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Nurse Practitioners and The Future of Health Reform
Micah Weinberg, PhD President, Bay Area Council Economic Institute CANP Annual Conference 2016
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Nurse Practitioners and The Future of Health Reform Micah Weinberg, - - PowerPoint PPT Presentation
Nurse Practitioners and The Future of Health Reform Micah Weinberg, - - PowerPoint PPT Presentation
Nurse Practitioners and The Future of Health Reform Micah Weinberg, PhD President, Bay Area Council Economic Institute CANP Annual Conference 2016 1 The revolution is happening, right, folks? Folks? 2 COVERAGE DELIVERY COST 3 The
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COVERAGE COST DELIVERY
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The Reform (Almost) Everyone is Talking About
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Medi-Cal Powering CA Coverage Expansion
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Source: California Budget Project
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Medi-Cal Now a Major Source of Coverage for Working Californians
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Covered California Covering California?
- Enrollment hovering around 1.3 million since 2013
– But waystation more than destination
- 90% of enrollment in big four health plans
– Blue Shield, Anthem, Kaiser Permanente and HealthNet – Minor plan enrollment did increase in 2015 – Two “lanes” (PPO + Kaiser, others)
- Attempting aggressive move into quality measurement and
delivery system reform
– Along with other payers – Working through plans
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State-based Reform, State-based Results
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The Reform (Almost) No One is Talking About
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Few Employer Cite ACA as Major Cost Driver
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Source: PwC Health Research Institute, Touchstone Survey 2015
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“Socialized Medicine” … Not Very Socialized
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Are we living in the Republican healthcare fantasy future?
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Paying for value?
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But falling share of US Doctor Visits Capitated
14 Source: Zuvekas and Cohen, Health Affairs, 2016
And only 3% of providers say they are “highly prepared” to make transition to value! (HIMSS Cost Accounting Survey, 2016)
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Higher cost sharing, generally less care
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Source: PwC Health Research Institute, Consumer Survey 2015
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Medical Home or “Medical Homewrecking?”
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Plenty of room for real delivery reform
- Alta Bates Medical
Center: 50% of ER for non-urgent care
- 70% of those patients
live within one mile of an FQHC
- Need better regional
coordination/data exchange for “hotspotting”
Source: Sutter Health/Better Health East Bay
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Full Practice Authority!
- Better Access
- Better or Same Quality
- Lower or Same Costs
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This is the good news! (?)
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Source: PwC Health Research Institute, 2016
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Many New Expensive Drugs & Tech …
Source: “An Evaluation of Specialty Drug Pricing Under the Pharmacy and Medical Benefit,” March 2014. Source: Congressional Budget Office, 2009
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But far less health …
- 1 more year life
expectancy by 2030 for Medicare beneficiaries
- However, vs 2010
Hypertension 18% Heart disease 19% Diabetes 62% 3 or more 54%
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Source: Schaeffer Center, USC, 2015 Source: CA Center for Public Health Advocacy, 2106
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Precision Medicine … More Promise than Practical Reality
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Will the robots save us?
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Will it matter if we become “single payer” … … on purpose or accidentally?
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Thanks a lot, Micah. Way to start our conference out on such a positive note.
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Choosing Our Future: Step 1 - Humility
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Choosing Our Future: Step 2 – Start with Public Health
- Comprehensive Community Redesign
– Smart growth – Food system – Criminal justice system – Economic opportunity = health
- But again humility particularly about economic policy
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Choosing Our Future: Step 3 – Pick a System … Any System
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Choosing Our Future: Step 3 – Reward the Production of Health
- But … incentives are
not enough
- Have to have
– Aligned incentives (single system) – Consumer protections – Technical capability – Correct personnel – Health system not healthcare system
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[Placeholder for blatant pandering.]
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Thank you!!
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