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CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 1
Presenters:
Promoting Regulatory Excellence
Ed O’NeilCatherine Dower
The Affordable CareAct:
Will regulation of theprofessions be
relevant?
Welcome to SanFrancisco
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“My mom Catherine works at UCSF.She studies different doctor’soffices around the US, and tries toimprove their work and health lawsthrough reports (oral, as well aswritten).”
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CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 2
PatientProtectionandAffordableCare Act
Five ACAcategoriesrelate to ourwork
Coverage Workforce
Pay forquality
Innovations inCare Delivery
Financing
ExpandCoverage
CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 3
Nurse
Practitioners,
19%
Physician
Assistants,
7%
Physicians,
74%
WorkforceSupply andDemand
Old formula &assumptions:• Ratios of licensees to
population• Always need more
New Realities• Teams serving panels• Self care and DIY• Nuanced supply &
demand
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CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 4
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 decreasecosts --improve access and quality of care
Financing:Providerpaymentpolicies
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
Tyingpaymentto quality
CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 5
InnovativePracticeModels
Yesteryear’s Model• Patient-CenteredMedical/Health Homes
• Community Clinics
• Nurse-ManagedHealth Clinics
• School-based clinics
• Sites using telehealth
• Retail clinics
Regulation
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Modern Regulation
• Rise of science newknowledge
• Accumulation of capital incorporations
• Progressive movements
• Desire to rebalance power
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Three Purposes
• Protect the public
• Protect the Guild orProfession
• Improve society
Regulation
CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 6
16
Licensure
Accreditation
UniversityStatus
More Education
Research
HigherIncome/Status
Flexner’s Paradigm
US Health Care: Four Options
•Drive it less- ration
•Shift the costs
•Pay less for it- controls
•Build a new chassis• Expensive• Overbuilt• Underperforming
Practice Model
What Changed?• Professional role• Management of information• Sequencing of care• Engagement of consumer• Engagement of community• Practice model• Business model
New Value Proposition Created
CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 7
19
We’ve been at this for awhile
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Add These Numbers
21
Add These Numbers
1000
CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 8
22
Add These Numbers
1000
40
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Add These Numbers
1000
40
1000
24
Add These Numbers
1000
40
1000
30
CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 9
25
Add These Numbers
1000
40
1000
30
1000
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Add These Numbers
1000
40
1000
30
1000
20
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Add These Numbers
1000
40
1000
30
1000
20
1000
CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 10
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Add These Numbers
1000
40
1000
30
1000
20
1000
10
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Add These Numbers
1000
40
1000
30
1000
20
1000
10
= 4100
Getting off thehamster wheel • Training & Education
• Licensure & Discipline
• Legal and RegulatoryScope of Practice
• Performance Data
CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 11
Training and EducationOld assumptions
• Profession control
• Formal education:university-based
• Clinical training
• Siloed
31
New Realities
• Info:
– Web-based, available
– Varied quality
– Driven by problems
• Competencies:
– Tech savvy
– Work in teams
– Listen to client
– Integration
Licensure & Discipline
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Old assumptions
• Professions defineand control
• Slow
• Administrativeprocess
New Realities
• Professional andpublic roles
• Real time/immediateaccess to data
• Public opinion andmarket judgment
New models willpush for
expansion,clarity andoverlappingscopes ofpractice
Legal and Regulatory Scope of Practice
Old model example
California medical assistantsmay administer medication byintramuscular injectionsincluding flu and pneumoniashots unless at a localgovernmental or private,nonprofit agency that receivedvaccine from state departmentof health at no charge, whereadministration of vaccine shallbe performed by MD, RN, orLVN.
CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 12
Performance Data
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Old assumptions
• Guarded
• Narrowly sourced
• Dated
New Realities
•Open sourced:consumer, pro
•Richly sourced, varied
•Current, moving toreal time
Three Take-AwayThemes
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INTEGRATION
CLEAR 2012 Annual Educational ConferenceOpening Keynote
September 6-8
San Francisco, California 13
ACCOUNTABILITY
CREATIVITY
39
Thank You
• Ed- [email protected]
• Catherine – [email protected]
