1. THE HEALTH CARE SAFETY NET
COMTEMPLATING THE FUTURE

2. ********************************************************
TODAY… High levels of uncompensated care continue to pressure safety net provider’s fragile funding base …
2016, the Cost of Uncompensated Care (UCC) UWMedicine provided to low income un/under insured exceeded $233M.
UWMedicine also incurred $128M in unfunded costs related to Graduate Medical Education (GME)
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The primary source of UCC is services provided to those covered through government sponsored programs (e.g. Medicare, Medicaid).
UWMedicine funds UCC primary through the margin earned on services provided to the commercially insured.

3. Current … Trends threaten to destabilize safety net provider’s fragile funding base …
PUBLIC PROGRAMS
PRIVATE INSURANCE
ACA Fix/Replace
AHCA ($24M/yr.)
BCRA ($83m/yr.)
Disproportionate Share (DSH)
Medicare ($28m/yr.)
Medicaid ($33M/yr.)
Medicaid Managed Care Rule – Supplemental Payments ($100m/yr.)
340B Drug Discount Program ($4m/$30m/yr.)
Provider Based Payment ($14m/yr.)
Market Pressure
Shift to VBP
Narrow Networks
HBE/Individual Market Instability
Cost shifted to consumers, increasing out of pocket costs
Premiums, Co-pays, Deductibles
HSA/High Deductible Plans
Causing patients to delay seeking care, increasing the cost of care and provider’s bad debt exposure
General Trends –
Aging of population from private insurance into Medicare
Work force shortage and required realignment of professional training

4. QUESTIONS?
COMMENTS?