We re getting started. Rick Mullaney is at the podium. The focus today is on the affordable care act in florida with attention to the exchanges.
10 legislators from the florida house are here.
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The PPI Healthcare conference is tomorrow and there are plenty of hospital CEOs presenting. We have access to their presentations.
Follow on the link below to review today's presentations:
http://issuu.com/arashkamiar/stacks/39ed0cb262074bb08ca202c8653c7ce2
This is the link to the names & faces of the presenters:
http://www.metrojacksonville.com/article/2013-nov-jus-public-policy-inst-hosts-healthcare-policy-conf
Another Link to their bios:
http://www.ju.edu/PPI/Documents/JU%20PPI%20Healthcare%20Policy%20Conference%20-%20Presenter%20Bios%20(2013).pdf
)
Ford Koles
Executive Director
The Advisory Board Company, Washington, DC
Is presenting.
Why would someone sign up with "obamacare"? Lower premiums but it is known that those who desperately need insurance would sign-up. The problem is if the young, healthy do not sign-up. The actuarials cannot work out the young and healthy. It is possible that we will have a bunch of sign-ups at the last minute, as young and healthy people are prone to do....wait till the last minute.
Koles presentation slides on this link:
http://www.ju.edu/PPI/Documents/JU%20PPI%20Healthcare%20Policy%20Conference%20-%20Ford%20Koles%20Presentation%20(2013).pdf
The big danger for florida.
(Check out his axioms of hospital economics)
The standard Robust employer sponsored coverage is hampered high cost and more restrictions.
Steady public payer pricing : New Danger: Medicare rate cuts, contingent payments widening gap to goal for feasible cross- subsidization
Predictable Volume Channels
New Danger: Falling utilization rates coupled with non-traditional competition narrowing potential volume strea
More threatening than employers dropping coverage...it's not that the affordable care act is causing employers to dropping healthcare. That trend was there prior to the act, 11% drop in one year.
The big issue is this...
Insurance companies are launching a new way to do insurance from defined benefit to defined contribution. It's the same change that was made as companies switched from pensions to 401k.
The future of employer - sponsored insurance:
The movement is to high deductible plans, 5k to 7k deductibles...which means price sensitivity like never before.
New Competitors emerging in ripest markets. Walgreens is handling more than just treating runny noses. Walgreens is becoming primary care.
What do they do to price? This isn't a physician model. This is a nurse practitioner model.
Per Walgreens "Our vision is to become 'My Walgreens' for
everyone in America by transforming the
traditional drugstore into a health and daily
living destination..."
The way the market handles health care is changing dramatically. "big box co" aka Costco wants to become the largest primary care provider in the nation. Many people scoff at that as a possibility but it's possible. Prices will be driven down.
"Case in Brief: BigCo - Costco
• Large corporation with over 4,000 retail stores in the United States
• Phasing out current retail clinic model, extending primary care access through
virtual and in-store delivery channels"
Koles has one big message here the old way of doing things is dying. Compares the healthcare industry to major airlines that are failing.
Commercial insurance companies recognize that they are losing and are trying what they can to keep customers by bundling benefits to justify high premiums.
Let's get the two groups who are spending money get closer together, meaning providers and patients.
Walmart streering employees to preferred providers for surgical care, "domestic medical tourism."
"travels cheap...healthcare is expensive." - walmart. Companies sendng patients to other states for cheaper treatment because of partnerships.
Anticipating the "activated" patient.
In the past you didn't have to worry about prices but now we will care because we will have more out of pocket expense. There are apps that will tell you the cost of services for every spot in your town, city, state. So now, patients pull out their phone and say "oh, really" on prices at expensive patients.
On to Yelp!
Yelp originally started as a place to review doctors. Doctors are under review now by patients. Their reputation is at stake.
The health care industry is nervous because prices are going down...but the groups that lead with low prices will gain market share.
Ford Koles is a brilliant speaker. He's calm, clear, methodical and keeps you engaged with really dry information. That's a skill. I hope the rest are as good! ;)
laparker sign-in info is saved on my computer and I inadvertently posted under her name.
