Health Reform: Local Safety Net Implications Karen J. Minyard, Ph.D., Executive Director, Georgia Health Policy Center, Georgia State University

Sources of Coverage in North Carolina: Before and After Full Implementation of Health Reform Note: This shows the non-elderly and is a preliminary estimate, subject to revision. “Other” is comprised of the following: Medicare (disabled or end-stage renal patients), Champus, CHAMPVA (coverage for armed forces and veterans families) and Indian Health Services. Estimates are based on 2008 numbers.

Remaining Uninsured Approximately 1/4 to 1/3 will be non-citizens Those with incomes between 100% and 250% have income volatility that results in transitions in and out of Medicaid eligibility and insurance subsidy categories Those who are uninsured are likely to be younger and healthier than those currently uninsured and those who become insured

Medicaid Insurance Subsidies Approximately $1 Trillion Fees, Penalties, Medicare & Taxes Savings Funding & Spending Sources of Revenue Federal Expenditures

Changes in Public Coverage Changes in Private Coverage Improving Health Care Quality Improving Health Major Components of Change

BEHAVIORAL HEALTH CHRONIC DISEASE MANAGEMENT DIAGNOSTIC SERVICES Rx MEDS EMERGENCY & TRAUMA CARE SOCIAL SERVICES ORAL HEALTH PUBLIC HEALTH DEPARTMENTS COMMUNITY SERVICE BOARDS FQHCs HOSPITALS NON- PROFIT CLINICS PRIVATELY INSURED PATIENTS STATE FUNDS CHARITABLE CONTRIBUTIONS PATIENT FEES DRUG COMPANIES COUNTY FUNDS FEDERAL FUNDS NEEDS OF THE UNINSURED PRIVATE OFFICES PRIMARY CARE SAFETY NET PROVIDERSFINANCING SOURCES DURABLE MEDICAL EQUIPMENT Rx DRUG PROGRAMS COORDINATION OF CARE IN- PATIENT CARE SPECIALTY CARE

NEEDS OF THE UNINSUREDSAFETY NET PROVIDERSFINANCING SOURCES

An Example of the Impact of Health Reform on the Healthcare Workforce in Georgia Approximately 1.2 million Georgians will gain health coverage through Medicaid and Health Insurance Exchanges Rough estimates indicate that this coverage will generate 1.2 – 2 million additional physician visits per year in Georgia* This translates into an additional shortfall of physicians in Georgia* The elimination of copays, deductibles, and coinsurance for many preventive services may also increase the demand for primary care providers *Dr. Patricia Ketsche, Associate Professor, Institute of Health Administration, J. Mack Robinson College of Business, Georgia State University

Health Reform Provisions to Increase Primary Care Workforce $11 billion to increase/expand Federally Qualified Health Centers (FQHCs). Reallocation of unused medical residency sites with preference to high need states State workforce planning grants Loan repayment and scholarship programs Primary Care Extension Program Increases in Medicare and Medicaid payments for primary care providers

8 Critical Activities Provide Access to Affordable Prescriptions Culturally & Linguistically Competent Medical Homes Manage Chronic Diseases Assure Access to Specialty & Hospital Care Coordinate Care Continuum Connect to Prevention & Wellness Services Outreach & Enroll into Eligible Programs Develop Strategies to Provide Access/Cover Low-Wage Workers

Grant Opportunities Prevention and Wellness Community Transformation Grants Grants to Promote Positive Health Behaviors and Outcomes Incentives for Preventing Chronic Disease in the Medicaid Population Maternal, Infant, and Early Childhood Home Visiting Programs National Diabetes Prevention Program Small Employer Workplace Wellness Grants Coordination Navigators -Health Insurance Exchange -Patient Community-Based Care Transitions Program Community Health Teams Community-Based Collaborative Care Network Program Community Benefit Quality Care Medication Management Services in Treatment of Chronic Diseases Primary Care Extension Program Health Professions Training and Continuing Education National Centers of Excellence for Depression

Reflection From the perspectives of Care Share and the local networks: –What will be the key needs and outcomes related to health reform that the program and the local networks should focus on? –What do you see as the “levers” of highest value? –How is this different during transition and after full implementation?

Reflection During Transition Needs/ Outcomes High Value Levers Program Level Local Networks After Full Implementation Needs/ Outcomes High Value Levers Program Level Local Networks