public health writing question
Please see attachment. Also, i have attached the class PowerPoint for support. It is very important this assignment is written in a reflective form.
Requirements: Reflective
PHRC 4962 / PHRM 5962 Essentials of Professional Practice II Healthcare Finance Application Reflection Winter Semester 2023 INSTRUCTIONS Use materials covered as part of this course (posted in Canvas and from in-class activities) and from elsewhere to answer the following questions. These questions are reflective inquiries, answer accordingly. In other words, reflect. OUT-OF-POCKET EXPENSES Question #1 Please answer the following questions/statements. Explain to a patient what out-of-pocket expenses are and what is included. What impact do these expenses have on a patient’s access to care? What impact do these costs have on population health? FORMULARIES Question #2 Please answer the following questions/statements. How would you explain a formulary exclusion to your patient? In your experience, are formularies useful? Why or why not? PHARMACY BENEFIT MANAGERS Question #3 Please answer the following questions/statements. What roles do PBMs play in healthcare financing? What are some of the current issues surrounding PBMs? What will be the key impacts, according to you, of the Supreme Court’s ruling in Arkansas vs. PBMs case? Explain your answers.
2 EPP-2 Healthcare Finance Reflection Winter Semester 2023 (continued) AFFORDABLE CARE ACT Question #4 Please answer the following questions/statements. How are circumstances in the healthcare system similar now to the year 2009? How will these similarities drive healthcare reform over the next two years? What do you suggest should be done to help solve some of the health care problems we see now? Support your reflections with facts. Format This application reflection must be posted before the stated deadline. Your reflection should be formatted in the same matter as the questions, with the question number listed and the corresponding answer given below it. Your answer to each question should provide evidence of a deep reflection on the topic asked. Grading This assignment is the comprehensive, end-of-Module assessment for this material; it is worth 14% of your overall course grade. Your efforts to answer these questions should reflect the significance of the assignment. This assignment will be graded on your reflective insight, critical thinking involved in your answers, and relevance to the modules presented. Reflections must be posted by the due date using 12-point, Times New Roman font, and 1.5 line spacing. Due Date Healthcare Finance Application must be posted before Tuesday, 14 February 2023 at 23:55. You may upload this Learning Activity earlier if you wish. Please post this Assessment as Microsoft Word document only (*.doc or *.docx).
1/6/20221A Health Economics Perspective on Public HealthµIoana Popovici, Ph.D.Associate ProfessorDepartment of Sociobehavioral and Administrative PharmacyCollege of PharmacyModule Topicsµwhat is health economicsµallocating limited healthcare resources: disease treatment versus health promotion, vaccination, educationµhealthcare: right or privilege?µsocioeconomic disparities in health and the development of public health insurance programsµPublic Insurance programs (Medicaid, Medicare, CHIP, etc.)µPrivateinsurance(PPOs, ACOs, etc.)µsocioeconomic disparities in health and the need for health insurance reform (reform efforts, Affordable Care Act)µimplications for pharmacists12
1/6/20222Module ObjectivesDiscuss the importance of health economics in the allocation of limited healthcare resourcesContrast health promotion, disease prevention, education, and vaccination with disease treatment from an economic perspectiveRecognize the need for public health insurance programs and the need for health insurance reformCompare and contrast the public health insurance programs in terms of coverage and eligibility (Medicare, Medicaid, CHIP, etc.)Differentiate between the different private health insurance plans (PPO, HMO, etc.) Compare and contrast between private and public health insurance programsDescribe how the ACA impacts healthcare coverage and services in the healthcare system HealthµHealth µgenetic factorsµenvironmental factorsµlifestyleµhealthcareµHealth -a state of complete physical, mental and social well-being (World Health Organization)µVictor Fuchs (Professor of Economics, Health Research and Policy, Stanford University) µthe greatest current potential for improving the health of the American people is to be found in what they do or dont do for themselves.34
