WHAT’S ON THE HORIZON: HEALTH POLICY IN IN AN UNCERTAIN TIM IME CHRISTOPHER PLEIN, PH.D. EBERLY FAMILY PROFESSOR FOR OUTSTANDING PUBLIC SERVICE WEST VIRGINIA UNIVERSITY WVMGMA STONEWALL RESORT, 2018
THE MANDATE “MGMA empowers medical group practices to innovate and create meaningful change in healthcare” About MGMA 2018
THE MANDATE What are the pre-requisites for effective and meaningful change?
THE MANDATE • Appreciating Context • Understanding History • Identifying a Path Forward • Recognizing Trade-Offs • Considering Resources
TODAY’S THEMES • Time and Space • Post-Modern Healthcare • Weaponizing Healthcare in Politics • What’s on the Horizon?
TIM IME & SPACE Credit: https://www.pexels.com/photo/astronomy-constellation-cosmos-dark-433155/
TIM IME “The American Medical Association takes the stand that the best quality of medical service is obtained when the patient is guaranteed freedom of choice of his physician.”
TIM IME The quote on the prior slide is from an article on military healthcare from 1938 – yes, 80 years ago. Source: George Cottel , “Medical Care of Naval Families.” U.S. Naval Institute Proceedings (October 1938)
SPACE “ The worldwide web, the dominant medium of the postmodern world, has blown away the doors and walls of the locked library as efficiently as, but much more quietly than, semtex .” J.A. Muir Gray in the Lancet (1999).
TIM IME & SPACE “ Disease has become a bureaucratic – and thus, social and administrative – as well as biological and conceptual – entity.” Charles Rosenberg, Our Present Complaint: American Medicine, Then and Now (2009).
TIM IME & SPACE: : TENSION Market Market Control Autonomy Regulatory Regulatory Autonomy Control
TIM IME & SPACE: : COMPLEXITY “With path -dependent processes, the outcome is unpredictable at the start. Small, often random events early in the process are ‘remembered,’ continuing to have influence later.” Atul Gawande (2009).
POST MODERNISM Credit: wordpress.com
POST-MODERN HEALTHCARE • The social construction of healthcare • Role, status, and authority • New approaches and models of care
QUIC ICK CONTEXT: P PRE-MODERN HEALTHCARE • Healthcare as art, craft, and science • Individual and decentralized practice • Identification and development of a profession • The generalist approach • The age of discovery See Kernick and Sweeny 2001, Muir Gray 1999, Rosenberg 2009, Starr 1982.
QUIC ICK CONTEXT: M MODERN HEALTHCARE • Healthcare as science • Increased specialization • The medical-insurance-policy complex • Professionalization and deference to expertise • Incremental but substantial growth in costs • A semi-closed system of stakeholders and interests See Starr 1982, Muir Gray 1999, Rosenthal 2017
SOCIA IAL CONSTRUCTION OF HEALTHCARE • Promotion, wellness, and treatment • Population health and disparities • Knowledge claims, values, and culture
RECONSIDERING AND REFRAMING The Case of Substance Use Disorder
REDEFINING ROLES • Reorienting status and authority among providers • Patient-centered care • The emergent role of “mid - level” providers
TIM IME & SPACE – AGAIN IN Credit: Immersion Imagery
DIS ISPARITIES, DIS ISTANCE, AND ECONOMIES OF SCALE • Coverage does not equal access • The tyranny of geography • The challenges of need and want
RETROFITTING FOR POST-MODERN HEALTHCARE We proceed into the future with existing infrastructure and practices, adapting them to new demands and circumstances.
Credit: Chris Plein
ADAPTING TO NEW CONDIT ITIONS Our healthcare delivery systems and practices must respond to new technological, legal, social and demographic realities.
Credit: Chris Plein
POLIC ICY PRESCRIPTION Healthcare for All !!!!! ????
WEAPONIZING HEALTHCARE IN IN POLIT ITICS Credit: New York Magazine/Daily Intelligencer 9-11-18
POST MODERN POLIT ITICS • Hyper-partisanship • Single-Issue politics and campaigns • Astroturf movements • Absolutism rather than compromise
EIG IGHT YEARS AND COUNTING: : THE ACA BATTLE • Legislative Battles • Judicial Conflict • The States: A Fifty-Front Contest
ACA: : MEDICAID IS IS THE STORY • According to the Kaiser Family Foundation, since the ACA expansion option average monthly Medicaid enrollment has increased: United States 28 percent West Virginia 53 percent Virginia 10 percent Kentucky 105 percent Source: Kaiser Family Foundation (2018)
ACA: : MEDICAID IS IS THE STORY Average Month 2014 2018 West Virginia 354,544 543,569 United States 56,533,472 73,355,220 Source: Kaiser Family Foundation (2018)
WHAT’S ON THE HORIZON ? • Medicare reform • Medicaid tweaking • Pre-existing conditions • Scope and Practice • Consolidation, Integration, and Acquisition
HEALTHCARE POLITICS DEFINED…… Credit: Lonnie Long
RESOURCES Cottel , George. 1938. “Medical Care of Naval Families.” U.S. Naval Institute Proceedings (October) Gawande, Atul . 2009. “Getting There from Here.” The New Yorker (January 26). Kaiser Family Foundation. 2018. State Health Facts: Monthly Medicaid and Chip Enrollment. https://www.kff.org/statedata/ Kernick , D. and K. Sweeney. “Post Normal Medicine.” Family Practice . 18 (4): 356- 358. Muir Gray, J.A. Muir. 1999. “Postmodern Medicine” The Lancet 354: 1550-1553.
RESOURCES Medical Group Management Association. 2018. “New MGMA Provider Compensation Data Further Demonstrates Nationwide Primary Care Physician Shortage.” Press Release. https://www.mgma.com/press-releases/new-mgma-provider-compensation-data New England Journal of Medicine. 2017. “What is Patient - Centered Care?” NEJM Catalyst (January). https://catalyst.nejm.org/what-is-patient-centered-care/ Rosenberg, Charles. 2009. Our Present Complaint: American Medicine, Then and Now . Johns Hopkins Press. Rosenthal, Elisabeth. 2017. An American Sickness . Penguin Press. Starr, Paul. 1982. The Social Transformation of American Medicine . Basic Books.
ACKNOWLEDGEMENTS Thanks to Lonnie Long, MPA program graduate assistant, for valuable research assistance and editorial suggestions. Many thanks to the students of Public Administration 670: Health Systems who helped to discuss and identify some of the themes reviewed and discussed in this presentation.
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