Just a few floors above the craps and Roulette tables in Las Vegas, economists, political commentators, health plan executives and others speaking at the 2012 Managed Markets Summit were placing safe bets on at least one big thing: the spending spree in healthcare can't be sustained.

Ben Sasse, PhD, a former U.S. Assistant Secretary of the HHS and a current university president, believes healthcare reform will be very costly and that reform, Medicare and Medicaid along with Social Security and interest on debt will take up 70 percent of the nation's budget within 18 years.

Sasse, who so aptly explained everything from the fiscal cliff to budget offsets, says already Medicare and Medicaid have turned the U.S. into an insurance company that happens to own a bit of a Navy.

The MM Summit sponsored by Pinsonault Associates featured two and a half days of conversation about the upcoming presidential election and whether a Romney win could really unravel so-called ObamaCare, and if Obama is re-elected, how will the whole reform thing work.

Among the highlights:

  • If Obama wins, it's almost certain the ACA would survive because neither the House nor Senate would have enough override votes. However, actually implementing state exchanges and Medicaid expansions in multiple states by 2014 seems unworkable, Sasse says. If Romney wins, parts of the ACA could be repealed.
  • MCOs are busy trying to figure out how to serve individuals through the exchanges, says Christine Solberg Strahl, specialty pharmacy program manager at HealthPartners in Minneapolis. The biggest thing on my mind is the coming change in customer mix.
  • The ACOs brought into the market via the Affordable Care Act are reshaping the ways hospitals think about specialty pharmaceuticals. They want to dramatically improve their specialty pharmacy dispensing rate via outpatient pharmacies in order to better control patient care, said Atheer Kaddis, vice president of managed markets for Diplomat Specialty Pharmacy. If they're on the hook for an unnecessary readmission, they want to be able to dispense and track patients expensive specialty drugs.
  • On the importance of tort reform, Democrat Robert Reich, the former labor secretary to President Bill Clinton, said it is important but contributes just 8 percent to inefficiencies in healthcare cost (far behind unnecessary duplication of services and administrative costs). Charles Krauthammer, a columnist, commentator and non-practicing psychiatrist, says defensive medicine is a large part of unnecessary medical costs and that tort reform is crucial.
  • Pharma will have to work really hard to convince providers about the value of their drugs once  they are at risk for patient health costs, says Joel Owerbach, vice president and chief pharmacy officer of Excellus Blue Cross and Blue Shield. Already, he says physicians tend to be much tougher on drug value than the health plan. When they're on the hook for the cost, watch out formulary access could be even tighter.

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