Koles just wrapped up. We are on to Patrick Geraghty, Chairman and CEO Blue Cross Blue Shield of Florida.
He leads with compliment Koles on a great presentation but saying we don't agree on some things.
You can follow Geraghty's presentation here:
http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference (http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference)
The same policy will double in monthly cost in 2014. It is important that the young, healthy person is in the pool to keep prices down.
How Florida Blue see the market place:
"everyone needs to change"
"patients are becoming consumers. They want information. They want choices. Frankly, that is a good thing."
We are on the backend of healthcare. We incentivized once people were ill. The shift needs to be on the front end. We are going to incentivize on the front end, before people are sick.
Geraghty, discussing how they are no longer an insurance company but a "health solutions company." Right now, we are in "we are awesome" part of his presentation. We are entering into how their change of mission is changing how they do business.
It sounds like Geraghty's Florida Blue is getting into actual healthcare vs insurance care.
Has purchased several physician groups and dozens of Patient Centered Medical Homes.
They are not trying to force one approach to every market but are open to every market having a unique solution.
Discussion of their retail centers because they understood that health care is moving towards a retail world.
Will Weatherford just walked in, speaker of the house of florida legislature.
Geraghty's is still, mostly, and completely, giving a speech about Florida Blue. We are on how their retail centers are built to be inclusive and help with a cultural shift towards living healthy and something about literacy.
This is a ra-ra speech but it is info I don't mind hearing.
Geraghty is another great speaker. Dynamic.
Conflict of interest for an insurance company to be involved in health care in the same manner as Florida Blue?
A good Article about Florida Blue's reorganization, discusses a bit about potential conflict of interest.
http://miami.cbslocal.com/2013/07/25/florida-blue-wants-restructuring/ (http://miami.cbslocal.com/2013/07/25/florida-blue-wants-restructuring/)
Now we are on to "Key Policy Issues":
Launches straight into canceling issues at the advent of Affordable Care Act (ACA)
1. Cancellations vs. Transitions. : "What Florida Blue did was comply with the law."
"Because of the affordable care act. your plan will no longer be available after the end of the year."
2. Marketplace impacts: We shouldn't be raising taxes on insurers. We're only charging the consumer. We think it's counter productive.
3. Medicaid Expansion - Florida should take these funds. But how do we take these funds and radically transform this system not funnel funds into a broken system. We can take these funds and transition the system. We are in support of expansion.
we continue to believe that covering as many americans as we can is a good thing. We need to have as many people as possible included. We still haven't dealt with uncompensated care where others have to cover the costs of those who can't pay.
Speech over.
Will Weatherford Speaker The Florida House of Representatives is presenting now, after the short break.
Thinks that allowing kids to stay on parents plans longer and not discriminating against preexisting conditions is a good thing. A good part of the law.
Now on to the exchange...
so far, 4.8 million have received a letter saying their plan has been cancelled but only 100k people have signed up through the exchange.
On Medicaid:
1990: 70k people on medicaid
today: 3.3 million people on medicaid
We spend $23 billion a year on medicaid. Everywhere else that is struggling is struggling because of medicaid.
Currently, medicaid is a 50/50 match. And, he doesn't think that the Feds will be able to maintain the 90/10 slit for expansion. If they don't it is an additional spend of 3 billion. Asks, "shouldn't we take the time to see how this will impact out state?"
Weatherford, funny...cracks jokes and dynamic speaker.
Wonders why people who should be able to get a low cost subsidized insurance plan on the exchange should be put on medicaid instead.
If you make less than 12k for year you don't get a subsidized plan you get medicaid. Says, you are creating two americas.
Hospitals lose money on every medicaid patient they see.
Before we put the state at risk with the expansion of medicaid we should be looking at other alternatives. And, if you think that expanding medicaid will solve our healthcare program it won't.
How should we do this?
State driven with a focus on driving cost down. We shouldn't discriminate against the poor.
The long term answer to this problem is investing in education...which leads to better jobs.
Don Gaetz President The Florida Senate
- speaking now.
