Medicare Issues GMU.


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Medicare Issues GMU. Walk 19, 2009 Jack Ebeler. Medicare just issues Wellbeing change, protection scope Privilege change Government spending plan Other human services issues (IT, quality… .). Medicare enhance program mostly back change, or protection elective w/in change, or
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Medicare Issues GMU March 19, 2009 Jack Ebeler

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Medicare just issues Health change, protection scope Entitlement change Federal spending plan Other social insurance issues (IT, quality….) Medicare enhance program mostly fund change, or protection elective w/in change, or spare spending plan dollars, or yield long haul manageability, or decrease variety, or enhance quality, or… All streets lead to Medicare…

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OUTLINE I. Brief Medicare nuts and bolts II. Social insurance costs, government spending plan III. Medicare headings

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I. MEDICARE BASICS

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Medicare – extremely essential nuts and bolts Eligibility General: age 65, or receipt of inability protection, ESRD Part A (HI): qualified for Soc. Sec (paid finance expense) Part B (SMI): month to month premium ($96.40) Part D (Rx Drug): wellbeing arrangement premium Benefits Acute consideration advantages, now including medications, some post-intense Deductible, expense sharing; no disastrous utmost Medicare covers about a large portion of aggregate wellbeing consumptions Most recipients supplement scope to take care of expense sharing, different advantages

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Multiple projects and methods for financing advantages Traditional charge for administration Medicare, parts An and B (doctor\'s facility, doctor, lab, analytic innovation, post intense SNF, home wellbeing, hospice) – not long haul mind Usually with some type of supplemental scope for expense sharing Prescription medication program – new part D program– regulated through contending private back up plans Medicare Advantage Program – scope of Medicare A&B advantages, as a rule part D drugs too, through a private safety net provider that is completely capitated

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Sources and employments of stores, Medicare, 2009 Source: Kaiser Family Foundation Fact Sheet (www.kff.org)

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Medicare Population About 85 percent of the Medicare populace is over the age of 65; the other 15 percent qualify on the premise of inability or ESRD. About a large portion of the populace has wage beneath 200% of the government neediness level About 33% have 3 or more endless conditions Most going through is for those with various interminable conditions More than one-fourth have a subjective or mental impedance. About one-fifth are likewise qualified for Medicaid Most have supplemental advantages of some sort.

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Income status of Medicare recipients, 2005 Source: MedPAC Data Book, June 2008; In 2005, destitution level $9,367 for individual; $11,815 for couples

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Medicare has gradually moved to more means-testing of advantages and pay related financing There are currently various levels of Medicare recipients: Poorest – Medicaid/Medicare duals Above Medicaid however <@150% of FPL: little/no premium or Medicare expense sharing for secured advantages “Average” recipients: pay part B/D premium (rd. @$130/mo) in addition to deductibles, copays in parts A, B, D Higher salary recipients Tax on 35% of SS advantage - >HI: normal about $135/mo. Staging in higher part B premium – up to 80% Administration spending plan proposes higher part D (drug) premium too

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Most recipients have scope that supplements Medicare

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Spending concentrated among little partition of recipients, 2005 (average of wellbeing protection) MedPAC Databook, June 2008 (www.MedPAC.gov)

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II. Wellbeing SPENDING, FEDERAL BUDGET

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Health consideration spending (both open and private) keeps on growwing as an offer of GDP CBO Long Term Budget Outlook, 2008, Alternative Fiscal Scenario

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U.S. Human services Spending Much Higher Than Other Countries Health Spending as a Percent of GDP, 2002 “U.S. Wellbeing Spending Habits Grab International Attention,” Health Affairs July/August 2005 Note: Most late information demonstrate that NHE as percent of GDP in the U.S. in 2002 were 15.4% not the 14.6% given in the diagram.

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The government spending plan: Medicare and Medicaid represent higher shares of GDP and drive the elected spending plan up too CBO Long Term Budget Outlook, 2008, Alternative Fiscal Scenario

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The enormous “entitlement reform” issue is not the maturing of people born after WW2, it is rising medicinal services costs There will be all the more elderly as gen X-ers age. What\'s more, there will be a greater amount of the more seasoned elderly (85+) who need considerably more medicinal services. Be that as it may, human services expenses are the primary driver of Medicare’s monetary issues. The “entitlement” civil argument is not, scientifically, a “aging” face off regarding. It concentrates on fundamental social insurance cost swelling and its effect on open projects and open money

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Growth in government wellbeing spending: “excess cost growth”, not maturing, is the issue CBO, November 2007

