Catamount Health and Health Care Reform in Vermont - PowerPoint PPT Presentation

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Catamount Health and Health Care Reform in Vermont

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Catamount health is funded primarily by the federal government and the GC. ... Catamount health builds on and expands the governor's chronic care initiative. ... – PowerPoint PPT presentation

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Title: Catamount Health and Health Care Reform in Vermont


1
Catamount Health and Health Care Reform in Vermont
Kenneth E. ThorpeEmory University
2
Context for Reform
  • High and Rising Cost of Health Care--Growth in
    Vermont has exceeded the national average
  • Without reform, the rise in health care costs
    will absorb 25 of the total growth in payroll
    over the next 5 years.
  • Approximately 10 percent of Vermonters 65,000
    remain uninsured.
  • We face gaps in the quality and safety of health
    care in the state
  • Vermonters receive approximately 60 to 70 percent
    of clinically recommended health care (e.g. only
    half of Vermont diabetics routinely monitor their
    blood glucose).

3
Context for Health Care Reform in Vermont
  • To address these problems health care reform must
    transcend a simple debate over insurance!
  • Reform must by SYSTEMIC, impact all Vermonters
    and address
  • The high and rising cost of health care
  • Gap between ideal and actual practice of care,
    particularly among the chronically ill
  • The uninsured

4
Context for Health Care Reform Key Facts
  • About 80 percent of healthcare spending in
    Vermont is traced to patients with a chronic
    health condition. This is not an insurance issue
    it is a care management, delivery system and
    payment issue.
  • 2. Chronically ill patients in the state do not
    receive all, or in many cases most, clinically
    recommended care. This includes patients in the
    single payer Medicare program, those with private
    insurance, Medicaid and the uninsured. This
    increases costs and produces substandard medical
    outcomes.

5
Context for Reform Key Facts of What Really Is
Driving the Rise in Healthcare Spending
  • 3. Two-thirds of the rise in the cost of private
    health insurance is traced to a rise in the share
    of adults and kids treated for chronic illness
    and innovations in medical treatmentlargely new
    drugs.
  • 4. About 30 percent of the rise in spending is
    associated with the rise in obesity prevalence
    over the past 15-20 years

6
The urban (and rural)-myth of hospital-
generated increases in health care spending
Health Spending VERMONT VERMONT VERMONT
Health Spending 1980 1990 2000
Hospital 45 38.8 34.9
Physician 20 24.0 25.0
Prescription Drugs 5.7 7.6 11.0
7
Continued Dramatic Declines in Hospital Occupancy
Rates Associated with Changing Technology and
Patient Characteristics, Vermont and US, 1970-2003
8
Trends in Hospital Capacity, US and Vermont
1970-2003 Beds per 1,000 Resident Population
Impact of Technology and the Rise in Chronic
Illness Continues to Reduce the Overall Share of
Hospital Spending
9
Context for ReformAligning Reform with the
Underlying Problems in the System
  • Systemic reform of Vermonts health care will
    require
  • A major focus on the chronically ill that account
    for 80 percent of health care spending and most
    of the growth in spending
  • A redesigned delivery system to improve quality
    and outcomes
  • Changes in the way physicians are paid to care
    for patients

10
Context for Reform
  • Systemic reform will require
  • Efforts to reduce administrative complexity and
    reduce excess clinical spending
  • Investments in information technology, patient
    safety and error reduction
  • Major expansions of coverage with universal
    insurance the ultimate target

11
Catamount Health
  • Will
  • Enroll uninsured and eligible VHAP adults,
    Medicaid and Dr. Dynasaur children
  • Provide the ability to purchase comprehensive,
    affordable health insurance for all uninsured
    Vermonters. Premiums reduced by up to 90.
  • Have low administrative costsabout 4.
  • Improve the quality of care delivered to all
    chronically ill patients, and improve the value
    of care purchased
  • Reduce the administrative burdens facing
    physicians
  • Lower health insurance premiums paid by workers
    and employers by 4 to 6 percent when the plan is
    fully implemented by reducing the cost shift, and
    reducing administrative costs and additional
    spending linked to medical errors and events.

12
Impacts of Catamount Health
  • Will reduce the level and growth in health care
    spending
  • Through statewide use of the chronic care model
    for all Vermonters
  • Through reduction in the existing cost shift
    built into premiums
  • Through simplified administration and lower
    administrative costs
  • Common claims forms
  • Health information technology initiative (health
    record)
  • Electronic billing
  • Administrative costs of Catamount health about
    4!

13
Catamount Health
  • Combination of VHAP policies and Catamount health
    initially enroll about 20,000 uninsured
  • Lowers private health insurance spending through
    use of chronic care management, reduction in
    medical errors, administrative costs and
    reduction in cost shift

14
Catamount Health
  • Places Vermont as the national leader in
    treatment of chronic disease through an
    innovative new delivery model, lower
    administrative and clinical costs. Improves the
    value of the dollar spent on health care.
    Provides the state a clear market advantage in
    attracting and retaining business.
  • Provides business community short and long term
    answer to high and rising health care spending.
  • Places Vermont as the national leader in focus on
    population health, primary and preventive care

15
Private Insurance Spending (Millions of Dollars),
Currently Insured Reform vs. No ReformSpending
Falls by 550 Million Over the Next Ten Years.
16
Financing Choices
  • Total spending on Catamount health and the
    Governors plan are similar.
  • Approaches for financing the costs of the two
    proposals differ however.
  • The Governors plan is financed by increasing
    employer spending on health care by 45 to 50
    million.
  • Catamount health is funded primarily by the
    federal government and the GC.

17
Conclusions
  • Catamount health builds on and expands the
    governors chronic care initiative. We cannot
    control the growth in spending without a focus on
    chronic illness and population health
    initiatives, period.
  • It assures the chronic care infrastructure will
    be available to all chronically ill patients in
    the state, not just the privately insured
  • It reduces administrative and clinical costs.
  • It reduces substantially the number of uninsured
    in the state and provides them affordable
    comprehensive insurance
  • It generates about 550 million in savings to
    employers and insured working families over the
    next ten years
  • It will improve the quality of care, and provide
    better value for each health care dollar spent.
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