NASHP STATE HEALTH POLICY CONFERENCE OCTOBER 5, 2010

Health Reform Matrix  OPCA’s tool for tracking health reform:  Key areas that impact CHCs  $$ to support CHC growth  National Health Service Corps expansion  Medicaid expansion to 133% of federal poverty level  Insurance exchange and CHCs  Heightened focus on cost and quality 2 Hostetler

A new study indicates that upcoming shortages of primary care physicians may be worse than projected, as will patients' access to primary care. --American Academy of Family Physicians Workforce Issues 3 Hostetler

 Costs of hiring and training  Lack of recruitment staff  Physician shortage  CHC challenges  Location, population complexity, pay The CHC Recruitment Climb: Getting Steeper 4 Hostetler

And Yikes! CHC patients expected to double by Hostetler

CHC Residency Program  Health reform act opportunity  Difficult for CHCs  Best candidates: Larger CHCs  Other CHCs will partner with residency programs 6 Hostetler

 Offers exposure to CHCs  70% of students continue working with populations in need  Boosts job satisfaction for CHC providers  Strengthens partnerships with academic institutions OPCA’s SEARCH program 7 Hostetler

Historically used at CHCs Utilizing Mid-Level Providers Oregon’s ratio of physician to mid-level Currently 1:1 May evolve to 1:3 or more 8 Hostetler

 Training curriculum needs to improve  To “hit the ground running”  Example: Pacific University PA program  Primary care home model = more patients per provider team Utilizing Mid-Levels (cont’d) 9 Hostetler

Physicians in “medical home” demonstration projects report job satisfaction rates going up tremendously. -- Patient-Centered Primary Care Collaborative Primary Care Home Model 10 Hostetler

 Issues with current primary care model  Pressures of the 10 – 15 minute visit  Negatively impacts patient outcomes  Provider satisfaction: More than money How the Primary Care Home Can Help 11 Hostetler

What is a Primary Care Home?  Flexible, based on population need  Patient-centered experience  Quality & safety  Team-based care  Enhanced access  Coordination of care  Behavioral health integration 12 Hostetler

Environment:  Payment focused on old model  Workforce not trained for model  Current economic environment & need to focus on access  Payers don’t want to wait for transformation Challenges, Barriers and Competing Priorities 13 Hostetler

Clinic level:  Capturing data  Spreading leadership and buy-in throughout the clinic  Finding resources  Allowing providers time to lead Challenges, Barriers and Competing Priorities (cont’d) 14 Hostetler

 Account for social factors  Support model for entire patient population  Minimize clinics’ administrative burden and cost  Tailor payment to reward movement on indicators  Pay for work that improves care  Allow time for care  Fund learning collaboratives Key Issues for Payment Reform 15 Hostetler

 Policy alignment and opportunity  Oregon’s initiative is improving:  Provider satisfaction  Basic patient satisfaction  Some clinical quality indicators Exciting Developments 16 Hostetler

Contact Information Craig Hostetler Executive Director Oregon Primary Care Association Phone: Thank You! 17 Hostetler