In 2006, Don Gaetz became the first non-legislator in more than 50 years to be elected to the Florida Senate without opposition. He was reelected to represent his Northwest Florida district in 2010 and 2012. Additionally, in November 2012, Senator Gaetz was unanimously elected by his colleagues to serve a two year term as President of the Florida Senate.
Before being elected to the Senate, President Gaetz was the Superintendent of the Okaloosa County School District. During his term of office from 2000 to 2006 Okaloosa Schools became the highest performing public school system in Florida and won numerous national awards for academic excellence.
President Gaetz is the retired co-founder and vice chairman of a multi-state health care corporation and is a former president of the National Hospice Organization. He is a member of St. Paul's Lutheran Church in Niceville. President Gaetz and his wife, Victoria, have two children. His son, Matt Gaetz is State Representative for District 4 in Northwest Florida.
It's a little difficult to listen to Gaetz and I am mostly not listening. He has an old school, southern Shakespearian style.
This is his approximate speech:
http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference_0c7f2c84b6f060 (http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference_0c7f2c84b6f060)
It's a very political sounding speech. Any considerable points are lost in the noise of his speaking style.
Almost, reminiscent of Clint Eastwood's speech at the republican convention. The one where the imaginary Barak Obama is seated in a real chair. Gaetz had a series of questions for Secretary Sebelius to which all of her government answers were "no".
We are onto panel time with Weatherford, Geraghty, Koles and Gaetz. The previous speakers.
Geraghty says that the reason why so much face time is required for patient care is because that is where payment happens. The more digital payment become the more home based/virtual care we can have the lower prices can be lowered.
Koles:
5% of floridians are really sick. 20% are the rising risk. How do we figure out the really risky people in the 20%. They come at us out of nowhere. Some it is going to become really creepy and big brotherish to find out who those people are.
End of session one!
This is awesome. I think we are on to a lunch break.
We're on to the 2nd session. Shorter presentations than a panel discussion.
On the stage:
Russ Armistead: CEO UF Health
Moody Chisholm: CEO St. Vincent Healthcare
Jim O'Loughlin: CEO, Memorial Hospital
Dr. William Rupp: CEO, Mayor Clinic in Florida
Hugh Greene, CEO Baptist Health
Jim O'Loughlin speaks first:
Begins to describe the historical context to help frame what is happening today.
1940s - During the war there were wage controls to prevent inflation. So, employers added health benefits to recruit employees.
1960s - congress recognized the short comings of employer based insurance. The elderly, poor and women were largely left out. Medicare/Medicaid created.
1980s - Reagon required hospitals to under the Emergency Medical Treatment and Active Labor Act (EMTALA) to provide care to every patient seeking care regardless of their ability to pay.
The policy decisions have created gaps:
- 3.9 million of floridians have no insurance.
- majority are low-income working families
- 38% are below the poverty level.
- 60% have at least one full time worker in the family.
Medicaid Expansion:
- by 2014 states may extend medicaid eligibility to all legal residents.
Hugh Greene, CEO of Baptist Health is speaking:
http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference_31243d157102b2 (http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference_31243d157102b2)
The 7 Assumptions for Health Care's Future according to Hugh Greene, CEO of Baptist Health:
1. Change is inevitable. That status quo is not sustainable.
2. Delivery system changes, including payment methodology will occur. Pay for performance is here to stay.
3. Consumerism in health care will continue to rise with greater transparency of price and outcomes.
4. Greater provider accountability for performance related to quality
5. Greater integration of health care providers.
6. Major shortage of physicians and other clinical staff. 1) New demand as more people are covered 2) as the population ages more people need care 3) medical workforce is getting older/retiring.
7. Health care will remain vibrant in the local economy, and US health care will remain among the best in the world.
We are being warned that the next presentation is controversial.
Moody Chisholm, CEO of St. Vincent's Healthcare is speaking:
St. Vincent is committed to the care of all persons and that is backed by our Catholic Values regardless of their stage in life. "Everyone has inherent dignity and the RIGHT to healthcare."
We are supportive of aspects of this very flawed bill.
