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Health Care Reform Memo: October 15, 2012

Deloitte Center for Health Solutions publication

The health care reform memos are issued on a weekly basis, highlighting news from the previous week's activities in the administration and implications for the C-suite and various stakeholder groups.

My take: open enrollment season

From Paul Keckley, Executive Director, Deloitte Center for Health Solutions

Last week, I had the honor of speaking to Deloitte’s retired partners about the future of the U.S. health care system and what might be expected about health reform after the elections. I typically allow half of my allotted time for Q&A but it wasn’t enough. I spent an hour in the lobby after my formal session ended answering questions, and was reminded once again how deeply personal and relevant health care is to our older citizens.

Their questions were thoughtful—what’s the root cause of high costs? Will doctors be there to treat us if Medicare keeps paying them less? Will the quality of medical training suffer because it’s no longer attracting the best and brightest? Which systems in the world offer an alternative to be considered? Will the election outcome alter the course of health reform? How will the system in the U.S. look for my kids and grandkids? And others. Great questions not easily answered in sound bites.

Today is the beginning of the Medicare open enrollment season, which continues through December 7, 2012. In most markets, television ads are reminding seniors about their choices to enroll in traditional Medicare or choose from several Medicare Advantage options. Last year, about 13 million seniors chose the Part C option and understandably because studies show it provides (1) seniors increased access to primary and specialty care (2) improved quality and (3) lower avoidable readmissions to hospitals. For most seniors, it’s a time to step back and ponder their health—perhaps discussing their decision with a family member or advisor. But for most, it’s a sobering decision not quickly made.

No doubt, the candidates in tomorrow’s debate at Hofstra will hear from a senior in the Town Hall format asking their respective views about the future of the Medicare program. The campaigns have staked out positions that contrast how its sustainability might be achieved while agreeing on the necessity and urgency of changes. Both agree its costs are too high and burdensome to future generations: neither side disputes the projections that enrollment will swell to over 80 million in 20 years and costs will increase from 3 percent of gross domestic product (GDP) to 6.5 percent. They disagree on how to fix it.

The future of Medicare is a defining issue in Campaign 2012. For older Americans regardless of political persuasion, health status or economic means, it is their lifeline. For younger Americans, it is a fiscal challenge in an increasingly complicated world. And for those in the middle, it’s a program that may or may not be there for them, or pay out what they estimate they paid in. Each perspective is understandable.

At last week’s Deloitte Partners’ meeting in San Francisco, one of the luminary speakers at the event, encouraged the packed audience of 5,000 to surround ourselves with “truth tellers.” We need truth tellers in health care. We need truth tellers about Medicare, and we need them in our companies and organizations.

What encouraged me most in the lobby Thursday afternoon was the retired partners’ thirst to know the facts about health care. They were interested in Medicare, but more interested in the overall performance of the health system and changes necessary to keep what works and fix what doesn’t.

Perhaps the greatest challenge facing our democracy is our willingness to allow truth telling. We are a culture that holds dearly to the protection of free speech, even when what’s said is in violent disagreement with our own views. In many organizations and election cycles, killing the messenger is easier than dealing with truth, and distortion of facts is an accepted element of advocacy.

Our seniors and generations that follow want leaders who are objective about the whole body of facts, systematic in evaluating their consequence, validity and reliability, and clear in articulating their substance. The future of Medicare and the U.S. health system requires no less.

Paul Keckely

Paul Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutions

PS – (1) A study published in the January 2012 edition of Health Affairs found that beneficiaries with diabetes in a Medicare Advantage special needs plan (SNP) had “7 percent more primary care physician office visits; 9 percent lower hospital admission rates; 19 percent fewer hospital days; and 28 percent fewer hospital readmissions compared to patients in fee-for-service (FFS) Medicare.” (Source: Robb Cohen, Jeff Lemieux, Jeff Schoenborn and Teresa Mulligan, “Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients,” Health Affairs, January 2012, 31(1), 110-119.)

