RECOMMENDED RECOMMENDED ACTIONS FOR HEALTH ACTIONS FOR HEALTH

CARE REFORM IN CARE REFORM IN ALASKAALASKA

Kenneth W. Kizer, MD, MPHAlaska State Hospital and Nursing Home Association

Fairbanks, AKSeptember 9, 2010

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Panel ObjectivePanel Objective

To consider some preferred strategies and actions for health care reform in Alaska.

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Foundational Assumptions and BeliefsFoundational Assumptions and Beliefs1.1. To be successful, health care reform must address the root To be successful, health care reform must address the root

cause problems – not just the symptoms. (Some of these cause problems – not just the symptoms. (Some of these problem may be external to the health care sector.)problem may be external to the health care sector.)

2.2. The disproportionate growth of health care spending is not The disproportionate growth of health care spending is not sustainable, and thus, maintaining the status quo is not a sustainable, and thus, maintaining the status quo is not a realistic option. realistic option.

3.3. The PPACA will significantly increase demand for health care The PPACA will significantly increase demand for health care services, but is less likely to significantly “bend the cost curve” services, but is less likely to significantly “bend the cost curve” in the next 10 years.in the next 10 years.

4.4. The federal government will become a larger purchaser of The federal government will become a larger purchaser of health care in Alaska at the same time that it must become health care in Alaska at the same time that it must become much more aggressive about controlling the rate of growth in much more aggressive about controlling the rate of growth in government health care spending.government health care spending.

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Foundational Assumptions and Beliefs Foundational Assumptions and Beliefs 5.5. Achieving the desired degree of coordination of services Achieving the desired degree of coordination of services

and quality improvement will require much greater and quality improvement will require much greater collaboration between and among providers.collaboration between and among providers.

6.6. Implementation of PPACA’s delivery system change and Implementation of PPACA’s delivery system change and cost control strategies will require a robust supporting cost control strategies will require a robust supporting infrastructure that includes many things, including IT, infrastructure that includes many things, including IT, human capital management, joint decision making, a human capital management, joint decision making, a performance management system, strong clinical performance management system, strong clinical leadership, training, and effective governance. leadership, training, and effective governance.

7.7. The health care workforce problems, especially physician The health care workforce problems, especially physician shortages, are likely to worsen in Alaska as the demand for shortages, are likely to worsen in Alaska as the demand for health care services increases. health care services increases.

8.8. Expanded use of non-physician caregivers supported by Expanded use of non-physician caregivers supported by organized systems of care utilizing HIT and other advanced organized systems of care utilizing HIT and other advanced technologies will be necessary.technologies will be necessary.

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Recommended StrategiesRecommended Strategies

1.1. Be very clear about the problems that need to Be very clear about the problems that need to be fixed – i.e., what needs to be reformed. be fixed – i.e., what needs to be reformed. (PPACA includes an array of intended solutions (PPACA includes an array of intended solutions that may or may not be the right ones for that may or may not be the right ones for Alaska’s problems.)Alaska’s problems.)

2.2. Articulate a clear vision for health care reform in Articulate a clear vision for health care reform in Alaska - and the values upon which it is based.Alaska - and the values upon which it is based.

3.3. Build clinical leadership capacity in the state.Build clinical leadership capacity in the state.4.4. Plan for considerably expanded use of non-Plan for considerably expanded use of non-

physician caregivers that are supported by physician caregivers that are supported by organized organized systems of care utilizing HIT and of care utilizing HIT and other advanced technologies.other advanced technologies.

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A Disruptive Innovation A Disruptive Innovation for the Health Care for the Health Care

Workforce Problem….Workforce Problem….

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The Doctor of Nursing PracticeThe Doctor of Nursing Practice

The Doctor of Nursing Practice (DrNP/DNP) – a new The Doctor of Nursing Practice (DrNP/DNP) – a new type of type of independent licensed practitionerindependent licensed practitioner having having prescribing and admitting privilegesprescribing and admitting privileges

Pioneered at Columbia University’s Advanced Pioneered at Columbia University’s Advanced Practice Nursing projectPractice Nursing project

1 year advanced didactic training and 1 year 1 year advanced didactic training and 1 year patient care residency after the Masters degreepatient care residency after the Masters degree

Competency-based educational approach with Competency-based educational approach with heavy emphasis on chronic disease management heavy emphasis on chronic disease management skillsskills

Columbia graduated first class of DrNPs in 2005Columbia graduated first class of DrNPs in 2005 NBME offered first national certifying exam in 2008NBME offered first national certifying exam in 2008 >70 schools currently moving to accept DNP >70 schools currently moving to accept DNP

students students

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Recommended StrategiesRecommended Strategies5.5. Aggressively pursue efforts to align hospitals and Aggressively pursue efforts to align hospitals and

their medical staffs. Alignment is taken to mean the their medical staffs. Alignment is taken to mean the intentional congruence of goals, priorities, intentional congruence of goals, priorities, structures and processes to achieve mutual benefit, structures and processes to achieve mutual benefit, and requires:and requires: Clearly defined expectations Clearly defined expectations A shared understanding of what is needed to A shared understanding of what is needed to

accomplish the expectations and a coherent accomplish the expectations and a coherent plan for doing soplan for doing so

A supporting infrastructure to operationalize the A supporting infrastructure to operationalize the planplan

A performance management system with A performance management system with performance measures linked to strategic goalsperformance measures linked to strategic goals

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Panel….Panel….