Evolution of Government Health Care

Presented by Charlene Frizzera at the CEO Roundtable on August 12, 2015

America's presidents have advocated some form of social insurance since Theodore Roosevelt was in the White House. Examine the federal government's evolving role in health care delivery and learn how agencies such as the Centers for Medicare and Medicaid Services (CMS) transitioned from overseeing legislation to originating policy. Glimpse the future of CMS and explore the impact its initiatives will have on insurers in the coming years.

Transcript

1. Charlene Frizzera, President & CEO, CF Health Advisors
2. Evolution of CMS Programs 2
3. Evolution of Leadership 3
4. Evolution of CMS Bruce Vladeck Administrator, 1992-1997, Clinton Administration Columbia University; the New Jersey State Health Department; Robert Wood Johnson Foundation; United Hospital Fund of New York Nancy-Ann DeParle Administrator, 1997-2000 Clinton Administration Bass, Berry, & Sims law firm; Tennessee state government; the Office of Management and Budget; the Balanced Budget Act of 1997 4
5. Evolution of CMS Tom Scully Administrator, 2001-2003 Bush Administration US Senator office; Akin, Gump, Strauss, Hauer & Feld LLP; President H.W. Bush presidential campaign; the Office of Management and Budget; Patton Boggs, LLP; Federation of American Hospitals; Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) Mark McClellan Administrator, 2004-2006 Bush Administration Brigham and Women’s Hospital; Treasury for Economic Policy, President’s Council for Economic Advisors, Food and Drug Administration; Deficit Reduction Act of 2005 5
6. Evolution of CMS Don Berwick Administrator, 2010-2011 Obama Administration Harvard Community Health Plan; National Demonstration Project on Quality Improvement in Health Care; Institute for Healthcare Improvement; Patient Protection and Affordable Care Act Marilyn Tavenner Administrator, 2011-2015 Obama Administration Hospital Corporation of America; Virginia State government; CMS; Patient Protection and Affordable Care Act Andy Slavitt Administrator, January 2015- Present Obama Administration Goldman Sachs, McKinsey & Company, Health Allies, OptumInsight, Optum, 6
7. Evolution of Programs 7
8. CMS Then & Now Then Now • Emphasis on claims processing • FFS delivery as primary payment model • CMS personnel composition: • Accountants • Auditors • Contract Managers • Regulation Writer • Decrease in claims processing • Capitated system as primary payment model • CMS personnel composition: • Limited accountants • Political Appointees • Industry Experience • ‘Meaningful’ Regulations • Emphasis on frontline & innovative models 8
9. CMS Then & Now in Numbers 9 224 366 1,090 2,298 3,022 4,130 5,198 6,841 7,891 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 1967 1970 1980 1990 1995 2000 2005 2010 2013 Amount (in millions) Fiscal Year Medicare Administrative Expenses 60.8 182.2 428.7 940.9 1062.7 0 200 400 600 800 1000 1200 1980 1990 2000 2010 2013 Program Expenditures ($billions) Total Medicare Medicaid 43.3 47.6 65.5 75.7 81.4 90.2 0 10 20 30 40 50 60 70 80 90 100 1995 2000 2005 2010 2013 2014 Annual Enrollment (in Millions) Medicaid and CHIP Enrollment 19.1 24.6 29.6 37.1 42.0 46.9 52.3 54.0 0 10 20 30 40 50 60 1966 1975 1985 1995 2005 2010 2013 2014 Enrollment (in millions) Medicare Enrollment Tends
10. Evolution of Payment and Delivery System Reforms 10
11. Risk Bearer Government bears risk Payor Bears Risk Government and Provider Share Risk Risk shared throughout the System Care Controller Individual Provider Payor Provider Teams Payor and Provider Teams Payment Mechanism Payment based on Fee Schedule Payment Based on Risk Fee Schedule with Quality Incentives Risk based with Quality Incentives Profit Mechanism Profit Based on Procedure Volume Profit Based on Beneficiary Volume Volume with Incentives Quality Rewards Risk based with Quality Rewards Future of Health Care Payment and Delivery 11 Fee For Service Managed Care Managed FFS Integration and Value PAST PRESENT FUTURE
12. Thank You 12