Medicare & Medicaid Economic Trends: Rise of Open Access Plans and Declining Out‑of‑Pocket Spending

Restructure Medicare & Medicaid: Economic Factors— Rise in Usage of “Open Access” Healthcare Plans Makes It Harder to Control Patient Choices...Subsequently, Cost of Care Increases Societal demand for less restrictive health insurance has driven a gradual switch to open access plans. These plans offer consumers greater choices of medical providers, but at higher costs. Share of Tightly Managed vs. Open Access Healthcare Plans in USA, 1988 - 2008 ATi mee mm me = te ma i =~ Se —— Open Access (PPO + POS) —Tightly Managed (Conventional + HMO) % of All Healthcare Plans Other (HDHP) 0% T T T T T T T T T T T T T T 1 1988 1996 2000 2002 2004 2006 2008 Note: PPO is Preferred Provider Organization, which allows enrollees to select any doctor / hospital in the insurance provider's network without going through a primary care physician. HMO is Health Maintenance Organization, which requires enrollees to coordinate ail healthcare via a primary care physician (a family doctor). POS is Point Of Service, which combines the features of an HMO and a PPO. HDHP is High-Deductible Health Plan, a form of catastrophic coverage with lower premiums and higher deductibles than a traditional plan. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2009; KPMG Survey of KP Employer-Sponsored Health Benefits, 1993, 1996; The Health Insurance Association of America (HIAA), 1988 (@E www.kpcb.com USA Inc. | What Might a Turnaround Expert Consider? 293 Restructure Medicare & Medicaid: Economic Factors— Less Incentive for Consumers or Providers to Control Costs When Someone Else (Government / Taxpayers) Pays the Bills Out-of-Pocket Spending Accounted for Just 12% of Healthcare Spending in 2009, Down from 48% in 1960 Out-of-Pocket Payments Medicare + Medicaid Payments == =Qut-of-Pocket Medical Payments as % of Disposable Income ~--- 35% Medicare Introduced Payments as % of Total Healthcare Spending C/O 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 KP Source: Department of Health & Human Services, Centers for Medicare & Medicaid Services. (@ www.kpcb.com USA Inc. | What Might a Turnaround Expert Consider? 294 HOUSE_OVERSIGHT_020988