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 Reform (Almost) Everyone is Talking About 4

Medi-Cal Powering CA Coverage Expansion Source: California Budget Project 5

Medi-Cal Now a Major Source of Coverage for Working Californians 6

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 • 7

State-based Reform, State-based Results 8

The Reform (Almost) No One is Talking About 9

Few Employer Cite ACA as Major Cost Driver Source: PwC Health Research Institute, Touchstone Survey 2015 10

“Socialized Medicine” … Not Very Socialized 11

Are we living in the Republican healthcare fantasy future?

Paying for value? 13

But falling share of US Doctor Visits Capitated 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) 14

Higher cost sharing, generally less care Source: PwC Health Research Institute, Consumer Survey 2015 15

Medical Home or “Medical Homewrecking ?”

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

Full Practice Authority! • Better Access • Better or Same Quality • Lower or Same Costs 18

This is the good news! (?) Source: PwC Health Research Institute, 2016 19

Many New Expensive Drugs & Tech … Source: “An Evaluation of Specialty Source: Congressional Budget Office, Drug Pricing Under the Pharmacy 2009 and Medical Benefit,” March 2014.

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% Source: Schaeffer Center, USC, 2015 Source: CA Center for Public Health Advocacy, 2106 21

Precision Medicine … More Promise than Practical Reality 22

Will the robots save us?

Will it matter if we become “single payer” … … on purpose or accidentally?

Thanks a lot, Micah. Way to start our conference out on such a positive note. 25

Choosing Our Future: Step 1 - Humility 26

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 27

Choosing Our Future: Step 3 – Pick a System … Any System 28

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 29

[Placeholder for blatant pandering.] 30

Thank you!! 31