the 2012 Election

power point - Colorado Health Institute

Webinar Basics• How do I ask questionsduring the webinar?• Recorded webinar andPowerPoint slides will beavailable after the webinar.• Special thanks to our funders:2

Your PresentersMichele LueckPresident/CEOEmily KingResearch Analyst

Today’s Discussion• Implications for Colorado regarding thenational election• Trends we can count on in (still) uncertaintimes4

Three Take-Aways1. National election results point to a clearerpath ahead for ACA implementation.2. “Uncertainty” takes on a different, moreoperational flavor – dollars and timing.3. Trends afoot in Colorado to improve qualityand lower costs continue a forward march.5

Shifting Gears:The 2012 Election66

New CHI Publication7

Much Remains the Same• The ACA remains the law of the land• The balance of federal power remains largelyundisturbed• President (D), Senate (D), House (R)• The balance of state power has changed:• Governor (D), Senate (D), House (D)8

1. Will Colorado Participatein the ACA’s Medicaid Expansion?• Legislation favoring and opposing theexpansion is anticipated in the 2013 session• The cost of the Medicaid expansion is unclear• Democratic control may ease passage of anexpansion• Additional spending, given the tenuouseconomy, will be carefully watched9

At Issue:Adults Without Dependent Children, 101-133% FPL10

2. Will Colorado Health Care Programs Fall Off theFiscal Cliff?11

What to Watch in ColoradoFederal grant dollar availability;especially Exchange (COHBE)Medicare provider rates will be cutby 2%Funding of Colorado Department ofPublic Health and Environment at risk12

3. Will Uninsured ColoradansDecide to Buy Health Insurance?• Beginning in 2014, most Coloradans will berequired to have health insurance• The tax penalty may not be a strongdisincentive• The long-term viability of the Colorado HealthBenefit Exchange (COHBE) depends on adiverse risk pool13

Willing to Pay for Health Coverage• 20% of those whoare “able” to paysaid they are not“willing” to payanything• 1 in 10 are ableand willing to paybetween $1-$25per month14

4. Will More Colorado Employers ProvideAffordable Health Insurance?15

5. Will Pending Colorado Health Care ReformProjects Get Funding and Approval?• Expect a cascade of funding and rule-makingdecisions• The Department of Health and HumanServices is expected to release ACA rules andregulations• Colorado awaits word on a number of federalgrant applications16

6. Who Will Set the Health Policy Agenda in the2013 Legislative Session?• In Colorado:a shift of power tothe Democrats• GovernorHickenlooperand his reelection• New leadership inhealth committees17

Insight from the November 1 Budget Proposal• Proposed expenditures around systemefficiencies and integration:• MMIS• Dental benefits• BehavioralHealth expansions• Provider rates andnetwork adequacy18

Anticipate Alignment and Operations Changes• DOI and regulatory issues for Exchangeoperations• Waiver modernization from HCPF (and others)to better serve sub-populations19

Trends Afoot – Before,During and AfterElection-Year Politics2020

The Big Idea? Bend this Curve!21

What’s the Big Idea?22

A Primer: Federal And State InitiativesFederal Initiativesand Funding• Defining the “What”State Models ofInnovation• Finding the “How”23

Colorado Payment Reform Initiatives24

The Outlook: Five Trends1. The Role of Public – Private Partnerships2. Medicaid: The Promise of Integration3. Room for Experimentation: HB 12814. Whose Cost Curve? A Dilemma for SmallEmployers5. A Steep Learning Curve: PurchasingInsurance25

#1: The Role ofPublic- PrivatePartnerships2626

The Importance of Partnerships• Contractual agreement• Public agency (federal, state or local) and aprivate sector entity• Skills and assets of each are shared to delivera service or facility• For the use of the general public• Sharing in the risks and rewards• National Council of Public Private Partnerships•

An Example:Comprehensive Primary Care Initiative28

#2: Medicaid: ThePromise of Integration2929

Medicaid: The Promise of Integration30

Medical Home: Impact on Cost Control• CMHI demonstrates savings but targeted tolower-cost populations• Colorado programs still being evaluated, earlyreturns and national results encouraging• Complex, lengthy, resource-intense processfor practices to become medical homes31

#3: Room forExperimentation:HB 12813232

Room for Experimentation: HB 1281• HB 12-1281: The Medicaid Innovation Bill• Calls for payment reform pilot projects• Away from fee-for-service, toward global payment• Built on existing ACC framework• Pilots evaluated after 2-3 years33

#4: Whose Cost Curve?A Dilemma for SmallEmployers3434

Remember This?35

Whose Cost Curve?SOURCE: Medical Expenditure Panel Survey 36

Employers and the 30-Hour Requirement50%45%46%40%35%30%25%20%15%30%24%22%20%16%21%10%5%0%Retail andhospitalityGovernment Manufacturing Health careservicesTransportation/Communication/UtilityFinancialservicesOther servicesSOURCE: “Health reform poses biggest challenges to companies with the most part-time and low-paid employees” Mercer LLC, August 8, 201237

#5: A SteepLearning Curve:Purchasing Insurance3838

Employer and Employee Learning CurveWhere YouBuyWhat YouBuyWho BearsRiskThe Cost ofCoverageBrokersBasic Health PlanEmployerEmployerSHOP ExchangeGoldEmployeeIndividual ExchangeSilverEmployeePrivate ExchangesBronzeGovernmentBroker Market“Health” PlanInsurerSubsidy?39

Benefit Design: The New Frontier40

Three Take-Aways1. National election results point to a clearerpath ahead for ACA implementation.2. “Uncertainty” takes on a different, moreoperational flavor – dollars and timing.3. Trends afoot in Colorado to improve qualityand lower costs continue a forward march.41

Upcoming Webinars• November 14: Colorado's Medicaid Toolbox:Approaches to Improving Quality and ControllingCosts - Jeff Bontrager• November 28: 2013 Budgets and Strategies: Colorado'sHealth Agencies - CHI Staff• December 12: To Expand or Not To Expand: Colorado'sLooming Medicaid Decision - Michele Lueck• December 19: Legislative Forecast: Health Care PolicyTrends to Anticipate in 2013 - Megan Lane42

Michele Lueck 720.382.7073 LueckM@coloradohealthinstitute.orgEmily King 720.382.7085 KingE@coloradohealthinstitute.org43

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