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Boston University Medical Center

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the Health Advocate
the Health Advocate

a part of "The Path Forward for Academic Medical Centers: Innovation", Economics and Better Health, an Economic Studies and Engelberg Center for Health Care Reform event at the Brookings Institutuion

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Massachusetts Health Care Reform and Impact to BMC April 27, 2009
Principles of Massachusetts Health Care Reform 2 1. Near-universal coverage 2. Shift DSH funding to coverage 3. Increase Medicaid rates 4. Business does its share ¨C Provide coverage, or pay a Fair Share ¡°Tax¡± 5. Cost & Quality Review
Coverage 3 Results Newly insured to date: Est. 2.6% remain uninsured, 432,000 growth in insured Expand Medicaid 76,000 growth New subsidized product 169,000 enrolled New individual/small group 39,000 enrolled options Employer based insurance 168,000 growth
Coverage 4 Eligibility process challenging for Low-Income population Annual eligibility determination required ? Manual, mail-based process results in thousands inappropriately losing eligibility Peak enrollment of 175,000 down to 169,000 resulting from: ? Ongoing churning ? Manual system
Coverage 57% newly insured are in Subsidized 5 Products Commonwealth Choice individual/small group product Medicaid 9% 18% Employer-based insurance 34% Commonweatlh Care subsidized Product 39%
Newly Insured in Massachusetts by Region 6 Geographic distribution of newly insured in Massachusetts is only available for the new subsidized product, Commonwealth Care. Commonwealth Care enrollment distribution Greater Boston 44,064 Northern Massachusetts 35,511 Southern Massachusetts 37,325 Central Massachusetts 28,253 Western Massachusetts 23,847 Total Massachusetts 169,000
Funding 7 Results Shift DSH Funding Safety Net financial support devastated, impacting hospitals serving a disproportionate share of low-income. Increase Medicaid Rates Mass. Hospital Assoc. reports actual rate decreased to 70% of Reform intent to increase costs. hospital rates from 80% to 95% of costs.
Business, Cost & Quality 8 Results Business Does its Share -Provide coverage 168,000 additional employees purchased insurance -Pay Fair Share ¡°Tax¡± Limited revenue collected Cost & Quality Review Efforts recently launched Chapter 305
BMC¡¯s Role in Health Care Reform 9 Coverage ? Moved more patients to coverage than all other hospitals in Massachusetts combined ? 150,000 low-income patients served annually ? BMC HealthNet Plan is the largest insurer of care to Medicaid and Commonwealth Care with 250,000 members. Financial Impact ? Payments to BMC are down to 64 cents/dollar ? FY 2010, BMC to receive $221 payments cut for low- income patient care
BMC¡¯s?cost?increases?averaged?only?4%?per?year? while?payments?fell?dramatically?below?cost?for? 10 the?same?volume?of?low?income?patients 160,000 $600,000 140,000 $500,000 120,000 Unduplicated low-income patients $400,000 Cost & Payments 000's 100,000 80,000 $300,000 60,000 $200,000 40,000 $100,000 20,000 0 $0 FY 06 FY 07 FY 08 FY 09 FY 10 Medicaid Commcare Uninsured Cost Payments

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Boston University Medical Center

  • 1. Massachusetts Health Care Reform and Impact to BMC April 27, 2009
  • 2. Principles of Massachusetts Health Care Reform 2 1. Near-universal coverage 2. Shift DSH funding to coverage 3. Increase Medicaid rates 4. Business does its share ¨C Provide coverage, or pay a Fair Share ¡°Tax¡± 5. Cost & Quality Review
  • 3. Coverage 3 Results Newly insured to date: Est. 2.6% remain uninsured, 432,000 growth in insured Expand Medicaid 76,000 growth New subsidized product 169,000 enrolled New individual/small group 39,000 enrolled options Employer based insurance 168,000 growth
  • 4. Coverage 4 Eligibility process challenging for Low-Income population Annual eligibility determination required ? Manual, mail-based process results in thousands inappropriately losing eligibility Peak enrollment of 175,000 down to 169,000 resulting from: ? Ongoing churning ? Manual system
  • 5. Coverage 57% newly insured are in Subsidized 5 Products Commonwealth Choice individual/small group product Medicaid 9% 18% Employer-based insurance 34% Commonweatlh Care subsidized Product 39%
  • 6. Newly Insured in Massachusetts by Region 6 Geographic distribution of newly insured in Massachusetts is only available for the new subsidized product, Commonwealth Care. Commonwealth Care enrollment distribution Greater Boston 44,064 Northern Massachusetts 35,511 Southern Massachusetts 37,325 Central Massachusetts 28,253 Western Massachusetts 23,847 Total Massachusetts 169,000
  • 7. Funding 7 Results Shift DSH Funding Safety Net financial support devastated, impacting hospitals serving a disproportionate share of low-income. Increase Medicaid Rates Mass. Hospital Assoc. reports actual rate decreased to 70% of Reform intent to increase costs. hospital rates from 80% to 95% of costs.
  • 8. Business, Cost & Quality 8 Results Business Does its Share -Provide coverage 168,000 additional employees purchased insurance -Pay Fair Share ¡°Tax¡± Limited revenue collected Cost & Quality Review Efforts recently launched Chapter 305
  • 9. BMC¡¯s Role in Health Care Reform 9 Coverage ? Moved more patients to coverage than all other hospitals in Massachusetts combined ? 150,000 low-income patients served annually ? BMC HealthNet Plan is the largest insurer of care to Medicaid and Commonwealth Care with 250,000 members. Financial Impact ? Payments to BMC are down to 64 cents/dollar ? FY 2010, BMC to receive $221 payments cut for low- income patient care
  • 10. BMC¡¯s?cost?increases?averaged?only?4%?per?year? while?payments?fell?dramatically?below?cost?for? 10 the?same?volume?of?low?income?patients 160,000 $600,000 140,000 $500,000 120,000 Unduplicated low-income patients $400,000 Cost & Payments 000's 100,000 80,000 $300,000 60,000 $200,000 40,000 $100,000 20,000 0 $0 FY 06 FY 07 FY 08 FY 09 FY 10 Medicaid Commcare Uninsured Cost Payments