Transcript Health Care Reform Update - PHS Commissioned Officers

The State of Our
Professions in Light of
Health Care Change
Florence Clark, Ph.D., OTR/L, FAOTA
AOTA President
June 21, 2012
Components of My Talk
Major Changes to Health Care Policy
New Paradigm of Care
What Does It Mean for Our Professions?
Opportunities for Health Professions
Major Changes to
Health Care Policy
2010-2020:
The Decade of Health Care Reform
• Significant changes
in the way the
federal government
supports health care
• Increased regulation
and accountability
Health Care Reform
•Regulation
and coverage
• Major expansion
of coverage
•Bending the
cost curve
2010-2013: Regulation and Coverage
• Dependent coverage through age 26
• Elimination of:
o pre-existing condition
exclusions for children
o lifetime limits
2014: Major Expansion of Coverage
• Employer penalties if no provision for health
coverage
• Health insurer industry fee
• Medicaid expansion
2015-2020: Bending the Cost Curve
• Medicaid penalty for not
adopting Electronic Medical
Record software
• IPAB (Independent Payment
Advisory Board)
• Excise tax on high-cost health
plans (Cadillac plans)
• Reduced payment for hospitalacquired conditions
• Individual mandate becomes
effective
New Regulators
• CMS Innovation Center
o
Reduces spending while increasing
quality
• Independent Payment
Advisory Board (IPAB)
o
Implements policies
•
•
36 member board, conducts
research
• National Prevention, Health
Promotion, and Public
Health Council
o
Funding for prevention and public
health programs
•
Support and coordinate services for the
underserved
Community Living Assistance
Services and Supports
(CLASS)
o
•
Disseminate evidence on effective
preventive services
Community-Based
Collaborative Care Network
(CCN) Program
o
• Patient-Centered Outcomes
Research Institute (PCORI)
o
U.S. Preventive Services Task
Force (USPSTF)
o
15 members, make financial
recommendations
• Health Insurance Reform
Implementation Fund
o
•
Provides in-home services to keep people
out of long-term care facilities
Federal Coordinated Health
Care Office (within CMS)
o
Coordinate Medicare and Medicaid
o
National workforce strategy
Workforce Advisory
Committee
New Paradigm of Care
Old Model
Linear
New Model
Complicated
Genetics
Behavior
Community
Individual
Choices
Environment
Life
Circumstances
Medical
System
Paradigm Shifts in Primary Care
Institute for Funcational Medicine: IFM White Paper: Jones et al (2010) 21st Century
Medicine: A New Model for Medical Education and Practice
What Does It Mean for
Our Professions?
Emphasis on Collegiality
and Teamwork
http://www.toastmasters.org/MainMenuCategories/FreeResources/QuestionsaboutLeadership/Teamwork.aspx
Need to Be Responsive to
Population Shifts and Trends
Medicaid Population
• New federal policies will increase
national Medicaid enrollment by 40%
by 2016 (~ 24 million more individuals)
• Hospitals:
o Learn to operate according to Medicaid rates
o Aggressively market to the population
Fast Facts
• 83% of health care expenditures
in the U.S. are devoted to people
with chronic conditions.
• 3% of the population (those with 5
or more chronic conditions)
consume 67% of health care
resources.
Source: Agency for Healthcare Research and Quality
Source: Department of Labor; Bureau of Census
Source: DDS Update Report on ASD, 2007
Be Responsive to Trends
• Social networking in health care
o Web-based information
• From sickness to wellness
• Ramp up home/community-based health
care
• Home is where the innovation will happen
• Nothing about us without us
Need to Be Evidence-Based:
The Linchpin of Reimbursement
Evidence-Based Practice
is “the
integration of the
with
and the
. It also
requires the health professional to take
into account characteristics of the
in which they work.” (Hoffman, Bennett &
DelMar, 2010, p. 3)
Hoffman, T., Bennett, S. & DelMar, C. (2010). Introduction to evidence-based practice. In T. Hoffman, S. Bennett & C.
DelMar (Eds.). Evidence-based practice across the health professions, pp. 1-15. Elsevier Australia: Chastswood, NSW.
The healthcare practitioner’s
tendency towards inquiry
• A Spanish study found improved
persistence when an answer could be
found in less than 2 minutes; whereas
likelihood of continuing the search
dropped to 40% if it took 30 mins or more
Hoffmann, T., Bennett, S., Del Mar, C. (2010). Evidence-based practice: Across the health professions. Chatswood, New South Wales, Australia: Elsevier.
The Process of Evidence-based Practice:
THE IDEAL
Ask a
question
Access the
information
Appraise
the articles
found
Apply the
information
Audit
Hoffman, T., Bennett, S. & DelMar, C. (2010). Introduction to evidence-based practice. In T. Hoffman, S.