1/6/20223Healthcare in the U.S. µlife expectancy:µ1900: 47.3 yearsµ2017: 78.6 yearsµleading causes of death:µ1900: communicable diseases µinfluenza and pneumonia, tuberculosis, diarrheaµ2017: chronic diseasesµheart disease, cancer, accidents (unintentional injuries), chronic lower respiratory diseasesµ2020: COVID-19 µ3rdplaceHealthcare in the U.S. (cont.)µHealthcare system focus:µdiagnosis and treatment of disease µpromotion of healthµ1979 -Healthy People: The Surgeon Generals Report on Health Promotion and Disease Prevention (Department of Health and Human Services (DHHS) )µHealthy People 2030 vision: a society in which all people live long, healthy livesµObjectives (https://www.cdc.gov/nchs/healthy_people/hp2020/hp2020_topic_areas.htm):µphysical activityµnutritionµobesityµtobacco useµsubstance useµaccess to health services56
1/6/20224Healthcare Spending in the U.S.µU.S. healthcare spending grew 4.6 percent in 2019, reaching $3.8 trillion or $10,966 per personµ$3,800,000,000,000µAs a share of the nation’s Gross Domestic Product (GDP), health spending accounted for 17.7%µSpending accounts for 1 of every 9 employees in the U.S.µUS healthcare system is the most expensive in the worldµ5,000 hospitals, 30,000 nursing homes, 800,000 physicians, 2.8 million registered nurses, and 10 million other healthcare workers (300,000 pharmacists)µExercise: estimate the number of healthcare professionals in Cooper City (population 35,000) based on approximate U.S. population 300 millionµBy 2028, health spending is projected to reach $6.2 trillionµhttps://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.htmlµU.S. health spending fell for first time in 60 years in 2020 (2% decline)78
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1/6/20226Healthcare Spending in the U.S.Sources of Financing 1929, 1970, and 2012GetzensHealth Economics & Financing, 5thEditionCopyright John Wiley & Sons, Inc.Factors linked to increases in U.S. Healthcare SpendingµInflationµExercise: Convert $1 in 1929 dollars to 2021 dollarsµUse inflation calculator here: https://data.bls.gov/cgi-bin/cpicalc.plµU.S. population growth (122 million in 1929 to 330 million today)µIncreases in healthcare professionals incomesµGrowth facilitated by the shift from individual payments to third-party financing (cost-shifting)µIncreases in range and intensity of healthcare services => increases in life expectancy => larger elderly population => more healthcare spending1112
1/6/20227Distribution of Individual Medical Care Expenditures1314
1/6/20228The Concentration of Personal Health ExpendituresGetzensHealth Economics & Financing, 5thEditionCopyright John Wiley & Sons, Inc.1516
1/6/20229U.S. Sources and Uses of Healthcare Funds, 2010GetzensHealth Economics & Financing, 5thEditionCopyright John Wiley & Sons, Inc.1718
1/6/202210Pharmaceutical Spending in the U.S.µPharmaceutical expenditures -10% of healthcare costsµFastest growing segmentµExpected to increase by 50% in the next decadeµAmericans spend more on medicines than Japan, Germany, France, Italy, Spain, UK, Australia, New Zealand, Canada, Mexico, Brazil, and ArgentinacombinedSources of Funds for Pharmaceutical ProductsGetzensHealth Economics & Financing, 5thEditionCopyright John Wiley & Sons, Inc.1920
1/6/202211Health InsuranceµHealthcare in the U.S. expensiveµA small percentage of the population consumes a large share of the total healthcare spentµWho pays for the healthcare of those who are sick?µCould the 1-5% with the greatest personal healthcare expenses be able to pay for these without health insurance? Who pays?µIs it fair that we contribute to the healthcare expenses of others?µWhat is the reason we agree to contribute to the expenses of others?µRisk aversionµHealth insurance protects us against this risk of sudden large healthcare expensesµTrade health insurance premium every month for expenses coverage if sick2122
1/6/202212Methods for Covering RisksµUse private savings to pay for current expensesµIndividuals trade with themselves at different time periodsµAssistance from family and friendsµMutual obligation and reciprocityµCharity as a means of social exchangeµLimited for most peopleµSocial healthcare insuranceµContributions are mandatory through the tax systemµPrivate medical care insuranceµIndividual perspective: trade monthly premium for affordable treatment if/when sickµSocietal perspective: risk poolingPrivate Health Insurance Risk PoolingµClub with 100 membersµRisk of getting sick: 1/100 (1%)µHealthcare expenditure: $25,000µAnnual contribution per member: $250µMoney earns interest in a bank accountµEvery year, money used to pay healthcare expenses of sick memberµSocietys point of view:insurance is a method of pooling risk such that a persons loss (when sick) is shared across many peopleµRisk pooling: funds are collected from many people (most healthy) and used to cover for a few peoples illnesses 2324
