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Health Reform: A Contrarian’s Perspective Presented by: Si Nahra, Ph.D., President February 28, 2012
© Copyright 2012 Health Decisions, Inc. 2 Pioneering Specialists in Group Health Care Post-Payment Administration for 25 Years Unblemished track record – no HIPAA violations or employee issues First with 100% claim audits Introduced the use of claim audits for recovery Originated linking of enrollment reconciliation with claim audits Started dependent eligibility audits 15 years ago Revolutionized data intake with payer-defined data – always successful Re-defining competitive bidding Extending control of data to self-funded plans of all sizes Putting meaning into fiduciary oversight via Routine Plan Monitoring
Why You Are Here Health reform in America has little to do with the Affordable Care Act (AKA “ObamaCare”). This effort, like so many before it, will leave behind layers of new rules and regulations. But true health reform will continue in spite of and not because of federal efforts. This webinar will attempt to put US health reform into perspective by exploring its contradictions and by examining how we have reformed – and are reforming still -- our definitions of “need” and “risk” without government dictates. © Copyright 2012 Health Decisions, Inc. 3
Approach Five Contrarian Couplets Brief Histories of Need and Risk NOT trying to convince anyone. Just trying to broaden the discussion. Lack of Q&A a blessing and a curse. Follow-up discussions welcomed. © Copyright 2012 Health Decisions, Inc. 4
Five Contrarian Couplets Written before Obama even ran for president. Changed very little over time. Each Couplet could be its own webinar. Here, they provide an orientation. –One and Two eliminate distractions –Three and Four offer an alternative orientation –Five hazards a guess at where reform is going © Copyright 2012 Health Decisions, Inc. 5
Contrarian Couplet #1 The US should adopt a single-payer, National Health Insurance (NHI) system. No one alive today will live to see the US adopt a single-payer, NHI system. © Copyright 2012 Health Decisions, Inc. 6
Contrarian Couplet #2 Public policy debate about health reform will continue to rise and fade producing incremental reforms that further complicate an already complex health system. Actual reform will continue unabated, outside the public policy arena, adapting and assimilating any pubic policy initiatives. © Copyright 2012 Health Decisions, Inc. 7
Contrarian Couplet #3 Americans are not willing to pay premiums for health insurance they may not use. Americans are willing to pay a fair price for health services they use. © Copyright 2012 Health Decisions, Inc. 8
Contrarian Couplet #4 Uninsured persons are now a permanent (but ever changing) part of the US health system. The terms “uninsured” and “underinsured” are obsolete and should be replaced by the concept of the “self-funded individual” which encompasses all Americans. © Copyright 2012 Health Decisions, Inc. 9
Contrarian Couplet #5 Collective actions by corporate interests have led to the US health system we have today. Collective actions of organized individuals will truly reform the US health system of tomorrow. © Copyright 2012 Health Decisions, Inc. 10
A Brief History of Reform PeriodNeedRisk Post WWII - 1960How much more do we need? (Hill-Burton) Rise of BCBS and community rating 1960’s – 1980’sWhat do we really need? (CON and “H S A”) Underwriting/HMO/ self- funded groups 1980’s – 2000’sWhat do we need to pay for? (Medicare) Risk shifting Higher cost sharing 2000’s – CurrentDo YOU really need that? (personal responsibility) Self-funded individual © Copyright 2012 Health Decisions, Inc. 11
The Future? Self-funded plans will focus on individual enrollees not employees and their families. Self-funded plans can facilitate individual communication and action. Areas where self-funded plans and individual financial interests align: –Improper use of Emergency Rooms –Chronic care management –Prescription drug costs –Others? © Copyright 2012 Health Decisions, Inc. 12
© Copyright 2012 Health Decisions, Inc. 13 Past Webinars Available Recordings of past webinars are available upon request, or through Si’s Library ( www.healthdecisions.com/library ) including: www.healthdecisions.com/library December, 2011 – 2012: What Does it Hold for Self-funded Health Plans? November, 2011 – Overpayment Collection October, 2011 – Finding Provider Fraud September, 2011 – Complete Enrollment Validation August, 2011 – New HIPAA Accounting Requirements July, 2011 – Dos and Don’ts of Competitive Bidding June, 2011 – You’ve Done a Dependent Audit. Now What? May, 2011 – Two Dozen Reasons for Claim Payment Error April, 2011 – How Does Your Plan Compare? March, 2011 – How Medicare Can Help Employer Health Plans February, 2011 – Administrative Fee Inflation
© Copyright 2012 Health Decisions, Inc. 14 For More Information Contact email@example.com 734-451-2230
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