NASHP State Health Policy conference October 5, 2010

NASHP STATE HEALTH POLICY CONFERENCE

OCTOBER 5, 2010

Health Reform Matrix

OPCA’s tool for tracking health reform:http://www.orpca.org/advocate-for-health-centers/federal-policy

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

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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 Issues3

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Costs of hiring and training

Lack of recruitment staff

Physician shortage

CHC challengesLocation, population complexity, pay

The CHC Recruitment Climb:Getting Steeper

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And Yikes!

CHC patients expected to double by 2014

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CHC Residency Program

Health reform act opportunity

Difficult for CHCs Best candidates:

Larger CHCs Other CHCs will

partner with residency programs

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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 program7

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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

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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

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Physicians in “medical home” demonstration projects report job satisfaction rates going up tremendously.

--Patient-Centered Primary Care Collaborative

Primary Care Home Model

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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 HomeCan Help

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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

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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, Barriersand Competing Priorities

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Clinic level: Capturing data Spreading

leadership and buy-in throughout the clinic

Finding resources Allowing providers

time to lead

Challenges, Barriersand Competing Priorities (cont’d)

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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

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Policy alignment and opportunity

Oregon’s initiative is improving: Provider satisfaction Basic patient satisfaction Some clinical quality indicators

Exciting Developments16

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Contact InformationCraig Hostetler

Executive DirectorOregon Primary Care Association

Phone: 503-228-8852Email: chostetler@orpca.org

Thank You!17

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