(2) Additional research co-authored by researchers affiliated with The Brookings Institution concluded that Medicare Advantage plans outperformed the Medicare FFS program in nine out of 11 clinical quality measures. This means that Medicare Advantage enrollees received the level of effective care recommended by a doctor with greater frequency than patients in Medicare FFS, for nine of the 11 procedures studied. (Source: Robert Zirkelbach, America’s Health Insurance Plans’ Statement on Medicare Advantage, September 2012.)

(3) A recent study published in the American Journal of Managed Care (AJMC) found that the Medicare Advantage readmission rate was about 13 to 20 percent lower than that in the Medicare FFS program. (Source: Jeff Lemieux, Cary Sennett, Ray Wang, Teresa Mulligan, and Jon Bumbaugh, “Hospital Readmission Rates in Medicare Advantage Plans,” American Journal of Managed Care, 18(2), February 2012)

Implementation update

Study: ACO savings limited

Researchers used a predictive modeling simulation to show potential shared savings for management of type 2 diabetics between the ages of 65-75. “We found that a ten-percentage-point improvement in performance on diabetes quality measures would reduce Medicare costs only by up to about 1 percent. After the costs of performance improvement, such as additional tests or visits, are accounted for, the savings would decrease or become cost increases. To achieve greater savings, accountable care organizations (ACOs) will have to lower costs by other means, such as through improved use of information technology and care coordination.”

(Source: David Eddy, Roshan Shah, “A Simulation Shows Limited Savings From Meeting Quality Targets Under The Medicare Shared Savings Program”, Health Affairs October 2012 Volume 31, Issue 10.)

Background: Section 3022 of the Affordable Care Act (ACA) established the Medicare Shared Savings program whereby hospitals and other medical providers can create an ACO that’s clinically integrated to manage Medicare FFS enrollee health for three years and share in savings from improved health (based on 33 measures) and reduced costs. ACOs receive shared savings if certain benchmarks, set by Centers for Medicare & Medicaid Services (CMS), are met. More than 250 organizations currently participate in ACOs—two-thirds led by large multi-specialty physician organizations.

My take: the core competencies required to be a ACO center around clinical integration—the coordination of care management for a defined patient population across the continuum of care with infrastructure necessary to manage outcomes and costs and appropriate incentives so that all parties can achieve optimal results. There are two primary rationales for developing an ACO: (1) the upside savings for managing patient populations on a risk basis with payers including Medicare, Medicaid, commercial plans and employers and (2) avoidance of penalties from Medicare and other payers based on fraud, avoidable readmissions, unnecessary care and waste.

Accountable Care is here to stay because clinical integration is an imperative in the delivery system. The infrastructure, workflows, and management of costs and quality across a seamless system of patient care management are core competencies required of winners in the new normal. Notably, in the Medicare ACO, a strong primary care network is essential along with an infrastructure that allows monitoring of patients through the system seamlessly to track costs, outcomes and service delivery. An ACO for purposes of contracting with Medicare only is risky as all things being equal: the costs are higher than most estimates and the shared savings from Medicare will not offset costs. But ACOs for the purpose of penalty avoidance are both necessary and urgent: clinical integration is the most fundamental change of the delivery system’s transformation. It is table stakes for avoiding penalties from unnecessary and unsafe care regardless of an organization’s appetite to contract with Medicare or other payers on a risk basis. So while it is not surprising that this study showed the costs higher than the return for the Medicare ACO, it does not negate the inevitable: clinical integration to avoid penalties is the new normal.

