1. Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e This material (Comp1_Unit9e) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. The Evolution and Reform of Healthcare in the US Learning Objectives 2 Describe evidence-based medicine, clinical practice guidelines, and quality indicators in medicine (Lecture a, b, c) Describe the patient-centered medical home model (Lecture d) Discuss the key issues driving healthcare reform in the US (Lecture e) Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e

3. Healthcare Reform In The US 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Long history of healthcare reform in the US The Social Security Amendments of 1965 –President Lyndon B Johnson signed the bill –2 amendments to the Social Security Act of 1935 Title XVIII – later known as Medicare –Part A: hospital insurance for elders –Part B: supplementary medical insurance Title XIX – later known as Medicaid –healthcare for economically disadvantaged individuals

4. The EMTALA Act The Emergency Medical Treatment and Active Labor Act (EMTALA) –Passed by Congress in 1986 Part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) –EMTALA mandates hospitals and ambulance services to provide care to all, without discrimination –Applies to hospitals that participate in Medicare program 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e

5. The CHIP Program 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e State Children's Health Insurance Program (SCHIP), also known as the Children's Health Insurance Program (CHIP) –Legislated in 1997 under title XXI of the Social Security Act –Administered by the Department of Heath and Human Services –Provides matching funds to states to insure children

6. The HIPAA Act 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Health Insurance Portability and Accountability Act (HIPAA) in 1996 Workers could keep health insurance coverage with a change in their job status Mandated standards for protecting privacy and confidentiality of health information

7. Attempting Comprehensive Healthcare Reform 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Unsuccessful attempts: –1933: President Franklin D Roosevelt attempted to include public funding for healthcare programs in the Social Security Act –1949: President Harry Truman considered universal healthcare as part of the Fair Deal plan –1974: President Richard Nixon introduced the Comprehensive Health Insurance Act

8. Attempting Comprehensive Healthcare Reform (continued) 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Unsuccessful attempts: –1993: Task Force on National healthcare Reform, headed by First Lady Hillary Rodham Clinton Aim: to provide universal healthcare –2001: Patient Bill of Rights - allowed fundamental rights for patients as consumer

9. Two New Acts: New Healthcare Reform Measures 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Patient Protection and Affordable Care Act (PPACA) –Signed by President Barack Obama on March 23, 2010 Healthcare & Education Reconciliation Act –Signed on March 30, 2010

10. Insurance Reform 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Affordable Care Act, 2010 –The Pre-Existing Condition Insurance Plan (PCIP) administered by states or the US Department of Health and Human Services Is a new health coverage option for patients who currently cannot get health insurance Plan functions until 2014 In 2014: start of health insurance exchanges –Competitive marketplace where individuals and small businesses can buy health benefit plans from a menu of choices

11. Insurance Reform (continued) 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Individual and group health plans cannot have lifetime dollar value limits Insurers cannot rescind coverage in most cases No pre-existing condition exclusions for children As of September 2010, young adults under age 26 can usually be insured under a parent’s insurance Improved insurance options for early retirees Insurers must justify increases in health plan premiums

12. Preventive Care Reform 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Health plans will be required to offer many preventive services without charging a co- payment or deductible Preventive services that are rated A or B by the US Preventive Services Task Force will be included in this reform

13. Preventive Care Reform (continued) 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Establish the National Prevention, Health Promotion and Public Health Council to develop a national strategy to improve the nation’s health Require chain restaurants and food sold from vending machines to disclose the nutritional content of each item

14. Medicare Reform 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e The life of the Medicare Trust fund will be extended to at least 2029 Commitment to reduce Medicare fraud by 50 percent by 2012 In 2011 -- 50% discount on brand-name drugs when patients reached the Medicare Part D coverage gap (prescription ‘donut hole’ ) Patients will pay less every subsequent year until 2020, when the Medicare Part D coverage gap will disappear

15. Medicare Reform (continued) 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Efforts to improve care coordination between clinicians to reduce unnecessary hospital re-admissions Hospitals will receive incentives to improve quality of care measures After 2014, the Affordable Care Act limits the amount that Medicare Advantage plans can spend on administrative costs and profits

16. Medicaid Reform 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Increase the Medicaid drug rebate percentage Establish the Community First Choice Option in Medicaid Create a new plan option to permit Medicaid enrollees to designate a provider as a health home

