Quality and Health Care Reform

1. Quality and Health Care Reform • Kate Navarro-McKay, Partnership for Quality Care October 5, 2010

2. About Partnership for Quality Care • Members include nation’s largest healthcare union with more than 1 million caregivers. • Member organizations provide care to 60 million patients annually • Members include diverse health care providers, many states, national leaders in quality. • Goal: Reliable and affordable access to healthcare coverage for all Americans within a health care system that aggressively promotes improved quality and efficiency.

3. Remember Health Reform Headlines? • Search of US Newspapers & Wire Stories finds: • Hospital Readmissions: 497 News Stories • Death Panels: 1,750 News Stories

4. Major Provisions of the PPACA • Insurance Coverage Expansions • Patient Protection & Insurance Market Reform • Revenue Measures & Deficit Reduction • Spur System Delivery Changes

5. What’s All This, Then? • Requirement that chain eateries post calorie counts • Break time for nursing mothers to express breast milk • Why? Ask Joe Biden.

6. Familiar Quality Approaches: Reports, Measurements & Penalties Hospital Readmissions & Hospital Acquired Conditions Standardized LTC Complaint Form & Review of 5-Star Rating System Value Based Purchasing Public Reporting & Increased Data Collection Higher Penalties & Many Disputes National Strategy for Quality Improvement New Models of Reimbursement & Care Delivery Accountable Care Organizations Bundled Payments Medical Home Demonstrations Community-based Care Transitions Demo Center for Medicare and Medicaid Innovation Comparative Effectiveness Research Major Areas of Quality Impact

7. ...And Don’t Forget Healthcare IT • ARRA (“Stimulus Bill”) provides $20 billion in HIT funding • back-loaded to hit in 2011, mostly incentive payments for meaningful use of certified health IT • PPACA Innovations Demand Effective Information Sharing • HIT seen as key “connection” facilitator

8. Just the Tip of the Iceberg... Demonstration on Culture Change and the Use of Information Technology in Nursing Homes • “Demonstration” • 312 Mentions • “Pilot” • 80 mentions Independence at Home Medical Practice Pilot Program Value-Based Purchasing Demonstration Programs Demonstration Projects to Address Health Professions Workforce Needs Demonstration Concerning Individualized Wellness Plans Demonstration Project to Evaluate Integrated Care Around a Hospitalization Pilot Testing Pay-for-Performance Programs for Certain Medicare Providers

9. PQC Response to Health Reform • Culture of Health Project—“Next Phase” of Health Reform • 4 areas of nationwide goals for clinical improvement (readmissions, sepsis, HAIs, asthma) • Health Improvement for Healthcare Workforce • Workforce Innovation and Investment • Nationwide, Expansive, Ambitious

10. What’s a Nurse Got To Do With It? • Nurses are Key to Making Quality Innovations Work for Patients and Organizations • High Level of Patient Interaction • Provide Continuity, Command Respect, Possess Expertise • Care Team Leader

11. What Should We Be Doing? • Anticipating Change: Once in a Generation Opportunity • Asking Yourself How Can We Think “Outside the Box” • Working Collaboratively on Institutional Priorities • Partnering With Administrators and Leaders to find the “Win-Win-Win”for Patients, Providers, and the Institution • Think about Systems and Teams

12. Uh, what if this doesn’t work?

13. Questions?

14. Kate Navarro-McKayPartnership for Quality Careknm@pqc-usa.org701-428-1298