1/6/202213Health Insurance TerminologyµPremiumfor coverageµAgreed upon fees paid for coverage of medical benefits for a defined benefit periodµCan be paid by employers, unions, employees, or shared by both the insured individual and the plan sponsorµDeductibleµFixed dollar amount during the benefit period -usually a year -that an insured person pays before the insurer starts to make payments for covered medical servicesµPlans may have both per individual and family deductiblesµCoinsurancerate µA form of medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount, if any, was paidHealth Insurance Terminology (cont.)µCopaymentµA form of medical cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is receivedµMaximum plan dollar limit µThe maximum amount payable by the insurer for covered expenses for the insured and each covered dependent while covered under the health planµMaximum out-of-pocket expenseµThe maximum dollar amount a group member is required to pay out of pocket during a yearµUntil this maximum is met, the plan and group member shares in the cost of covered expensesµAfter the maximum is reached, the insurance carrier pays all covered expenses, often up to a lifetime maximum. (See previous definition.)2526
1/6/202214Healthcare: Right or Privilege?µ2020: 30 million Americans uninsuredµ1965: Medicaid and Medicare programsµ2010: The Patient Protection and Affordable Care Actµuniversal coverage -access to healthcare coverage for every citizenµpurpose: access to healthcare and improve major gaps in coverageµnumber of uninsured decreased from 44 million in 2013 to 27 million in 2016µpay for other peoples healthcare?µdisease cure/treatment versus disease prevention/health promotionµmanaged careµsingle-payer plan?µdecisions based on economic evaluations2728
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1/6/202216Affordable Care Act (ACA)µThe comprehensive healthcare reform law enacted in March 2010 µThe law has 3 primary goals:Make affordable health insurance available to more people. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100% and 400% of thefederal poverty level.Expand the Medicaid programto cover all adults with income below 138% of the federal poverty level. (Not all states have expanded their Medicaid programs.)Support innovative medical care delivery methods designed to lower the costs of healthcare generally.µhttps://www.kff.org/health-costs/issue-brief/summary-of-coverage-provisions-in-the-patient/3132
1/6/202217Summary of Coverage Provisions in the Patient Protection and Affordable CareActExpansion of Public ProgramsThe Medicaid expansion to 138% of the federal poverty level ($15,415 for an individual and $31,809 for a family of four in 2012) for individuals under age 65American Health Benefit ExchangesThe creation of health insurance exchanges through which individuals who do not have access to public coverage or affordable employer coverage will be able to purchase insurance with premium and cost-sharing credits available to some people to make coverage more affordableChanges to Private InsuranceNew regulations on all health plans that will prevent health insurers from denying coverage to people for any reason, including health status, and from charging higher premiums based on health status and genderYoung adults will be allowed to remain on their parents health insurance up to age 26The penalties to employers that do not offer affordable coverage to their employees, with exceptions for small employers.3334
1/6/202218Thank you!35
1/6/20221A Health Economics Perspective on Public HealthµIoana Popovici, Ph.D.Associate ProfessorDepartment of Sociobehavioral and Administrative PharmacyCollege of PharmacyModule Topicsµwhat is health economicsµallocating limited healthcare resources: disease treatment versus health promotion, vaccination, educationµhealthcare: right or privilege?µsocioeconomic disparities in health and the development of public health insurance programsµPublic Insurance programs (Medicaid, Medicare, CHIP, etc.)µPrivateinsurance(PPOs, ACOs, etc.)µsocioeconomic disparities in health and the need for health insurance reform (reform efforts, Affordable Care Act)µimplications for pharmacists12