17. Quality Improvement 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Develop a national quality improvement strategy Establish a non-profit Patient-Centered Outcomes Research Institute to support comparative effectiveness research Improve coordination and integration of healthcare services for low-income, uninsured and underinsured populations by setting up a Community-based Collaborative Care Network Program

18. Workforce Reform 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Establish a Workforce Advisory Committee to develop a national workforce strategy Establish Teaching Health Centers to assist primary care residency programs Provide scholarships and loans for health professionals

19. Malpractice Reform 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Fear of medical liability leads physicians to practice “defensive medicine” 25 million dollars in grants to states to reduce medical malpractice law suits (Massachusettes Medical Society, 2008)

20. Prescription Drug Reform 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Authorize the Food and Drug Administration (FDA) to approve generic versions of biologic drugs FDA can grant biologics manufacturers 12 years of exclusive use before generics can be developed

21. Other Changes In 2014 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e By 2014: –US citizens and legal residents will be required to have qualifying health coverage –Limits on deductibles for health plans in the small group market –American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges will be created

22. Attempts to Repeal Healthcare Reform Law 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e Legislative attempts –Members of 111 th Congress introduced bills, but these did not progress –112 th Congress voted in 2011 to repeal the Patient Protection and Affordable Care Act and portions of the Healthcare and Education Reconciliation Act of 2010 –Unlikely to be approved by the Senate or President Obama Legal attempts –In 2011 a federal judge in Florida declared law unconstitutional

23. What Is The Best Way To Reform US Healthcare? 23 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e One opinion: “To reform US healthcare, start with systematic reviews” –Kay Dickersin, Director Center for Clinical Trials, Director US Cochrane Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD The United States has lagged behind other countries in making a national commitment to creating and utilizing research on “what works” Evidence-based healthcare: “the integration of the best research evidence with clinical expertise and will incorporate patient values”

24. The Evolution and Reform of Healthcare in the US Summary – Lecture e 24 Provided history of healthcare reform Detailed most recent healthcare reform legislation Discussed impact of healthcare reform legislation on the future Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e

25. The Evolution and Reform of Healthcare in the US Summary Described Evidence-Based Practice, clinical practice guidelines, and quality indicators in medicine Introduced the patient-centered medical home Presented the key aspects of healthcare reform in the US 25 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e

26. The Evolution and Reform of Healthcare in the US References – Lecture e References Adamy, J. (2010, June 1). Grants Aim to Reduce Medical Malpractice Lawsuits. Retrieved December 6, 2011, from The Wall Street Journal. Politics website: http://online.wsj.com/article/SB10001424052748704312104575299260780573220.html http://online.wsj.com/article/SB10001424052748704312104575299260780573220.html Bihari, M. (2010). Understanding the Medicare Part D Donut Hole Learn About the Medicare Part D Coverage Gap - Hitting the Donut Hole. Retrieved December 6, 2011, from About.com Health Insurance website: http://healthinsurance.about.com/od/medicare/a/understanding_part_d.htm http://healthinsurance.about.com/od/medicare/a/understanding_part_d.htm Emergency Medical Treatment & Labor Act (EMTALA) - Overview. (2011). Retrieved December 6, 2011, from Centers for Medicare and Medicaid Services website: https://www.cms.gov/emtala/https://www.cms.gov/emtala/ Good News for People with Medicare. (2010). Retrieved December 6, 2011, from HealthCare.gov. website: http://www.healthcare.gov/ http://www.healthcare.gov/ Investigation of Defensive Medicine in Massachusetts. Retrieved December 6, 2011, from Massachusetts Medical Society website: http://www.massmed.org/AM/Template.cfm?Section=Research_Reports_and_Studies2&TEMPLATE=/CM/Content Display.cfm&CONTENTID=27797 http://www.massmed.org/AM/Template.cfm?Section=Research_Reports_and_Studies2&TEMPLATE=/CM/Content Display.cfm&CONTENTID=27797 Medicaid and CHIP Program Information. (n.d.). Retrieved December 6, 2011, from Medicaid.gov website: https://www.cms.gov/home/chip.asp https://www.cms.gov/home/chip.asp Patient Protection and Affordable Care Act (PPACA). (2010). Retrieved December 6, 2011, from Marrs Maddocks + Associates Insurance Services, Inc. website: http://ppaca.com/index.php?page=hcr-timelinehttp://ppaca.com/index.php?page=hcr-timeline 26 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e