Bennett & C. DelMar (Eds.). Evidence-based practice across the health professions, pp. 1-15. Elsevier
Australia: Chatswood, NSW.
The Process of Evidence-based Practice:
THE REAL
• Barriers:
•
•
•
•
•
•
•
Professional training
Time
Resources
Inclination to embrace EBP
Belief it is not needed
$ to afford workshops
Research not viewed as relevant to their practice
So what is the “Real World” Alternative?
So How Can You Realistically
Practice Using Evidence?
Three Ways:
1. Have a working knowledge of research
designs and fluency in describing evidence
2. Include evidence in your Mindlines
3. Internalize a new identity as an evidencebased practitioner
Include evidence in your Mindlines
Mindlines
Clinician’s internalized guidelines for treatment
based on:
Educational foundations
Clinical reasoning
Experience
Continually evolve with new information
Gabbay, J. & Le May, A. (2011). Practice-based evidence for healthcare: Clinical mindlines. NY & London: Routledge.
Mindlines
local guidance
central guidance
“they say”
reps
colleagues
opinion leaders
patients’ views
experience
journals and
magazines
media
infrastructure
teaching/training
textbooks
education sessions
Gabbay, J. & Le May, A. (2011). Practice-based evidence for healthcare: Clinical mindlines. NY & London: Routledge.
p. 46.
Opportunities
Patient-Centered
Medicaid Medical Homes
• Locally-based facilities
• For patients with multiple
chronic conditions
o Care coordination
• Multidisciplinary Team provides
comprehensive care
• Based on documented value of primary care
Accountability Care Centers (ACC)
• Provider-led health care organization
o Aligns primary & specialty services
o Takes collective responsibility for improving patient care
• Bundled care
• Bonus on top of fee for service
o Shared data
o Payer retains risk
• Law rewards improved outcomes
o Increased alignment of services
• Payer and provider are one partner (e.g. Kaiser) or
share risk
Adherence & Quality
• Increase patient adherence to therapy
o Demonstrate impact of motivational, emotional, and contextual factors
• Improve overall quality and outcomes
o Think like consumers
o Know community
o Provide value
Research in Reform
• $1.1 Billion has already been committed toward
comparative effectiveness research
• Evaluation of health care delivery methods:
emphasis on prevention
• A non-profit Patient Centered Outcomes
Research Institute (PCORI) has been established
34
Innovation
Established in the Health Care
Reform Act
• The Center for Medicare and Medicaid
Innovation (CMI) to test innovative payment and
delivery models that reduce cost and improve
quality
• Primary care payment reforms, including Patient
Centered Medical Homes
35
Insurance Exchanges: 2014
• Statewide
• Assure all services are
included in offerings
• Insurers must comply with
consumer protections
Public Awareness
of Low Performing Systems and Hospitals
• Ratings of hospitals will be readily
available on the web
• Performance indicators profiled
Moving Forward…
• “Growth is the only evidence of life.”
o John Henry Newman, Apologia pro vita sua, 1864
• “The wheel of change moves on,
and those who were down go up
and those who were up go down.”
o Jawaharlal Nehru
• Get comfortable with change!
References
PricewaterhouseCoopers Health Research Institute
HealthCast: The customization of diagnosis, care
and cure (March 2010)
Between now and 2020, health systems will turn from reactive medicine to proactively understanding and supporting individuals in
managing their own health. Many health systems say they deliver patient-centered care, but PwC’s research found only pockets in
which this is evidenced. Health organizations remain too focused on their own organizations, not what’s best for the patient. Patientcentered care takes health systems out of their comfort zones, forcing them to integrate people, technologies and organizations that are
not part of their current routines.
Health Reform: Prospering in a post-reform world (May
2010)
While it might be overly dramatic to say that everything has changed with the passage of health reform, it can certainly be said that the
health system of tomorrow will not be the same as today. To prosper in the post-reform world, health executives will need to reassess
current strategies and find ways to work together. This PwC Health Research Institute report illustrates the mega trends that each health
sector will face as a result of health reform, the provisions in the law that are driving them, and recommendations on how organizations
can turn these challenges into new opportunities.
The New Science of Personalized Medicine (October 2009)
This PwC report addresses a key new force the healthcare industry faces - personalized medicine. This force is redefining the health
industry and disrupting the business models of healthcare organizations. Every player in the health industry, from pharmaceutical and
diagnostics companies to hospitals and primary care providers will have to change the way they relate to consumers if they are to
compete in an era of personalized medicine. Retailers, consumer product companies and other players accustomed to marketing
directly to consumers may have an advantage in this regard over organizations that traditionally have targeted physicians or businesses.
“PricewaterhouseCoopers” and “PwC” refer to PricewaterhouseCoopers LLP, a Delaware limited liability
partnership, or, as the context requires, the PricewaterhouseCoopers global network or other member firms
of the network, each of which is a separate and independent legal entity.