Provider Perspectives on Improving Health Care Grantmakers In Health Webinar August 13, 2015
Why This Webinar?
What Needs to Change to Improve the Health of the Nation? Access to Care Delivery System Transformation Prevention and Social Determinants of Health
Working in Silos Health Care Providers Foundations The Community • Doctors • Schools • Nurses • City Councils • Clinics • Food Banks • Hospitals • Homeless Shelters
We can tackle problems better together! Identify Address Evaluate
Doctors for America • 16,000 doctors and medical students across specialties in all 50 states • Our vision: a healthy America for everyone
Areas for Collaboration: Access to Care • Reaching the remaining 10% – Enrollment – Medicaid Expansion – Undocumented immigrants • Ensuring that coverage translates to care – Availability of providers – Affordability of deductibles and copays – Health literacy
Areas for Collaboration: Delivery System Transformation • Focusing on value over quality • Increasing coordination of care – Within the health care system – With community-based resources • Empowering patients
Areas for Collaboration: Social Determinants of Health • Food Security • Housing Quality and Security • Safe Communities to Walk, Run, and Play • Education / Literacy
What Doctors and Other Providers Can Do
Suggestions • Use us as a resource! • Work with us to connect health care providers with their communities. • Host forums with health care providers and the community.
Thank you! Alice Chen, MD Executive Director alice.chen@drsforamerica.org 202-481-7197 www.drsforamerica.org
Provider Perspectives on Improving Health Care Grantmakers In Health Webinar August 13, 2015
R. Shawn Martin Senior Vice President Advocacy, Practice Advancement, & Advocacy smartin@aafp.org 202.232.9033 @rshawnm
AAFP Total Membership 3
About the AAFP • 120,900 members – Practice in 95% of U.S. counties – 42% are female – 24% are new physicians • <7 years in practice – 18% are rural • 11, 309 resident physicians
Current State of Affairs 5
Changing Times 6
Ecology of Health Care 1,000 Persons 1 is Hospitalized 800 Report in an Academic Symptoms Health Center 8 are 327 Consider Seeking Hospitalized Treatment 13 Visit an 217 Visit a Emergency Physicians Office Department 113 Visit a 14 Receive Home Primary Care Health Care Physician 65 Visit a 21 Visit a Hospital complimentary of Outpatient Clinic alternative care provider
The Value of Primary Care • Patients experience the best outcomes in terms of wellness, health maintenance and overall cost of care when two items exists: – Health care coverage (insurance) – Continuous relationship with a physician, usually a family physician
4 Pillars of Primary Care Comprehensive Continuous Coordinated Connected
Primary Care Centric Health Care Primary Care Individual Patient Care Population Public Health Health
Primary Care is Complex Figure 1. Number and percentage of outpatient chronic condition visits by physician type in the past year, based on the 2008 National Ambulatory Medical Care Survey. * P <0.05 significant test done by SAS Procedure Surveyfreq Roa-Scott 2 test.
WORKFORCE CHALLENGES
Recognized Medical Specialties 1965 2014 145 10
WORKFORCE DISTRIBUTION
Graduate Medical Education Positions Distribution by State
4 Recommendations • Delivery systems built on 4 C’s of primary care • Intersection of primary care, public health, & population health • Integration of primary care & mental/behavioral health • Workforce development
18 18
Provider Perspectives on Improving Health Care Janet Haebler, MSN, RN Senior Associate Director of State Government Affairs, ANA Grantmakers in Health Webinar August 13, 2015
American Nurses Association AMERICAN NURSES ASSOCIATION Nurses advancing our profession to improve health for all
Tipping Point: The ACA & The Future of Nursing Report AMERICAN NURSES ASSOCIATION
KEY MESSAGE 1 NURSES SHOULD PRACTICE TO THE FULL EXTENT OF THEIR EDUCATION AND TRAINING AMERICAN NURSES ASSOCIATION Full Scope of Practice Recognize Nurses’ Economic Value Remove Barriers to Practice
KEY MESSAGE 2 PREPARE AND ENABLE NURSES TO LEAD CHANGE TO ADVANCE HEALTH AMERICAN NURSES ASSOCIATION
