Table of Contents – Reform

Responding to Healthcare Reform: A Strategy Guide for Healthcare Leaders

Foreword by United States Senator David Durenberger

Acknowledgements

Introduction  – The Theories of the ACA
     The Groundwork is Laid
     The Three Theories
          Sytems View
          Funds flow and Incentives View
          Markets View
     Strategy Development with Scenario Planning
     How to Use this book
     Summary
     Notes
     Annotated References

Systems

Chapter 1  – Chronic Disease Management and Primary Care
    
The Chronic Care Model
     The Hitech Act and Meaningful Use
     Policies to Support Chronic Care in the ACA
          Comparative Effectiveness
          Healthcare Home
          Shared Decision Making
     Summary
     Notes
     Annotated References

Chapter 2 – Productivity and Quality
      Productivity
          Value-Based Purchasing
          Productivity Improvements
     Quality 
          Quality Reporting
          Health Plans and Medicaid
          Support for Quality and Productivity Improvement
     Summary
     Notes
     Annotated References

Chapter 3 – Prevention and Wellness
    
Clinical Prevention
          Coordination
          Education
     Wellness
     Community Building
     Summary
     Annotated References

Chapter 4 – Systems View Scenarios
    
Chronic Disease Management
          Health Information Technology and Primary Care Providers
          Scenarios
          Strategy Options
     Consumer Engagement
          Prevention and Wellness
          Scenarios
          Strategies
     Summary
     Annotated References 

Funds Flow and Incentives

Chapter 5 – Payment Incentives
    
Incentives – The Carrots
          Accountable Care Organizations
          Bundled Payments
     Penalties – The Stick
           Readmission’s
           Hospital Acquired Conditions
     Fraud and Abuse – The Big Stick
          Recovery Audit Contractors
     Backup Plans
          Center for Medicare and Medicaid Innovation
          Independent Payment Advisory Board
     Summary
     Annotated References 

Chapter 6 – The Safety Net
    
Eligibility
     Dual Eligible Beneficiaries
     Hospitals
     Rural Healthcare
     Community Clinics
     Summary
     Note
     Annotated References

Chapter 7 – Funds Flow Scenarios
    
Healthcare Inflation
          Healthcare Cost Drivers and Physcian Engagment
          Scenarios
          Strategy Options
     Safety Net Success
          Community Enagement vs. Increased Medicaid Eligibility
          Scenarios
          Strategy Options 
     Summary
     Annotated References 
 

Markets

Chapter 8 – The Perfect Market – Health Insurance Reform
    
Universal Coverage
     Benefits
     Increased Government Regulation
          Medical Loss Ratios
          Rate Increases
          Administrative Simplification
          A True Marketplace?
     Summary
     Annotated References 

Chapter 9 – Market Scenarios
    
National Markets
          Participation in Health Exchanges and Local/National Providers
          Scenarios
          Strategy Options for Providers
          Strategy Options for Health Plans
     Summary
     Annotated References 

The Future and the Role for Health Professionals in Policy

Chapter 10 – the Future
    
The Process
          Lawsuits
          Oversight Hearings by Congress
          New Legislation and Budget Changes
          2012 Presidential Election
     Potential Targets for Change
          Insurance Mandate
          Standard Benefits
          Medicaid Funding Requirements of States
          Taxes
          Comparative Effectiveness Research
          Independent Payment Advisory Board
          Malpractice 
          The Public Option
     Good Ideas Likely to Remain
           Health Insurance Exchanges
           Quality, Workforce, Fraud and Innovation
           ACOs, Bundled Payments, Readmission’s, and Hospital Acquired Conditions
           What about a Repeal?
     Strategy Themes for the future
     How to do Health Policy
          Healthcare Associations and Lobbying
          Innovations in Care Delivery
          Policy Expertise  
     Summary
     Conclusion
     Annotated References    

Appendices

A: Discussion Questions

B: Congressional Research Service Summary of the ACA

References

Index

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