360° Insight: Health reform

PwC Health Reform WebCast Series

• Health reform on the fast track
  Wednesday, March 11, 2009
  Select to replay webcast.
  
  David Levy, Global healthcare sector leader was joined by subject matter specialists from PricewaterhouseCoopers on March 11, 2009 to discuss the impact the Obama stimulus package and the $630 billion reserve will have on the health industries. In addition, the webcast addressed the potential implications of these reforms as well as the positive and negative consequences for pharmaceutical firms, health insurers (payers), hospitals (providers) and employers.
• Healthcare payment bubble: Current and future changes in government payment
  Friday, September 25, 2009, 12:00pm - 1:00pm ET>
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  Annual increases in healthcare costs have resulted in growing criticism of the existing inefficiencies and incentives in the health industry. Listen to PwC as we address the potential changes in government payment being discussed in Washington, D.C. and the impact it could have on the entire health industry.
• New care models and accompanying reimbursement changes
  Friday, October 9, 2009, 1:00pm - 2:00pm ET
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  Efforts to make the health delivery more efficient and effective will impact all stakeholders. Health reform proposals could accelerate these changes through reimbursement incentives. Join PwC as we discuss these new care models and payment reforms. Join our distinguished faculty which includes:
  

  • David Levy, MD - principal and leader, PwC Global Health practice
  • Brett Hickman - partner, PwC Health Industries Advisory practice
• The value of innovation
  Friday, October 23, 2009, 12:00pm - 1:00pm ET
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  The value of innovation: From health IT, to the NIH to comparative effectiveness
  The stimulus is funneling $36 billion to drive adoption of electronic health records, $10 billion to fund more NIH research, and $1 billion to pay for comparative effectiveness studies. Health reform advocates say these and other proposals will drive efficiencies and new treatments. Join PwC as we discuss the implications of the government's investments in innovation.
  
  Join our distinguished faculty which includes:

  • Daniel Garrett - principal and leader, PwC Health Industries Technology practice
  • Paul Veronneau - principal and leader, PwC US Healthcare Payer practice
  • Todd Evans - director, PwC Health Industries Advisory Pharmaceuticals & Life Sciences practice
• New rules: Health insurance reform
  Friday, November 6, 2009, 12:00pm - 1:00pm ET
  Select to replay webcast.
  
  The precise destination of health insurance reform is not certain, but the course is set. To complete the journey, health organizations will need to prepare their strategies now.
  
  Join our distinguished faculty which includes:

  • Jeff Fusile - partner, PwC Health Industries Advisory Payer practice
  • Bill Rosenberg - director, PwC Global Human Resource Solutions practice
• Universal coverage: Evaluating the Massachusetts model
  Friday, November 20, 2009, 12:00pm - 1:00pm ET
  
  
  Massachusetts healthcare reform mandating universal coverage was enacted in 2006. The state established an independent public authority (Health Connector), which offers subsidized coverage and facilitates the selection and purchase of private insurance plans by individuals and small businesses. Three years later how is Massachusetts managing? Could this be a model for the nation? What lessons can we learn?
  
  Join our distinguished faculty which includes:
  

  • David Chin, MD - principal and leader, PwC Health Research Institute
  • Jack Rodgers Ph.D - managing director and leader, PwC Health Policy and Economics group
  • Jon Kingsdale, Executive Director, Commonwealth Insurance Connector

  Replay available Tuesday, November 24, 2009.
  
  Register online today at www.meetpwc.com/healthreform.

Additional PricewaterhouseCoopers perspectives on Health Reform

The United States spends close to 17 percent of its GDP on healthcare and that figure is projected to jump to 37 percent of GDP by 2050 if the trend continues. The Obama administration is banking on health information technology (IT), particularly electronic medical records (EMRs) and electronic health records (EHRs) to be one of the drivers of health reform. One of the next big challenges for the health industries is to build out a computerized infrastructure and make use of the data these systems will produce. An opportunity to produce, aggregate, and analyze meaningful data can transform the industry. Read more in Transforming healthcare through secondary use of health data.

The Obama administration has framed health reform around three goals, all of which could affect medical cost trends in 2010. Broader health insurance coverage, particularly if paired with an individual mandate, could reduce the cost shifting that increases medical costs to private payers. While the reforms themselves will have minimal short-term impact, if history is a guide, the prospect of health reform may help to sustain pressure on medical pricing in 2010. The last sustained period of national health reform debate was during the first Clinton administration. Although no significant health reform legislation was passed during that period, it created anxiety and disruption throughout the industry. Read more in Behind the numbers: Medical cost trends for 2010.

The stimulus funding for health IT is a small carrot compared to the amount of resources it will take to deploy this technology over the next five years. Also, providers will feel a big stick of Medicare penalties if they fail to use government-certified electronic health records in a certified manner beginning in 2015. Health IT is moving from a voluntary initiative over the past decade to a highly regulated one. Read more in Rock and a Hard Place: An analysis of the $36 billion impact from Health IT stimulus funding.

By several measures, access to care is jammed for many Americans, both insured and uninsured. As health reform in Massachusetts has demonstrated, access to coverage does not translate into access to care. As Congress discusses ways to provide the universal coverage that other nations have, discussion of access to care must follow closely behind. Health organizations and government can open the access logjams through changes in behavior, incentives and patient throughput. Read more in Jammed access: Widening the front door to healthcare.