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Medicare wellsprings of financing and deficiencies, as percent of GDP, 2000 - 2080

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Medicare spending per capita fluctuates altogether Total Medicare spending, and spending for patients in their most recent six months of life, shifts essentially by high and low spending areas. (Least) (Highest) Medicare Spending Quintile Fisher, et al., “The ramifications of provincial varieties in Medicare spending. Section 1: The substance, quality, and availability of care.” Annals of Internal Medicine, 2003:138(4)

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Higher going through is NOT connected with higher quality, fulfillment There is no relationship between\'s higher spending and particular markers of value care and administration. HEDIS Indicators Medicare Spending Quintile Fisher, et al., “The ramifications of provincial varieties in Medicare spending. Section 1: The substance, quality, and availability of care.” Annals of Internal Medicine, 2003:138(4)

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Medicare and Medicaid represent higher shares of GDP and drive the government spending plan up too – so? CBO Long Term Budget Outlook, 2008, Alternative Fiscal Scenario

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The government spending plan: normal incomes speak the truth 18-19% of GDP, so the “fiscal gap” is immense Average income CBO Long Term Budget Outlook, 2008, Alternative Fiscal Scenario

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With those deficiencies, the subsequent interest installments would predominate whatever is left of the monetary allowance – need limitation and new income Average income CBO Long Term Budget Outlook, 2008, Alternative Fiscal Scenario

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III. MEDICARE DIRECTIONS

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Medicare just issues Health change, protection scope Entitlement change Federal spending plan Other social insurance issues (IT, quality….) Medicare enhance program halfway back change, or protection elective w/in change, or spare spending plan dollars, or yield long haul maintainability, or lessen variety, or enhance quality, or… All streets lead to Medicare…

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Medicare headings Problems surely understood, driven by issues with FFS drug Care coordination is very uncommon Specialty care, innovation favored over essential consideration Quality deficient and exceedingly variable Health consideration costs high, variable and unsustainable Need for central change to address basic expenses: Focus of progress is enhancing conveyance, concentrate on worth; Need to characterize installment and scope ways to deal with backing/incent the progressions Sounds intelligent: yet costs = incomes

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Medicare: fleeting Deal with continuous, discriminating issues in setting of spending plan and human services issues: Set FFS installment redesigns Address MD installment levels (SGR), redistribution Access: start revamping essential consideration w/boosts in salary Reduce Medicare Advantage 14% excessive charge; rebuild for unique reason – elective conveyance What do about advantages/expense sharing – most recipients purchase security from the expense sharing – which expands Medicare spending?

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Medicare, long haul vehicle for investment funds and conveyance change Key theoretical patterns (1) Shift unit of investigation and installment from CPT code exchanges to scenes of consideration and packaging: Episodes that are clinically and monetarily pertinent, for patient and doctor Look to mind crosswise over suppliers and after some time Support incessant consideration coordination Re-standard installments from normal expense valuing to benchmark suppliers/regions

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Medicare, long haul Key applied patterns (2) Evidence-based exploration patterns may give new choices: scope (similar viability, scope with confirmation, and so on.) patient expense sharing (differentials) Migrate care coordination limit (IT, individuals) to conveyance framework to bolster care, far from seller administration of conveyance for payors Heading to degrees of danger sharing/supplier responsibility for some/or the greater part of a population’s consideration Continue wage tiering (officially exceptionally predominant in Medicare)

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Some particular strategy suggestions/stages Initial: Payment approach – whack-a-mole; moderate redistribution to PC Crosscutting mediations: P4Q; measure, report asset use; relative adequacy research, open reporting/straightforwardness Intermediate: Medical home for chronically sick – regularly scheduled installment Bundled doctor\'s facility affirmation: doctor\'s facility, MD, 30-day post release begin w/information reporting; starting lessening for high readmission rates; pilot for frameworks that can execute soon Better characterize post-intense scope, care, installment Longer-term: Accountability at conveyance framework for consideration

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Framing with wellbeing change convolutes, the comparison Two components of wellbeing change edge/muddle Medicare level headed discussion: Financing: President proposes $630 billion put aside for wellbeing change (scope development): @ ½ from reserve funds (for the most part Medicare) @ ½ from lapsing tax breaks on higher pay Insurance choice: arrangement elective for growing scope – some sort of protection trade with: Competing private safety net providers, alongside Public system With those choices under verbal confrontation, you get altogether different perspectives, positions on Medicare choices

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Medicare just issues Health change, protection scope En

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