Post on 17-Jan-2016
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Colorado Health Care
2014 Legislative
Agenda
Senator Irene Aguilar, MD
IOM: Best Care at Lower Cost
9.8%
7.2%
27.5%
17%
13.7%
24.8%
INSTITUTE OF MEDICINE 2012: US Health Care Annual Waste
$ 765 Billion
Variations Among Academic Medical CentersUCLA Mass
General Mayo Clinic
CMS Inpatient Quality Score
81.5 85.9 90.4
Source: Elliot Fisher, Dartmouth Medical School
Care Delivery & Spending, last 6 months of life
Total Medicare Spending
$50,522 $40,181 $26,330
Hospital Days
Physician Visits19.2
52.1
17.7
42.2
12.9
23.9Specialist/ Primary Care Ratio
2.9 1.0 1.0
6
Senate Bill 16: Context
• EMTALA: Emergency Medical Treatment & Labor Act• CMS: Center for Medicaid and Medicare Services• Emergency Medical Care: ambulances, surgeons,
cardiologists, operating rooms, hospitalization • Facility Fee: Supplemental payment to support the
full spectrum of emergency medical careCost shifting inpatient costs to consumers of the EDMedicaid, Medicare & TriCare do not pay this to FSEDs
A tale of two business models Panorama Orthopedics, Golden, CO
First Choice Emergency Center
Arvada, CO
Market Principles and Health Care• Consumers bear the cost of what they consume
Only 20% of Coloradans have high deductible plans80% pay Copayment only for Emergency Care
• Consumers have transparent information and make an informed choice on the purchased serviceMost consumers do not recognize the difference
between urgent care and emergency care facilitiesInsurers do not have a choice – must pay emergency bills
• Limited financial or regulatory barriers that prevent new suppliers from entering the market
Cost of Insurance• Based on actuarial analysis of the health of the
population, the cost of the services provided and frequency of use
• Oregon Experiment: 40% more ER visits• Geographic Region 11: Higher costs of services
October 2012 – September 2013One Insurer’s Data
TOTAL CHARGES SERVICECHARGES
FACILITYFEES
$1,923,867. $ 243,859 $1,680,008
EMERGENCY or URGENT ?• 59% of visits were for non-emergency care:
Allergic reactions including dermatitis and Hives Headaches, Back Pain, Sciatica Viral Infections, Strep Throat, Nausea
• 16% of visits were for conditions that might have needed immediate access to specialists Require transfer by ambulance to a hospital
FSED Testimony on Patient VisitsAVERAGEMONTHLY
VISITS
PERCENT UNINSURED
AVERAGE MONTHLY
PAID VISITS
HOURS OF PROVIDER COVERAGE
400 25% 300 720
Freestanding Emergency Rooms
H O 2U 0S 0T 4ON
Freestanding Emergency Rooms
H O 2U 0S 1T 4ON
CO SPRINGS: Freestanding Emergency Room
ARVADA: Freestanding Emergency Room
Which would you choose?
Which would you choose?
Jaguar XFStarting Price: $46,975
Hyundai ElantraStarting Price: $17,200
Determinants of Health
2011 U.S.
Healthcare Spending:
$2.7 Trillion
Table 2: Estimate of ACA Effect, 2016
No Reform With ACA ACA Impact
ESI 2,630,000 2,600,000 -30,000
Small Firm ESI (1-50 employees) 560,000 540,000 -20,000
Other ESI 2,070,000 2,060,000 -10,000
Unreformed Non-group 340,000 60,000 -280,000
Reformed Non-group 0 620,000 620,000
Tax Credit Recipients 0 470,000 470,000
Non-Recipients 0 150,000 150,000
Public Insurance 550,000 710,000 160,000
Uninsured 860,000 400,000 -460,000
Total 4,390,000 4,390,000→ →
→
Source: Dr. Jonathan Gruber’s analysis for the Colorado Health Benefit Exchange, 2011
Dr. Jonathan Gruber 9/16/11
22%
39%
10%
29%
Figure 4. Share of Colorado population without health insurance coverage, alternative funding
programs, 2015-24.
Cooperative would put Colorado on sustainable path: Spending growing no
faster than the GSP
Savings grow by “bending the cost curve” by reducing administrative share and restraining drug price inflation