Health insurers show little interest in providing coverage across state lines

A Georgetown University Health Policy Institute analysis concluded that insurers are not interested in providing coverage across state lines. The report analyzed six states—Georgia, Kentucky, Maine, Rhode Island, Washington and Wyoming—that have either adopted legislation to require, encourage, or study the feasibility of allowing the sale of health insurance across state lines or have formed interstate health insurance compacts. According to the study, purchasing insurance across state lines did not enhance consumer choice, increase competition, or make insurance more affordable for the following reasons:

  • True drivers of health insurance costs were not addressed or do not adequately account for the complexity of insurance regulation
  • The administrative hurdles necessary for full implementation are underestimated
  • None resulted in a single insurer entering a new market or the sale of a single new insurance product
  • The localized nature of health care delivery
  • Lack of organized champion or advocates from stakeholders, including the consumers and insurers the laws were designed to benefit

Background: Section 1333 of the ACA creates the option for Health Care Choice Compacts between two or more states. Participating states must pass legislation allowing their participation in a compact approved by the U.S. Department of Health and Human Services (HHS). Plans are subject to all regulations in the state where the plan is issued. In addition, at least 17 states considered some version of such legislation during the 2012 legislative session.

(Source: Sabrina Corlette, Christine Monahan, Katie Keith and Kevin Lucia, “Selling Health Insurance Across State Lines: An Assessment of State Laws and Implications for Improving Choice and Affordability of Coverage,” The Center on Health Insurance Reform, Georgetown University Health Policy Institute, October 2012.)

Comparative effectiveness research doesn’t always translate to better outcomes for patients

A RAND Corporation study concluded that comparative effectiveness research (CER) has not been readily applied at the bedside mitigating quality improvements. The systematic review found five explanations for the bench to bedside disconnect:

  • Financial incentives are not structured in a way to encourage practitioners to adopt evidence based practices.
  • The results of CER aren’t always clear cut—there will always be limitations and exceptions, clouding the waters for decision makers practicing medicine in the field
  • Physicians are skeptical of new information if it contradicts their training or decades of prior research and knowledge
  • The results of CER aren’t tailored to the needs of practitioners
  • Decision support tools are effective but not widely used

(Source: Rand Corporation, “Dissemination and Adoption of Comparative Effectiveness Research Findings When Findings Challenge Current Practices,” October 2010.)

Background: per Section 6301 of the ACA, Patient-Centered Outcomes Research Institute (PCORI) was established to conduct research on drugs, devices, procedures and the delivery system with a focus on clinical effectiveness research. Findings from this research will not serve as payment or coverage recommendations, but HHS can use findings from PCORI research to inform decision making.

My take: clinicians are busy, so they don’t always have time to stay abreast of changing science. Attending professional meetings is worthwhile for professional relationships, but inadequate to keep clinicians current and up-to-date. The solutions include: (1) increased access to clinical decision support tools in meaningfully-used electronic health records, (2) increased access to mobile applications for consumers to assess the evidence themselves, and (3) a public education effort targeting payers, consumers and policymakers to acclimate all to the explosion of science and the need for a “tools not rules” policy framework for its dissemination. The new normal requires fresh thinking about how we train providers to share information and decision making with consumers using technologies and coaching to engage individuals as activists in their care.

Note: this month’s issue of Health Affairs is themed “Current Issues in Comparative Effectiveness Research”—a must read on activities in PCORI and perspectives on efforts toward a national CER program.

Health reform polling roundup: public spilt on changes to Medicare

Pew Research Poll conducted October 4-7 of 1,511 U.S. adults found that public concern about the debt and deficit is high, but only two of a dozen options have majority support as the means to address the fiscal cliff: raising taxes on annual incomes over $250,000 (64 percent approval) and limiting corporate tax deductions (58 percent approval). Least popular options include cuts in education spending (75 percent disapproval) and 61 percent oppose cuts in funding for student loans. “Reducing Medicare benefits for higher income seniors” is almost evenly split: 47 percent approve vs. 49 percent disapprove while “raise contributions to Medicare for health care” received 57 percent disapproval vs. 35 percent approval.

Roper Center for Public Opinion Research’s iPoll reviewed by Kaiser Family Foundation: “On over 200 separate occasions since 1991, public pollsters have asked Americans which party they trust more to handle “health care” policy in general, and the answer has been fairly consistent: over time, Democrats have maintained an advantage over Republicans on the issue. However, while the Democratic edge has been quite consistent, the size of that advantage has been far from steady, and over the past four years it has remained smaller than in years past.” But during the past four years, that advantage has been noticeably smaller, dropping from about a 31 percentage point lead in 2008 to hover at about a 10 percentage point lead.

