1. Cancer Care Delivery System Transformation
Kenda K. Klotz, MPA,RN
12/29/2018

2. Impact of the Affordable Care Act
Health Care Insurance Exchanges will be set up and ready for accrual by October 1st, 2013.
Private Insurers as well as non-profit federal insurers will be part of the exchange.
The plans will range from bronze to gold.
Bronze plans will have a high deductible but lower monthly costs.
Gold plans will have a much lower deductible but higher monthly costs.
Outcome: An increase in insured patients
Uncompensated care in hospitals should be reduced
12/29/2018

3. Changes in Reimbursement Structure
Medicaid Expansion –Supreme Court upheld the ACA, but they determined that states could opt out of the expansion.
Michigan: Governor Snyder pledged support in February 2013 and has retitled the expansion to Healthy Michigan.
Eligibility will be based on the following criteria:
19 to 64 years of age
138% above the poverty level ($32k for family of 4)
The Federal government will provide 100% of the premium for 3 years
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5. Changes in Care Delivery System
Expectation for the health care community will be to provide high quality care at reasonable cost.
Payment will change from fee for service to values based payment. (Quality, Cost, Outcomes)
Population Health, Accountable Care Organizations, Medical Home models are all ways to attempt to decrease cost, manage patients across the care continuum and provide stellar outcomes.
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6. Changes in Care Delivery System
What will be the value proposition for consumers of health care? For commercial payers? For employers?
Employers expectations:
Cost Demands
Transparency with quality metrics
Predictability
Manageability
Quality Demands
Timely Access
Clinical Excellence
Employee Productivity
Choice of Provider
How will employers drive value?
Benefit design, contracting strategy, cost sharing and wellness
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7. Changes in Care Delivery System
What will be the value proposition for consumers of health care? For commercial payers? For employers?
Commercial payer’s expectations:
Cost Demands
Predictability
Appropriate Utilization
Optimal Site of Care
Quality Demands
Patient Satisfaction
Accessibility
Evidence-based Practice
How will commercial payers drive value?
Narrow Networks
Comparative Effectiveness
Payment Pilots
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8. Changes in Care Delivery System
What will be the value proposition for consumers of health care? For commercial payers? For employers?
Patient’s expectations:
Cost Demands
Transparency
Predictability
Managability
Exclusion as a factor in treatment decision
Quality Demands
Timely Access
Clinical Excellence
Choice of Provider
Clear and Compassionate
Communication
How will patients drive value? By using their voice and executing their choice.
Value Based Purchasing: payments increasingly tied to patients’ experience.
Cancer specific Patient Experience Survey will be initiated.
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9. Thank You
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