KEY MESSAGE 3 NURSES SHOULD ACHIEVE HIGHER LEVELS OF EDUCATION AND TRAINING AMERICAN NURSES ASSOCIATION
Strategic Investment Areas for Nursing Scope of practice/ AMERICAN NURSES ASSOCIATION full practice authority for all nurses (RNs and APRNs) Nurse leadership Education, especially academic progression ANFonline.org (RN-to BSN-programs)
More information is available on ANA’s website: www.NursingWorld.org
Pro vide rs Pe rspe c tive s o n I mpro ving He a lth Ca re Gra ntma ke rs in He a lth We b ina r Community He a lth Ce nte rs Ja son Pa tnosh Asso c ia te Vic e Pre side nt, Pa rtne rship a nd Re so urc e De ve lo pme nt Na tio na l Asso c ia tio n o f Co mmunity He a lth Ce nte rs jpatnosh@nachc.org / 301-347-0400 ext 2068
HE AL T H CE NT E RS I N A POST -ACA WORL D Whe re do we fit? Whe re do we sta nd? • Ac c e ss to prima ry c a re is vita l fo r c o st sa ving s a nd impro ve d o utc o me s • Unme t ne e d fo r o ur se rvic e s re ma ins e no rmo us – 62 millio n witho ut prima ry c a re • We e xpe c t inc re a se d de ma nd , a mo ng ne wly insure d a nd uninsure d (MA e xpe rie nc e ) e de ra l support, thro ug h 330 g ra nt a nd • F Me dic a id pa yme nt, c ruc ia l to mo de l o f c a re
HE AL T H CE NT E RS I N A POST -ACA WORL D “E ve ry Community He a lth Ce nte r is moving to a c hie ve the iple a im —impro ve the he a lth o f the po pula tio ns se rve d, tr impro ve the pa tie nt e xpe rie nc e , a nd b e nd the c o st c urve . T o a c c o mplish this, CHCs a re tra nsforming into pa tie nt- c e nte re d me dic a l home s (PCMH), whic h inc lude s the inte g ra tio n o f b e ha vio ra l a nd o ra l he a lth. K e y te ne ts o f the PCMH inc lude e ve ryo ne wo rking a t the to p o f the ir tra ining , lic e nsure , o r c e rtific a tio n; wo rking in c a re te a ms; a nd b e ing re spo nsib le fo r a pa ne l o f pa tie nts.” http://journals.lww.com/jaapa/Fulltext/2015/04000/Community_health_centers_at_the_crossroads__.9.aspx
HE AL T H CE NT E R F UNDI NG ST RE AMS DISCRE T IONARY MANDAT ORY • Annua l, up to Co ng re ss to • Re q uire d spe nding , unle ss de te rmine a mo unt Co ng re ss c ha ng e s the la w • Prio r to ACA, the o nly • Spe c ia l F und c re a te d in funding fo r CHC pro g ra m ACA to b o o st He a lth Ce nte r Ca pa c ity • Cut in 2011, b a c kfille d with ma nda to ry funds • Curre ntly $2.2 b illio n (F Y14) • Curre ntly $1.5 b illio n (F Y14) • Exte nsio n fo r 2 ye a rs • FY15 – T BA?
HE AL T H CE NT E RS F UNDI NG CL I F F …2 Ye a r De la y Ma nda to ry funding • wa s se t to e xpire a t the e nd o f F Y15 Witho ut a c tio n b y • Co ng re ss, up to 70% c o uld ha ve b e e n c ut to He a lth Ce nte r g ra nts NHSC, T HCs in sa me • po sitio n (tho ug h AL L ma nda to ry)
F I XI NG T HE CL I F F E xte nds, g ro ws • ma nda to ry funding $20b o ve r 5 ye a rs • Gro w fro m • c urre nt 22m pa tie nts to 35m Co ntinue funding • fo r NHSC, T e a c hing He a lth Ce nte rs
WORK F ORCE POL I CY CONCE RNS Na tio na l He a lth Se rvic e Co rps a nd T e a c hing • He a lth Ce nte rs GME pro g ra ms c urre ntly 100% funde d with ACA funds • F unding fo r NHSC e xpire s in 2017; T e a c hing He a lth Ce nte rs so o ne r Pre side nt pro po se d e xte nding , e xpa nding • NHSC, a nd b uilding o n T HCGME Wo rking a lo ng side c o a litio n pa rtne rs (AAF P, • AAMC, ACU, AAT HC) to e xte nd
WORK F ORCE DE VE L OPME NT • Gro wing o ur o wn – A.T . Stills Unive rsity (de nta l, me dic a l, b e yo nd) • Co mmunity He a lthCo rps • L e a de rship tra ining a c ro ss the C-Suite • Utiliza tio n o f CHWs a nd E ntry le ve l sta ff • Gro wth o f NPs, CNMs a nd PAs Be twe e n 2007 a nd 2012, the numb e r o f PAs, NPs, a nd CNMs • a t CHCs inc re a se d b y 61%, c o mpa re d with 31% fo r physic ia ns. Ho we ve r, se ve ra l po lic y a nd pa yme nt issue s je o pa rdize CHCs' a b ility to e xpa nd the ir wo rkfo rc e a nd me e t the c urre nt a nd rising de ma nd fo r c a re .
ARD! HE CE YOUR VOI E MAK
RE SOURCE S NACHC We bsite : www.na c hc .org NACHC Blog s (He a lth Ce nte rs o n the Hill, the Po lic y Sho p, He a lth Ce nte r Ne ws a nd Ha ppe ning s, e tc .): blog s.na c hc .c om @ NACHC o n twitte r
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