1/6/20222Module ObjectivesDiscuss the importance of health economics in the allocation of limited healthcare resourcesContrast health promotion, disease prevention, education, and vaccination with disease treatment from an economic perspectiveRecognize the need for public health insurance programs and the need for health insurance reformCompare and contrast the public health insurance programs in terms of coverage and eligibility (Medicare, Medicaid, CHIP, etc.)Differentiate between the different private health insurance plans (PPO, HMO, etc.) Compare and contrast between private and public health insurance programsDescribe how the ACA impacts healthcare coverage and services in the healthcare system 34
1/6/20223Public Healthcare Financing in the US-Social InsuranceµInsurer = GovernmentµMandatory contributionsµPrograms:µMedicareµMedicaidµVeterans Affairs healthcare (VA)µTRICARE µIndian Health Service (IHS)µFederal Employees Health Benefits Program (FEHBP)µChildrens Health Insurance Program (CHIP)656
1/6/20224MedicareµEstablished 1965µ~ 61 million beneficiaries in 2020µBeneficiaries: Who is eligible for Medicare?µ>65 years of ageµ< 65 years of age with disabilitiesµany age with end-stage renal disease (permanent kidney failure requiring dialysis or transplant)778
1/6/20225MedicareµStructure:µOriginal Medicare fee-for-serviceµPart A hospital careµPart B -outpatient care and physician servicesµPart C alternative option through private insurance plansµPart D optional prescription drug coverage through private insurance plansµMediGapprivate plans standardized by the Centers for Medicare & Medicaid Services (CMS) that cover out-of-pocket costsµFinancing: µBeneficiary premiumsµPayroll taxes (payroll tax = 2.9% paid jointly by employee -1.45%-and employer -1.45%-)µ2013 -tax increased to 3.8% for incomes above $200,000/yearµGeneral revenue910
1/6/20226Cost Control in MedicareµExpensive why?µCost control mechanismµDiagnosis related group (DRG) systemµIntroduced in 1984µRather than pay the hospital for each specific service it provides, Medicare pays a predetermined amount based on the Diagnostic Related Group, which is based on the patients age, gender, diagnosis, and the medical procedures involved in your careµReimbursements based on diagnosis, treatment, rather than length of stayµBased on the care given to and resources used by a "typical" patient within the group1112
1/6/20227Medicare Part A Hospital CoverageµMedicare Part A covers hospital expenses such as µinpatient care in hospitalsµskilled nursing facility careµnursing home care (inpatient care in a skilled nursing facility thats not custodial or long-term care)µhospice careµhome healthcareµEligibility: automatic enrollment in Medicare Part A for all Medicare recipientsµEvery American over age 65 is eligible to enroll in Part AµDisabled Americans who have been out of work for 2 years are also eligibleµMajority of Medicare Part A revenue is financed through payroll taxesµPremiums: No fee for the majority of beneficiaries*µ*A small number of beneficiaries (who didnt pay enough Medicare taxes during their working years) must pay a$471 monthly premium.µthe vast majority of enrollees are exempt: those who worked in the U.S. for at least 10 years and paid the Medicare taxesµDeductible: $1,484 in 202113Medicare Part B -Doctor and Outpatient ServicesµMedicare Part B covers medically necessary services such as µdoctors servicesµoutpatient careµlab tests and diagnostic screeningsµmedical equipmentµambulance transportationµpreventive careµEligibility: Medicare recipients -voluntary enrollmentµMedicare Part B is mostly financed by general revenues and beneficiary premiumsµPremiums: $148.50 monthly for 2021µIndividuals with an annual income of more than $88,000 pay a higher premium141314
1/6/20228Medicare Part C (Medicare Advantage)µEligibility: Medicare beneficiaries have the optionto receive their Medicare benefits through private health plans as an alternative to the federally administered traditional Medicare programµPlans are offered by Medicare-approved private companies that must follow rules set by MedicareµPlans cover everything that original Medicare covers µSome plans pay for services that original Medicare does not, including dental and vision careµMost plans also fold in prescription drug coverageµThese private health plans receive capitated payments to provide all Medicare-covered services to plan enrollees (Medicare pays the private insurance company a fixed amount every month to provide all Part A and B benefits)µIn addition, Medicare makes a separate payment to plans for providing prescription drug benefits under Medicare Part DµMedicare Part D is financed from general revenues and