A Kaiser Family Foundation review of 30 polls 1995-2011 found that in the last 17 years, a premium support alternative to traditional Medicare has never had majority support in the general public or among seniors. In the most recent poll (Pew Research September 2011), 62 percent disapproved of premium support.

(Source: Mollyann Brodie, Ph.D., including Claudia Deane, Sarah Cho, and Theresa Boston. Kaiser Health Tracking Poll, Public Opinion on Health Care Issues, Kaiser Family Foundation’s, September 2012.

Legislative update

HHS OIG: CMS not protecting Medicare enrollee personal health information optimally

Thursday, the Office of Inspector General (OIG) released its evaluation of CMS’s notification response to security or privacy breaches involving Medicare beneficiary protected health information (PHI) and medical identity theft. The report concluded that of the 14 breaches that occurred between September 2009 and October 2011, CMS notified beneficiaries, but failed to do so within the required timeframe on seven occasions. Notification letters for these breaches are required no later than 60 days after the date of discovery; the seven breach notifications that failed to meet this requirement were sent between four days and four months after the 60 day period. Other findings included contractors not consistently developing edits to stop payments on compromised identification numbers, and CMS offering fewer remedies to beneficiaries affected by medical identity theft than to providers. OIG provided the following recommendations to CMS:

  • Ensure that breach notifications meet the American Recovery and Reinvestment Act (ARRA) of 2009 requirements
  • Improve the compromised number database
  • Provide guidance to contractors about using database information and implementing edits
  • Find a way to ensure that beneficiaries whose PHI is stolen have access to needed services
  • Develop a way to reissue identification numbers to beneficiaries whose medical identification is stolen

Background: under ARRA, covered health care providers and plans must notify an individual whose unsecured PHI has been or is reasonably believed to have been accessed, acquired, or disclosed as a result of a breach.

Fungal meningitis outbreak prompts legislative action toward compounding pharmacies

In response to the fungal meningitis outbreak that has resulted in 205 cases and 15 deaths in 12 states as of today, legislators called for more information about compounding pharmacy regulation. The source of the tainted injectable has been identified as the New England Compounding Center (NECC) in Framingham, Massachusetts. Friday, the House Energy and Commerce Committee notified the Massachusetts Board of Pharmacy it is investigating the circumstances of its oversight of NECC to determine if any remedial measures were taken after the U.S. Food and Drug Administration (FDA) sent the center a letter warning of serious violations it witnessed during an inspection and why the NECC was able to continue operating in this manner more than six years after the fact.

Background: on October 4, 2012, the Centers for Disease Control and Prevention (CDC) and FDA released a health alert notifying the public of the cases among patients who received an epidural steroid injection prepared by NECC possibly impact up to 14,000 who received injections originating with NECC.

Related: Representatives Edward Markey (D-MA) and Rosa DeLauro (D-CT) sent letters to the FDA and HHS respectively and said they will introduce legislation to strengthen FDA oversight of compounding pharmacies. Per Representative Markey’s website, his legislation would require certain pharmacies that engage in interstate commerce to register and undergo thorough inspections of pharmacy facilities with the FDA, ban pharmacies from compounding drugs using ingredients not approved by the FDA, require compounding pharmacies to provide adverse event reports to the FDA, and require a warning to patients of any compounded pharmaceutical that has not been approved safe and effective by the FDA.

Background: in 1997 the FDA Modernization Act (FDAMA) exempted compounded drugs from the other requirements of the Federal Food, Drug, and Cosmetic Act with the requirement that the pharmacy is licensed in a state and makes the drug pursuant to a valid prescription for an individual patient. There are 56,000 pharmacies in the U.S. and 3,000 are compounding pharmacies. Guidelines for their safety and quality are overseen by a voluntary oversight organization Pharmacopia. The FDA does not review or oversee compounded drugs; 17 states use Pharmacopia guidelines for oversight.

