Transcript About Community Catalyst

The Affordable Care Act: Impact on
Seniors & Opportunities for Change
ROBERT RESTUCCIA
EXECUTIVE DIRECTOR
October 18, 2013
Grantmakers in Aging Annual Conference
Kansas City, Missouri
© 2011
About Community Catalyst
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Non-profit health care advocacy organization
Network of advocates in 40+ states
Building advocacy infrastructure
Leading broad-based issue campaigns
Launched new initiative, Voices for Better
Health
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2011
AGENDA
1. An Overview: The Affordable Care
Act & Seniors
– Improving Access
– Reorganizing Care Delivery
2. Medicare-Medicaid Beneficiaries
3. What Can You Can Do?
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An Overview:
The ACA & Seniors
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Building Blocks of the Law
• Gives more people access to
coverage
• Reforms insurance market
• Builds on Medicaid and
strengthens Medicare
• Improves the quality of care
people receive, especially for
those with chronic illness, and
cut costs in the process
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For People 50-64
• Elimination of pre-existing conditions
• Limits age rating
• Medicaid expansion subject to state
action
• Offers Marketplace plans with subsidies
up to 400% federal poverty level (FPL)
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Medicare Changes
• Extends the life of the
Medicare Trust Fund by
12 years
• Reduces waste, fraud,
and abuse
• Adds new protections for
seniors with Medicare
Advantage plans
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Improved Prescription Drug Coverage
• $250 one-time rebate in 2010
• 50% discount on brand name
drugs started in 2011
• Donut hole eliminated by 2020
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Photo by The Rogue, Flickr
Expanded Benefits and Access
• Free annual wellness visit
• No out-of-pocket costs for preventive
services
• Increased payments for primary care
providers in Medicaid
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"The Triple Aim”
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Delivery System Changes
• Center for Medicare & Medicaid
Innovation
• Avoidable Readmissions and
Complications
• Medicare-Medicaid Coordination
Office
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Care at Home
• Money Follows the Person
• Community First Choice Option
• Balancing Incentives Payment Program
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Medicare-Medicaid Beneficiaries:
The Vision and Opportunity
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Dual Eligible Demonstration Projects
• Design contracts to 15 states
• New financing options:
• Capitated Model: A state, CMS, and a health plan enter
into a three-way contract, and the plan receives a
prospective blended payment to provide
comprehensive, coordinated care.
• Managed Fee-for-Service Model: A state and CMS
enter into an agreement by which the state would be
eligible to benefit from savings resulting from initiatives
designed to improve quality and reduce costs.
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The Vision
• Fewer hospital readmissions
• Improved connections to communitybased services
• Better overall function
• Greater autonomy, dignity and
independence
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Sally and Edna’s Story
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Demonstration Project Proposals
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The Risk – Managing Money not Care
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The Risk – a $300 billion opportunity?
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Medicare-Medicaid Beneficiaries
What Can We Do?
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The Details Matter
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Enrollment
Marketing
Provider Networks
Long-Term Services
and Supports
• Assessment
• Care Coordination
• Benefits Package
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• Consumer
Engagement
• Appeals and
Grievances
• Payment Rates
• Savings
Expectations
• Quality
Measurement
• Cultural
Competence
Consumer Engagement
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Consumer-Provider Collaboration
Union of Policy and Practice
Consumers
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Geriatric
Providers
Thank You
ROBERT RESTUCCIA
EXECUTIVE DIRECTOR
COMMUNITY CATALYST
[email protected]