From our perspective we do not need expansion of medicare but we do need meaningful expansion of coverage.
77% of the uninsured are employed and, they are all jobs that we depend on as an economy (aside from their inherent worth).
With Medicaid we have adverse selection. Those that sign up are in the midst of healthcare expenses. We are going to pick up that tab one way or the other.
Medicaid is split with Fedieral government.
The costs of expansion from 2014 - 2021, $51 Billion by federal government and $3 billion by state.
Just the sales tax from federal funding and economic stimulus will create more than enough money to pay for the states share.
See the presentation on the link
http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference_1e51d5ab45d592 (http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference_1e51d5ab45d592)
Moody challenges Weatherford and advocates an expansion of coverage in a meaningful way.
We're onto Russ Armistead, CEO of UF Health
Presentation:
http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference_938c16056c95ff (http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference_938c16056c95ff)
Armistead is focused on his actual job function:
UF is a "safety net hospital" . These are places that see more people who are uninsured or can't pay. We are the canary in the mines. If we go trouble is coming. We have the least amount of cash on hand. About 30 days worth of operating cash. So, we are a signal to other hospitals.
What is UF Health:
Owned by the city and operated by UF Health Jacksonville.
5th largest employer in jax.
Low cost
Funding down 43% or 27million as compared to 2008.
Next Up is Bill Rupp, CEO of Mayo Clinic
The world is not about to end in healthcare.
Shows that the cost of medicare per recipient is vastly different per state in La Crosse, WI , $6k. In Miami, $17k.
Developing "Mayo Clinic Care Network" which is essentially a selling of their knowledge to hospitals.
lack of price clarity is going to go away. Admits that hospital pricing is meaningless "we get paid all sorts of prices by different insurance companies"
We're at the start of our first session. Joseph R. Antos of the American Enterprise Institute is speaking.
Repeats what has been said in prior presentations...the website is the least of our worries.
The current law went out of its way to not to disturb anything which is problem when we are facing the issues we are facing...to fix them there will have to be a shaking.
This is his presentation:
http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference_042caef6d01eca (http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference_042caef6d01eca)
Medicaid Expansion:
is it a no brainer?
"cheap" is not free.
lower federal payment for enrollees out of the woodwork.
the uninsured remain with us - and DSH is cu
coverage does not equal appropriate care
a deal is not necessarily a deal.
Antos is doing a bit of "sky is falling" .
Medicaid fosters dependency. Instead, promote a sense of ownership and responsibility. Allow Medicaid to provide bridge financing for those who are temporality uninsured. Promote main-stream coverage (premium assistance for employer-sponsored insurance.
Antos:
The New Norms, 2017 and beyond
- informed choice of health plans
- wider acceptance of fixed subsidies
- tighter networks
- non-physician practitioners, telemedicine
- smarter prevention
The Old Standbys
- Employer coverage remains dominant
- Medicaid reform depends on states, not feds
- Medicare continues to struggle with the new reality.
Dawn Emerick
CEO of Health Planning Council. 7 county organization. Starts speech. I was once a user of medicaid and I was really happy to have access to it as a single mother when I needed it.
Her presentation:
http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference_f5e8fdb04d0dd8 (http://issuu.com/arashkamiar/docs/ju_ppi_healthcare_policy_conference_f5e8fdb04d0dd8)
Emerick:
Insurance is just one piece of health.
USA is 72 in health system performance.
We spend 7.5k per person on health care in the us.
49 million people are uninsured in the USA.
In NE Florida total uninsured are 335k.
**take a look through Emerick's slides. Good charts to study. **
A donut hole will exist in NEFL if we do not expand medicaid.
Emerick encourages us to google "Oregon Medicaid Study". She disagrees that the study says that the medicaid option fails.
Oregon had enough money for 10k but they had 90k people eligible. They did a lottery and studied the 10k who enrolled. They compared the 10k people to private insurers and found that the health of the people were the same. They also found that those people on Medicaid sought medical attention more often than private insurers. The question, Emerick, says, why did those on Medicaid need to keep going back. This study is about the quality of care not the quantity of care.