MedPAC: 25 percent of Medicare admissions preventable

The Medicare Payment Advisory Commission (MedPAC) released a report evaluating the feasibility of measuring preventable admissions and emergency department (ED) visits as indicators of population-level quality of care. An analysis of Medicare data from 2006 to 2008 found that 25 percent of Medicare beneficiary hospital admissions were potentially preventable with proper ambulatory care as well as almost 60 percent of ED visits where beneficiaries were treated and released. Upper respiratory infections were identified as the most frequent reason for preventable emergency visit. The report recommends that further research be completed on the effect that ambulatory care has on preventing these hospital visits.

GAO: Medicare, Medicaid, CHIP fraud efforts

The U.S. Government Accountability Office (GAO) released its findings on the prevalence of fraud in Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) between 2005 and 2010. Results: Since 2005, cases involving pharmacies increased by 224 percent and the number of home health agencies investigated for fraud increased 125 percent. The GAO also reported that the majority of the 7,848 criminal cases investigated by HHS OIG were not referred to the U.S. Department of Justice for prosecution; 1,086 subjects were prosecuted and 85 percent of these subjects were convicted (18.7 percent were medical facilities and 30 percent were individuals or medical providers).

State update

State round-up

  • Reacting to the District of Columbia (D.C.) Benefit Exchange Authority decision to mandate individuals and small-businesses purchase their health insurance through the D.C. health insurance exchange’s (HIX), Wisconsin Senator Ron Johnson (R) opened an investigation into whether the D.C. mandate violates the ACA or harms residents.
  • California state officials, providers and Medicaid plans are lobbying to cap Medicaid spending per person, because state officials and providers see the policy as a way to avert Medicaid cuts during entitlement-reform talks next year.
  • The New Jersey Senate approved legislation this week to establish a state-run HIX. It is unclear if the legislation will be passed in the state Assembly; Governor Chris Christie (R) vetoed a previous HIX legislation in May, and has recently stated that he is considering all options for the state.
  • Kansas healthcare providers have been awarded almost $25.2 million in Medicaid incentive payments for establishing electronic health record (EHR) systems. Per ARRA, funds were allocated to 463 Kansas doctors and 31 hospitals.
  • The Alaska Native Tribal Health Consortium’s Telehealth Technology Assessment Center has been awarded a $1.2 million grant from the Health Resources and Services Administration to provide technology assessment and education to expand telehealth programs in other states.
  • Minnesota officials estimate its HIX could cost upwards of $40 million to operate in 2015. To date, the state has received over $70 million in federal HIX grants.

Industry news

GOP House members seek halt to meaningful use; HIMSS opposes

In response to a letter sent last week by GOP legislators, the Healthcare Information and Management Systems Society (HIMSS) issued a press release opposing the suspension of EHR incentive payments. The statement highlighted the “significant progress” made towards the adoption of EHRs and exchange of health information since the program was established in 2011. HIMSS refutes the Representatives claim that the program should not continue until HHS can advance interoperability, arguing that the Stage 2 final rule released in September “moves the nation definitively towards interoperability.”

(Source: Press Release, “HIMSS Opposes Call for Suspension of HER Incentive Program,” October 5, 2012)

The Office of the National Coordinator’s (ONC) Chief Dr. Farzad Mostashari dismissed the Representatives claims as pre-election tactics when speaking at a conference in Chicago last week.

My take: though efforts to slow the implementation of meaningful use are being pursued in some legislative circles, the notable advantages of meaningfully used EHRs to improved outcomes and safety, improved accuracy in diagnosis and treatment planning outweigh the disadvantages.

