL Tax on Cadillac Plans (2018) Closes Medicare prescription drug

“donut hole” Geographic variation

$400 million carrot for low cost / high quality states

IOM study

Key Items in Reform cont’d


Readmissions – imposes penalties for “excess” readmissions (heart attack, heart failure & pneumonia)

$7.1 billion over 10 years (2013)

Key Items in Reform cont’d


Healthcare Reform 2010-2019

Cost – $1 trillion/10 years

Coverage – 32 million

How – Individual and employer mandates

– Medicaid expansion

– Insurance exchanges

NJ Specifics – 923,000 of 1.3 million uninsured covered

– Hospitals will contribute $4.5 billion/ 10 years


Strategic Directions

Movement away from fee-for-service toward integration

Emphasis on value versus volume

Emphasis on quality versus quantity


“The Secretary Shall”

“The Secretary shall…”

Primary Care

Physicians

Specialty Care

Physicians

Outpatient Hospital Care and

ASCs

Inpatient Hospital Acute Care

Long Term Acute

Hospital Care

Inpatient Rehab

Hospital Care

Skilled Nursing Facility

Care

Home Health Care

Medical HomeMedical Home

Acute Care BundlingAcute Care Bundling

Acute Care Episode with PAC BundlingAcute Care Episode with PAC Bundling

Post Acute Care (PAC) Episode BundlingPost Acute Care (PAC) Episode Bundling

Accountable Care OrganizationsAccountable Care Organizations

Rethinking the Organization of CareWhere is your place? What is realistic? What is achievable?

Source: The American Hospital Association (AHA)


Reinvent ourselves as we continue to provide quality care, largely under old system (volume and procedures) even as we shift to P4P

Anticipate impact of reduced payments from Medicare

Get ready to jump to new way of doing business But don’t jump too soon or too late Many advise acute care hospitals to plan to reduce

costs to maintain profitability at Medicare rates

Strategic Issues for Hospital / Healthcare Leaders


Strategic Areas to Focus Upon

Enhance efforts to improve quality and patient safety (Focus on outcomes, care coordination, evidence based medicine & comparative effectiveness)

Reduce variation in care in your organization (then region, then state… county)

Increase clinical and operational efficiencies

Reduce avoidable readmissions


Strategic Areas to Focus Uponcont’d

Conduct community needs assessment (req’d for tax-exempt hospitals)

Assess/strengthen plan for HIT and EHR. Move to doctor/patient/hospital connectivity

Examine readiness for episodic payment, care redesign and ability to manage care across continuum

Foster better alignment with physicians

Quality

Health IT

Clinical Integration

Making Delivery System Reform a Success

Three Keys to Delivery System Reform


NJHA Healthcare Reform Resource Center

http://www.njha.com/Reform

Implementation schedule

Grant opportunities

Regulations

News and updates

Resources and links


The state is projecting a $10.5 billion budget shortfall on an approximately $30 billion budget

Cuts and reductions in governmental spending are highly anticipated

DHSS looking at consolidating funding

CMS approval of current budget plan still pending Increased assessment moving forward

FY12 State Budget


Healthcare Reform :State Implementation

NJ Protect High Risk Pool - Initiated August 2010 Administered by Horizon Blue Cross Blue Shield Coverage to approximately 21,000 individuals

Insurance Exchange Must be operational by Jan. 1, 2014 NJ DOBI recently awarded $1 million grant to review

exchange creation


Healthcare Reform :State Implementation

Insurance Reform August 16, 2010, NJ receives $1 million grant to

conduct premium reviews of health insurance companies

Medicaid Expansion Beginning Jan. 1, 2014, Medicaid coverage will be

expanded to 133% of the federal poverty level for non-elderly individuals


Questions?

Documents

Source: New Jersey Hospital Association Copyright 2010, New Jersey Hospital Association Health Reform and New Jersey Sally Roslow 609-275-4224 [email protected]