President Obama campaigned on a pledged to implement multiple changes in our healthcare system. A promise of universal access is central to his proposals. While covering every single U.S. resident may not be possible, Obama’s plan could get the nation closer to universal coverage than it has ever been. What does that mean for the health industry, employers, and patients? We recommend looking to Massachusetts, where many of the tenets of Obama’s reform are now in process. Read more in Healthcare policy in an Obama administration: Delivering on the promise of universal coverage.

PwC Health Reform WebCast Archive

• Health reform on the fast track
  Wednesday, March 11, 2009
  Select to replay webcast.
  
  David Levy, Global healthcare sector leader was joined by subject matter specialists from PricewaterhouseCoopers on March 11, 2009 to discuss the impact the Obama stimulus package and the $630 billion reserve will have on the health industries. In addition, the webcast addressed the potential implications of these reforms as well as the positive and negative consequences for pharmaceutical firms, health insurers (payers), hospitals (providers) and employers.
• Healthcare payment bubble: Current and future changes in government payment
  Friday, September 25, 2009, 12:00pm - 1:00pm ET
  Select to replay webcast.
  
  The inevitable trend of government reimbursements: Reduction and redistribution. Cuts in reimbursements to providers. Discounted, directly-negotiated prices to pharmaceutical and life sciences companies. Cuts in Medicare Advantage payments and competitive bidding for payers. New excise taxes on health plans, prescription drugs, and medical devices. These funds will be redistributed to subsidize coverage for low-income individuals, to expand Medicaid and Medicare, and to help small businesses provide health insurance to their employees. The payoff for all healthcare stakeholders could be billions of dollars in revenues from newly covered Americans.
  
  As healthcare stakeholders and policymakers continue to debate the details of healthcare reform, significant reform initiatives are already underway. Stimulus funding of electronic health records (EHRs) will hopefully lead the way toward better, more coordinated care at sustainable cost. The Obama Administration's expansion of the State Children's Health Insurance Program (SCHIP) provides a potential model for universal coverage.
  
  One delivery model getting a lot of attention is Accountable Care Organizations (ACOs). ACOs coordinate all patient care and manage all patient expenditures within a comprehensive network encompassing the entire continuum of care. They provide an overarching structure within which other reforms can thrive.
• New care models and accompanying reimbursement changes
  Friday, October 9, 2009, 1:00pm - 2:00pm ET
  Select to replay webcast.
  
  Share the wealth. Share the risk. Share accountability. Healthcare reform proposals currently under discussion in Congress are variations on these themes. Today's healthcare delivery system is evolving rapidly—pushed along by intensifying financial incentives—from fragmented care to integrated care. From competitive stakeholder relationships to cooperative ones. From skill-based medicine to evidence-based medicine. Centers for Medicare and Medicaid Services (CMS) are changing the way reimbursement will be made from passive payers of episodic healthcare services to active purchasers of integrated, coordinated health management services. To share risks and cost savings, CMS is piloting strategies such as bundled payments, Accountable Care Organizations (ACOs), and Value Based Purchasing.
  
  In fact, traditional roles are blurring as CMS begins to guide the evolution of healthcare delivery with incentive payments. There is a new focus on managing patient care through the medical home model as CMS invests in the education and deployment of primary care physicians, and gives them new roles in coordinating and managing healthcare delivery.
• The value of innovation
  Friday, October 23, 2009, 12:00pm - 1:00pm ET
  Select to replay webcast.
  
  Better measurements of clinical and operational quality. Coordinated, collaborative care models. Better transparency and accountability. Evidence-based best practices. Reimbursements based on performance. All represent the future of healthcare. All are enabled by health information technology (HIT). Almost every health reform provision depends on the ability to collect, manage, share, and analyze medical and business information. Information that is accurate, available, comprehensive, up-to-date, and secure. Healthcare stakeholders concur on the value of HIT, and believe that its evolution begins with interoperable electronic health records (EHRs). The Obama Administration agrees, and has earmarked $44 billion in stimulus funding to fast-track EHR implementation. Payments to adopters of EHRs are changing from rewards for voluntary initiatives to penalties for failing to meet mandated standards and timelines.
  
  Questions about the working details of HIT and how to pay for it remain to be sorted out. Nevertheless, organizations should focus now on practical considerations. Acquiring the right mix of skills. Developing the proper relationships. Establishing connectivity throughout the enterprise and with business partners. Securing adequate funding. Getting staff and physicians on board and preparing them to adapt to fast-approaching changes. Building an interoperable, secure information architecture. All healthcare sectors must play a role in making EHRs a reality as quickly as possible. Late adopters stand to become uncompetitive, or pay an enormous price to catch up.
• New rules: Health insurance reform
  Friday, November 6, 2009, 12:00pm - 1:00pm ET
  Select to replay webcast.
  
  Current health insurance reform proposals aim to substantially reduce the number of uninsured and underinsured Americans by setting standards, implementing health exchanges and providing subsidies. The question of whether or how to offer a public option is one of the most visible and contentious issues in the healthcare debate.  However, on many other issues, reform proposals agree in principle, if not in scope.  Insurers will soon operate in a more regulated marketplace. They will need to compete for potential new members in compliance with government regulations and oversight. All current reform proposals include health insurance exchanges, a venue where people can comparison shop for standardized health packages. The government will offer incentives to small businesses and individuals to whom health coverage remains a burden, and will impose tax penalties on those able to afford coverage yet choose not to buy it.  Details remain to be resolved regarding who will run health insurance exchanges, those eligible to buy insurance from them, and what plans they can offer.
  
  The precise destination of health insurance reform is not certain, but the course is set. To complete the journey, health organizations will need to prepare their strategies now.