Study: ACA impact on employer sponsored coverage, costs in 2012 negligible

Last week, the Urban Institute released a study of the ACA’s effect on employer-sponsored health insurance (ESI) coverage and costs, concluding that ACA requirements will have a negligible impact. Its model evaluated the effect on employer requirements for coverage, premiums and, if applicable, penalties or tax credits had the law been in effect in 2012. Key findings:

  • ESI coverage would have increased by 2.7 percent (from 152 to 156 million people) and employer spending by 2.2 percent (from $553 to $566 billion)
  • Small businesses (100 or fewer workers): reduces the costs of coverage by 7.3 percent per person insured, reduces spending by 1.4 percent for the group as a whole, largest increase in coverage (6.3 percent)
  • Mid-size businesses (101 to 1,000 employees): 4.6 percent increase in cost per person insured; mainly as a result of expanded enrollment, and penalties on as many as 5 percent of employers not currently offering coverage
  • Large businesses (1000 or more employees): 0.3 percent increase in cost per person insured

(Source: Linda J. Blumberg, Matthew Buettgens, Judy Feder, and John Holahan, Implications of the Affordable Care Act for American Business, Urban Institute Health Policy Center, October 2012.)

Reaction from James Whisler—National Leader, Health Actuarial Practice, Deloitte Consulting LLP

“I generally agree that much of the benefits-related impacts (e.g. lifetime limits, waiting periods, Essential Health Benefits) have little impact on the employer market. Having said that, does the fact that the share of people covered by employer based coverage stayed the same 2010-2011 mean the insurance reforms had little impact on costs? Modeling disruptive change by looking through the rear-view mirror and calibrating to historical decisions is notoriously difficult/fraught with error. Assuming that employers will not react by changing their contribution/subsidy levels for example is not an unreasonable assumption, but a significant assumption nonetheless. (Same with not assuming changes in employment patterns). Underplaying the impacts of rating restrictions for small group is a significant gap in this analysis. In a relatively moderate pre-reform rating case (+-25 percent for health) you would still have those at the bottom of the band see an increase of 33 percent (assuming the 1.0 stays the same). To assume that this is the environment for the “increased enrollment of healthy groups” is a stretch at best.”

PS - You can contact James at jwhisler@deloitte.com

PBM trade groups offers recommendations for reducing Medicare drug costs

Monday, the Pharmaceutical Care Management Association (PCMA) sent a letter to Senate Majority Leader Harry Reid (D-NV) and Speaker of the House John Boehner (R-OH) offering recommendations to save $100 billion over ten years and help avoid cuts called for in sequestration. PCMA represents pharmacy benefit managers (PBM) who administer prescription drug benefits for more than 210 million Americans with health coverage. Its recommendations:

  • Modernize Medicaid pharmacy: currently the program uses fewer generic drugs, rarely uses preferred networks, and pays drugstores more than double the dispensing fees of other insurers. By modernizing Medicaid pharmacy benefits, PCMA estimates the government could save $21 billion over the next decade.
  • Promote chronic care pharmacy and home delivery: currently, beneficiaries in Medicare Part D plans use home delivery one-fourth as much as private sector plans. Removing Medicare’s restrictions on home delivery and encouraging beneficiaries to fill prescriptions for maintenance medications by mail could save Medicare money, but might also improve drug adherence.
  • Allow plans in Medicare and the exchanges to negotiate discounts on every brand drug: price competition can be increased among brand drug manufacturers if the mandate that “all or substantially all” of the drugs in Medicare’s six protected classes be covered. This rule makes it difficult to negotiate price concessions and has increased prescription drug costs by $4.2 billion, according to the CMS Office of the Chief Actuary.
  • Maximize generic and therapeutic substitution in Part D: Congressional Budget Office (CBO) outlined potential savings that could result if generic and therapeutic interchange opportunities were increased in Part D, shifting spending from the most expensive drugs to equally effective, lower cost options.
  • Expedite the approval of biogenerics: reducing the number of years a company has exclusivity will increase the competition for biologic drugs.
  • Reduce generic cost-sharing for Part D low income subsidy enrollees: compared to other Part D enrollees, these individuals use more expensive brands. According to MedPAC, reducing or eliminating cost-sharing will increase the use of lower-cost generics with no compromise in quality or access.
  • Eliminate the tax deduction for direct-to-consumer drug advertising: the costs of advertising by brand drug manufacturers to drive consumers to take brand medications are tax deductible.

