The Patient Protection and Affordable Care Act [PPACA = ACA] ASAP Meeting Austin, Texas July 22, 2010 Norman H. Chenven CEO & Founder Austin Regional Clinic

Dr. George’s Charge: “Give a minute talk on the implications of healthcare reform for the care of patients with chronic disease and/or congenital abnormalities.”

Problems: American Health Care million Americans uninsured Too expensive Quality is erratic Inadequate information systems Lack of “System” Shortage of primary care access

What Did We Get? The Short Answer: An expansion of coverage An expansion of coverage Some health insurance regulatory reform Some health insurance regulatory reform Incentives to improve information systems Incentives to improve information systems Incentives to reward quality Incentives to reward quality Pilot projects to: Pilot projects to: Encourage the development of integrated/coordinated delivery systems. Encourage transparency with reporting on access, quality, service and cost. Reward efficiency and reduce cost.

Problem #1: 45 Million Americans Uninsured Expand Medicaid Mandates for employers and individuals. Subsidies for employers and individuals. Health insurance exchanges. High risk pool mandate. Residual uninsured: 10 – 20 million (illegal immigrants, penalty payers, other).

Problem #2: Too Expensive Pilot programs to encourage accountable care organizations (ACO) and payment bundling. Minimal concessions from the hospital and pharmaceutical industries for price reduction. A grab-bag of tax increases on insurers, very wealthy individuals, Medicare tax increase, “Cadillac” plan taxes, etc. Reduce Medicare Advantage subsidies. Tax on sun tanning salons.  But, in reality, the ACA does not adequately address increasing costs.

Problem #3: Erratic Quality Supports medical research and comparative effectiveness research. Mandates incentive payments for physicians and hospitals to measure and report on quality. Various pay-for-performance programs.

Problem #4: Inadequate Information Systems Fiscal Stimulus Bill provided $20 billion to install electronic medical records (EMR) and develop community based health information exchanges (HIE). Financial reward for quality reporting which will require more sophisticated IT systems.

Problem #5: Health Care System is Not a System Encourages the development of Accountable Care Organizations (ACO). Encourages the development of Patient Centered Medical Homes (PCMH).

Problem #6: Shortage of Primary Care Access Increase Medicare and Medicaid payments to primary care doctors. Increase payments for behavioral health. Promote Patient Centered Medical Homes (PCMHs). Fund primary care, Nurse Practitioner & Physician Assistant training programs. Administrative simplification mandates. Encourage and fund medical and nursing school expansions.

Patients with Chronic Disease or Congenital Abnormalities Prohibits insurance companies from denying coverage to children with pre-existing conditions (Fall, 2010). Prohibits insurance companies from denying coverage to any individual with a pre-existing condition (Jan, 2014). Limits premium variation to no greater than 3:1…except for age, geography, family size to tobacco use (Jan, 2014). Eliminates lifetime caps on insurance payments.

Patients with Chronic Disease or Congenital Abnormalities, cont’d: Extends ability of young adults to stay on parents insurance until age 26 (Fall, 2010). Preventive Health Services (U.S. Preventive Service Task Force) covered with no cost. Creates state based insurance exchanges and tax credits for low income individuals. Prohibits insurance policy rescissions unless well justified.