CEO of Haskell, Steve Halverson presenting.
He is the last speaker. His focus is to provide a business perspective on health care. Says "I'm not a doctor or a health care person, I think that nothing changes without a disruption."
Our healthcare system is a profoundly broken system.
The healthcare system has reached a breaking point.
The state is somewhat hostile to healthcare providers. 21% of the state do not have coverage. That is unusually high.
We already have a system of universal healthcare it is called the emergency room.
Our current form of universal health care is inefficient and is a hidden tax of 1k per family.
Quote from: TheCat on November 13, 2013, 10:58:27 AM
Hospitals lose money on every medicaid patient they see.
Before we put the state at risk with the expansion of medicaid we should be looking at other alternatives. And, if you think that expanding medicaid will solve our healthcare program it won't.
How should we do this?
State driven with a focus on driving cost down. We shouldn't discriminate against the poor.
The long term answer to this problem is investing in education...which leads to better jobs.
Some background on Weatherford.
QuoteBy rejecting the Medicaid expansion, Florida is estimated to be giving up $51 billion over 10 years to cover low-income residents. Under the law, the federal government would pay for 100 percent of the costs for the first three years of the program and then 90 percent thereafter.
http://www.politico.com/story/2013/03/florida-house-speaker-medicaid-expansion-dead-88945.html#ixzz2kYZwsXN5
QuoteFlorida House Speaker Will Weatherford (R-Wesley Chapel) continues to slam Medicaid even though it reportedly paid a "mountain" of his own family's medical bills.
Wednesday, at an event at Suncoast Tiger Bay, a non-partisan political club, Weatherford said "Medicaid has been proven to be one of the worst forms of insurance you can get in America,"according to the Tampa Bay Times. "Nobody in here wants to be on Medicaid."
Yet back in March, Weatherford was forced to admit that it was a Medicaid-backed program he had praised for paying $100,000 of his own family's medical bills when his brother passed away from cancer. His staff originally claimed a hospital charity had helped the Weatherfords with their hospital bills.
http://www.huffingtonpost.com/2013/09/11/will-weatherford-medicaid_n_3906937.html
What do you about it? First you have to ask the right question to get the right answer?
The wrong question is "should we expand medicaid?"
The right question is what is the best solution to healthcare?
As a business person, we start problem solving with an inventory of assets. Florida has incredible assets. Florida has a strong fiscal posture right now. We have a large population and we can apply scale to almost anything.
What we need is not an expansion of an already existing program. We need nothing less than a complete reinvention. First, we need broad coverage. Second, we need market driven solutions. I have practically unlimited faith in the power and creativity of a free market. [point to Florida Blue's approach as an example]. Third, very important, we have to get away from a fee for service model to an outcomes driven model. Fourth, we need to...[missed but something to the effect that we need to use the 51 billion from the feds to reinvent the system. ]
Said earlier:
"These debates about whether you are poor or really really poor bother me greatly."
Halverson does not believe the white house is being rigid.
In 20 years we will writing books about this stage in our history. We should not be witnesses to history but authors. We have the capacity to think on this. We have the capacity to act on this. It's easy to make fun of the Affordable Care Act but it has to come with alternate solutions. We have a moral imperative to fix this issue. I suggest that we start today to fix this problem. I believe we have a federal government that is attentive to it. My exhortation is to get on the field and engage robustly. The one thing the health care act did [whether you like it or not] was disrupt the system...let's take advantage of it.
Wow
Thanks for taking notes. I agree that Steve Halverson's wrap-up comments were particularly powerful -- this is a time of disruption and an opportunity for action. Mia Jones then made a request -- if this is a time for action, and the window of opportunity is short, what should we take to the legislature right now to be able to invest the $51 billion over 10 years to make substantive changes to the system that will answer the real question of improving health access and outcomes for the 3.9 million uninsured in Florida? Her question -- and Halverson's charge -- deserve a thoughtful response. It's not enough to mock a flawed law, because in doing so you're just defending a broken status quo. What are the changes we're willing to make at this moment of change?
I know I'll be thinking deeply about the question tonight ...