1. CLEAR 2011 Annual Educational Conference
September 8-10
The Affordable Care Act: Will regulation of the professions be relevant?
Ed O’Neil
Catherine Dower
Pittsburgh, Pennsylvania

2. Welcome to San Francisco

3. “My mom Catherine works at UCSF
“My mom Catherine works at UCSF. She studies different doctor’s offices around the US, and tries to improve their work and health laws through reports (oral, as well as written).”

4. Patient Protection and Affordable Care Act

5. Five ACA categories relate to our work
Coverage
Workforce
Five ACA categories relate to our work
Financing
Pay for quality
Innovations in Care Delivery

6. Expand Coverage

7. Workforce Supply and Demand
Old formula & assumptions:
Ratios of licensees to population
Always need more
New Realities
Teams serving panels
Self care and DIY
Nuanced supply & demand
Workforce Supply and Demand

9. Counties where the number of RDAs registrations relative to dentistry licenses is large, generally have the lowest dentistry licenses per population ratios. The converse is also true: counties with a high dentistry licenses per population ratio generally have a smaller number of current RDA registrations relative to current dentistry licenses.

10. Example: California’s Health Care Workforce: Moving Forward under ACA
Challenge
Growing pressure on safety net providers
Geographic maldistribution of workforce
Diversity challenges
Promise
Continued job growth despite the recession
HIT leveraged to facilitate new models of care
New finance and delivery models may decrease costs --improve access and quality of care

11. Internet searches for “Accountable Care Organizations”
September 2010: 346,000 results
January 2011: 1,300,000 results
October 2011: 4,200,000 results
February 2012: 38,400,000 results
Financing: Provider payment policies

12. Tying payment to quality

13. Innovative Practice Models
Patient-Centered Medical/Health Homes
Community Clinics
Nurse-Managed Health Clinics
School-based clinics
Sites using telehealth
Retail clinics
Yesteryear’s Model
Innovative Practice Models

14. Regulation Modern Regulation Rise of science new knowledge
Accumulation of capital in corporations
Progressive movements
Desire to rebalance power

15. Regulation Three Purposes Protect the public
Protect the Guild or Profession
Improve society

16. Flexner’s Paradigm Higher Income/Status Research More Education
University Status
He was born in Louisville, Kentucky, and graduated at Johns Hopkins University. His brother was Simon Flexner. Initially, he worked as a secondary school teacher and school principal, but after 19 years he returned to academia and did graduate studies at Harvard University and in Berlin.
He then became a member of research staff at the Carnegie Foundation (1908), which resulted in the "Flexner Report", which examined the state of American medical education and led to far-reaching reforms in the way doctors were trained.
Between 1912 to 1925, Flexner sat on the General Education Board, initially as a member and from 1917 as secretary.
With Louis Bamberger, he was initiator of the Institute for Advanced Study at Princeton, and he acted as its head from 1930 to 1939.
We must not overlook the role that extremists play. They are the gadflies that keep society from being too complacent.
Accreditation
Licensure

17. US Health Care: Four Options
Drive it less- ration
Shift the costs
Pay less for it- controls
Build a new chassis
Expensive
Overbuilt
Underperforming
How we see determines what we see.
Self fulfilling prophecy story.
Discuss dominant paradigms

18. Practice Model New Value Proposition Created What Changed?
Professional role
Management of information
Sequencing of care
Engagement of consumer
Engagement of community
Practice model
Business model
Tell Rose story and then dissect the elements of change: IT to move knowledge, new professional roles, new location of service, new role for patient, new role for family/community, “a” change not “the” change, leadership. Barriers to the change: finance, lack of seeing the whole
New Value Proposition Created

19. We’ve been at this for awhile

20. Add These Numbers

21. Add These Numbers
1000

22. Add These Numbers
1000 40

23. Add These Numbers
1000 40

24. Add These Numbers
1000 40 30

25. Add These Numbers
1000 40 30

26. Add These Numbers
1000 40 30 20

27. Add These Numbers
1000 40 30 20

28. Add These Numbers
1000 40 30 20 10

29. Add These Numbers
1000 40 30 20 10 =

30. Getting off the hamster wheel
Training & Education
Licensure & Discipline
Legal and Regulatory Scope of Practice
Performance Data

31. Training and Education
Old assumptions
Profession control
Formal education: university-based
Clinical training
Siloed
New Realities
Info:
Web-based, available
Varied quality
Driven by problems
Competencies:
Tech savvy
Work in teams
Listen to client
Integration

32. Licensure & Discipline
Old assumptions
Professions define and control
Slow
Administrative process
New Realities
Professional and public roles
Real time/immediate access to data
Public opinion and market judgment

33. Legal and Regulatory Scope of Practice
Old model example
California medical assistants may administer medication by
intramuscular injections including flu and pneumonia shots unless at a local governmental or private, nonprofit agency that received
vaccine from state department of health at no charge, where
administration of vaccine shall be performed by MD, RN, or LVN.
New models will push for expansion, clarity and overlapping scopes of practice

34. Performance Data New Realities Old assumptions
Guarded
Narrowly sourced
Dated
New Realities
Open sourced: consumer, pro
Richly sourced, varied
Current, moving to real time

35. Three Take-Away Themes

36. INTEGRATION

37. ACCOUNTABILITY

38. CREATIVITY

39. Thank You Ed- eoneil@thecenter.ucsf.edu
CLEAR 2011 Annual Educational Conference
September 8-10
Thank You
Ed-
Catherine – 39
Pittsburgh, Pennsylvania 39