The State of Our Professions in Light of Health Care Change
Florence Clark, Ph.D., OTR/L, FAOTA AOTA President June 21,
2012
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Components of My Talk Major Changes to Health Care PolicyNew
Paradigm of Care What Does It Mean for Our Professions?
Opportunities for Health Professions
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Major Changes to Health Care Policy
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2010-2020: The Decade of Health Care Reform Significant changes
in the way the federal government supports health care Increased
regulation and accountability
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Health Care Reform
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2010-2013: Regulation and Coverage Dependent coverage through
age 26 Elimination of: o pre-existing condition exclusions for
children o lifetime limits
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2014: Major Expansion of Coverage Employer penalties if no
provision for health coverage Health insurer industry fee Medicaid
expansion
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2015-2020: Bending the Cost Curve Medicaid penalty for not
adopting E lectronic M edical R ecord software IPAB ( I ndependent
P ayment A dvisory B oard) Excise tax on high-cost health plans
(Cadillac plans) Reduced payment for hospital- acquired conditions
Individual mandate becomes effective
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New Regulators U.S. Preventive Services Task Force (USPSTF) o
Disseminate evidence on effective preventive services
Community-Based Collaborative Care Network (CCN) Program o Support
and coordinate services for the underserved Community Living
Assistance Services and Supports (CLASS) 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 Workforce Advisory Committee o National workforce
strategy CMS Innovation Center o Reduces spending while increasing
quality Independent Payment Advisory Board (IPAB) o 15 members,
make financial recommendations Health Insurance Reform
Implementation Fund o Implements policies Patient-Centered Outcomes
Research Institute (PCORI) o 36 member board, conducts research
National Prevention, Health Promotion, and Public Health Council o
Funding for prevention and public health programs
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New Paradigm of Care
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Old Model Linear
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New Model Individual GeneticsCommunityEnvironment Medical
System Life Circumstances ChoicesBehavior Complicated
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Paradigm Shifts in Primary Care Institute for Funcational
Medicine: IFM White Paper: Jones et al (2010) 21 st Century
Medicine: A New Model for Medical Education and Practice
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What Does It Mean for Our Professions?
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Emphasis on Collegiality and Teamwork
http://www.toastmasters.org/MainMenuCategories/FreeResources/QuestionsaboutLeadership/Teamwork.aspx
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Need to Be Responsive to Population Shifts and Trends
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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
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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
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Source: Department of Labor; Bureau of Census
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Source: DDS Update Report on ASD, 2007
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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
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Need to Be Evidence-Based: The Linchpin of Reimbursement
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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.
Evidence-Based Practice
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The healthcare practitioners 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.
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The Process of Evidence-based Practice: THE IDEAL A Ask a
question A Access the information A Appraise the articles found A
Apply the information A 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.
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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 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?
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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 evidence- based
practitioner
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Include evidence in your Mindlines Include evidence in your
Mindlines Gabbay, J. & Le May, A. (2011). Practice-based
evidence for healthcare: Clinical mindlines. NY & London:
Routledge.
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local guidance they say central guidance reps journals and
magazines opinion leaders teaching/training education sessions
textbooks media patients views experience infrastructure colleagues
Mindlines Gabbay, J. & Le May, A. (2011). Practice-based
evidence for healthcare: Clinical mindlines. NY & London:
Routledge. p. 46.
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Opportunities
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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
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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
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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
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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
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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
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Insurance Exchanges: 2014 Statewide Assure all services are
included in offerings Insurers must comply with consumer
protections
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Public Awareness of Low Performing Systems and Hospitals
Ratings of hospitals will be readily available on the web
Performance indicators profiled
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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!
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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 PwCs research found only pockets in
which this is evidenced. Health organizations remain too focused on
their own organizations, not whats best for the patient. Patient-
centered 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.