Quotable

“The term grand bargain is shorthand for a compromise that addresses the long term trend of a budget that gets harder to balance as health costs rise and the population ages. The goal is to put in a deal in place now that shows the government is committed to a plan to shrink the deficit without shocking the economy in the near term.”

— Rich Miller, “Drenched in Debt,” Bloomberg Markets, November 2012

“Premium support, based on competitive bidding, may offer a fiscal solution if ACA reforms fail, but at the cost of making Medicare beneficiaries responsible for solving Medicare’s fiscal crisis. Success of the ACA can make premium support less risky by lowering traditional Medicare costs and helping to monitor and improve quality in private plans.”

— Song et al, “Potential Consequences of Reforming Medicare into a Competitive Bidding System,” JAMA, 308(5), August 2012

Fact file

  • Mortality rates: death rates dropped last year for five of the 15 leading causes of death in the U.S—decreases in heart disease, cancer, and stroke, contributed to a slight decline in the mortality rate decrease in 2011; the average life expectancy remained the stable at 78.7 years from 2010 to 2011. (Source: CDC)
  • Philanthropy to hospitals: U.S. nonprofit hospitals and health care organizations raised $8.941 billion in FY2011—an increase of 8.2 percent from FY2010. Median funds (cash plus pledges) raised for each dollar expended in fiscal year (FY) 2011 were $3.24 for all of the institutions surveyed, with academic institutions receiving the highest median funds raised per dollar of $7.58. (Source: Association for Healthcare Philanthropy, “FY 2011 Report on Giving”, October 2012)
  • Attitudes about U.K National Health Service (NHS): individuals saying that they are “very” or “quite” satisfied with the NHS fell from 70 percent in 2010 to 58 percent in 2011. (Source: NatCen Social Research, “2012 British Social Attitudes survey,” October 2012)
  • Cost barriers for adults with cancer history: young adults with a history of cancer were 67 percent more likely to go without care because of cost compared to those without cancer. Among young adults (ages 20-29) 44 percent of those with a history of cancer reported cost barriers compared to 16 percent without a history of cancer. (Source: Anne Kirchhoff et al, “Limitations in health care access and utilization among long-term survivors of adolescent and young adult cancer,” September 2012)
  • Medicare open enrollment awareness: 73 percent of Medicare enrollees are aware of the annual open enrollment period and, 68 percent utilize it to review their coverage options. Compared to the average Medicare enrollee, Medicare Advantage seniors are more aware of the open enrollment period, 87 percent, and more likely to review their coverage 78 percent. (Source: Kaiser Family Foundation, “2012 National Survey of Seniors,” October 2012)
  • Illegal drugs: $15 billion per year is spent to fight illegal drugs that account for 15,000 deaths per year. In 2011, prescriptions for opioids were $9 billion versus $4.5 billion in 2001. (Source: Joint Committee on Mental Health and Substance Abuse)
  • 2011 health insurance premiums by age for those with private coverage: $2,347 (18-below), $3,599 (19-44), $5,927 (45-54), $8,776 (55-54). (Source: Health Care Cost Institute, September 2012)
  • Food security: in 2011, 14.9 percent of households in the U.S. face food insecurity versus 11.9 percent in 1995. Low income single parent households with children highest: 36.8 percent (Source: U.S. Department of Agriculture)
  • Retirement security: 60 percent of women born 1946-1964 are not prepared for retirement versus 51 percent of men. (Source: AARP)
  • Public school teachers: 1 per 17.2 students in 1990 (2.4M), 1 per 15.2 students in 2010 (3.24M)—teacher workforce has increased almost 50 percent, salary up 3 percent over two decades. (Source: U.S. Department of Education)
National health reform: What now?

National health reform: What now?

At Deloitte, we continue to explore and debate the key questions facing 
the industry, and we look forward to helping our clients find and implement 
the right answers for their organizations. To learn more, visit www.deloitte.com/us/healthreform/whatnow today.

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