beneficiary premiumsµPremium: $148.50 monthly for the Part B premium for 2021, plus any additional premium set by the insurer15Medicare Part D -Prescription DrugsµOptional prescription drug coverage µPrior to its introduction in 2006 (Medicare Prescription Drug, Improvement, and Modernization Act), only 75% of elderly Americans had prescription drug insurance => Within 1 year, over 90% had coverageµEligibility: everyone with Part A or B -voluntary prescription drug benefits µCoverage is available through private insurance companies approved by Medicare µMedicare Part D is financed from general revenues, beneficiary premiums, and state payments µPremium: varies by plan, averages$30.50 monthly for 2021µMedicare subsidy covers most of that cost161516
1/6/20229Medicare Part DµTwo ways to use Medicare Part D:µMedicare prescription drug plans (PDP):µThese plans add drug coverage to the original Medicare planµMust have Part A and/or Part B to join a separate Medicare drug planµMedicare Advantage Plans (Part C) with prescription drug coverageµA specific Medicare health plan that offers Medicare prescription drug coverage through private insurance companies17What Medicare Part D drug plans coverµAll plans must cover a wide range of prescription drugsµFormulary: the approved list of medications coveredµPlans include both brand-name prescription drugs and generic drug coverageµThe formulary includes at least 2 drugs in the most commonly prescribed categories and classesµTiers (to lower costs)µMost Medicare drug plans place drugs into different levels called tiers on their formulariesµDrugs in each tier have a different cost (a drug in a lower tier willgenerally cost you less than a drug in a higher tier)181718
1/6/202210Medicare Part D formulary tiersµExample:Tier 1lowestcopayment: most generic prescription drugsTier 2medium copayment: preferred, brand-name prescription drugsTier 3higher copayment: non-preferred, brand-name prescription drugsSpecialty tierhighest copayment: very high cost prescription drugs19Medication Therapy ManagementµCMS has mandated that Part D sponsors offer beneficiaries a Mediation Therapy Management (MTM) programµMTM -free program offered by Part D plans to certain members to help improve their medication use so they can better manage their chronic conditionsµService: face-to face, via phone, mail, email, combinationµTargeted beneficiaries:µHave multiple chronic diseasesµTaking multiple Part D drugsµLikely to incur annual costs for covered Part D drugs that exceed $3,000201920
1/6/202211MedicaidµEstablished 1965µHighly subsidized insurance coverage to low-income families, nearly freeµ71 million Medicaid beneficiaries in 2020µFinanced and ran jointly by state and federal governmentsµState governments have wide latitude to set budgets, determine eligibility rules, and decide how generous their programs will beµ~15% of state budgets, 2ndto educationµfederal government matches state expenditures to help states finance Medicaid, but it also mandates minimum levels of coverage and eligibilityµEligibility vary state by state: µFinancial Eligibility: low incomeµNon-Financial Eligibility criteria: marital status, number of children, pregnancy, health (disabled, blind), immigration statusµAlmost all expenses are paid with taxpayers dollarsChildrens Health Insurance Program (CHIP)µEligibility: children up to 19 years of agewhose parents earn too much to qualify for Medicaid but not enough to afford private insuranceµState-federalpartnership that provides health insurance to low-income childrenµEach state offers CHIP coverage and works closely with its state Medicaid programµProvides comprehensive coverage µFederal and state governments jointly finance CHIPµPremium:free or families may be required to pay a modest enrollment fee or premiumsµ6.7 million children were enrolled in CHIP in 2020222122
1/6/202212Veterans Affairs and TRICAREµVA and Tricare provide medical benefits in military including reservists, national guard, military retiree and their dependentsµEligibility:µAny individual who serves on active duty in the armed forces and is discharged other than dishonorably is technically eligible to receive health services from the VAµMajority financed by the federal governmentµVA operates the nations largest integrated healthcare system (approximately 1,700 hospitals, outpatient clinics, counseling centers and long-term care facilities) with coverage for almost all medical services, such asµPrimary care or specialist physician office visits, immunizations, hospitalizations, emergency room visits, medical and surgical supplies, as well as prescription medicationsµVA provides care to nearly 9 million veterans µTRICARE µInsurance that is paid by the government, but uses private doctors and hospitalsµDoes not require services provided by the VA systemµFinanced by the federal government23Indian Health Services (IHS)µProvides health benefits to members of federally-recognized Native American Tribes and Alaska Native peopleµMajority financed by the federal governmentµHealth services are provided directly by the IHS, through tribally contracted and operated health programs, and through services purchased from private providersµCovers 2.6 million American Indians and Alaska Natives242324
1/6/202213Federal Employees Health Benefits Program (FEHBP)µProvides health benefits to civilian federal employees, former employees, family members, and former spousesµFEHBP is financed and managed by the federal Office of Personnel Management (OPM) (federal government) via a managed competition system by allowing qualified insurance companies, employee associations, and labor unions to promote health insurance plans to governmental employeesµFEHBP employers pay about 25% of the cost of insurance, the government pays the rest (75%)µFEHB program is the largest employer-sponsored group health insurance program in the worldµcovers 8 million federal employees, former employees, family members and former spouses25Private Health Insurance PlansµFee-for-serviceµTraditional type of insurance in which the health plan will either pay healthcare provider directly or reimburse after claim is filedµWhen medical attention is needed, the beneficiary can visit the doctor or hospital of their choiceµManaged care2526
1/6/202214Managed healthcare µManaged healthcare plans are an alternative to traditional healthcare plans like fee-for-service plansµManaged healthcare plans allow plan sponsors to negotiate reduced rates for their policyholders with hospitals, medical service providers, and physicians, by including them in the networkµIn the past few decades, managed healthcare plans have become a popular health insurance choice, as healthcare costs have increasedµThe type of managed plan you have will dictate how you obtain your medical services. µMain types of network health plans include:µHealth Maintenance Organization (HMO)µPreferred Provider Organization (PPO)µPoint of Service Plan (POS)Health Maintenance Organization (HMO)Gatekeeper principlePrimary care provider (PCP) serves as a gatekeeper and must authorize all medical services (visit to specialist)Services not authorized by the PCP will generally not be reimbursedRationale for gatekeeper is to avoid unnecessary expensesPreferred networksPlans will only pay for services provided by healthcare providers that they have contracted with, aka In Network providersPlans will not pay for Out of Network providersPatient premiums are generally lowest among managed care plans2728
1/6/202215Preferred Provider Organization (PPO)No gatekeeperPatients can choose their own providers (specialists) without having to use a designated PCP firstPreferred networks with some out of network coveragePatient can see any healthcare practitioner they want, but they are financially incentivized to see in-network providerse.g., Patient pays 10% to see in-network vs. 50% to see out-of-networkPatient premiums are generally higher than HMO premiumsPoint of Service (POS)µHybrid PPO-HMO plansµGatekeeper system like HMOµPrimary care physician who makes referrals to specialists as neededµMembers who see providers in the POS plan network generally pay a reduced service feeµMembers can see providers outside the plan network only if they receive a referral from their primary care physician, plus theyll generally pay a much larger percentage of the cost for out-of-network provider servicesµHigher copayments for outside plan providers but lower premiums than PPOs2930
1/6/202216Managed care comparisonIntegrated Delivery System(IDS)µA network of healthcare organizations all under the same parent companyµProvides all healthcare services to a group of patients, such as within a geographic locationµIncludes PCPs, physicians, hospitals, pharmacies, and insurersµNote: Not all models include all groupsµAll work towards the same financial and clinical goalsµMain benefit: improved the coordination and quality of care while controlling costsµDo not cover services from out-of-network providers and require referrals for most specialist visitsµExample: µFlorida Memorial Health Networkµhttps://www.memorialhealthnetwork.net/3132
1/6/202217Thank you!33
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