NASHP State Health Policy conference October 5, 2010

1. NASHP State Health Policy conferenceOctober 5, 2010

2. 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 Hostetler

3. Workforce Issues 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 Hostetler

4. The CHC Recruitment Climb:Getting Steeper • Costs of hiring and training • Lack of recruitment staff • Physician shortage • CHC challenges • Location, population complexity, pay Hostetler

5. And Yikes! CHC patients expected to double by 2014 Hostetler

6. CHC Residency Program • Health reform act opportunity • Difficult for CHCs • Best candidates: Larger CHCs • Other CHCs will partner with residency programs Hostetler

7. OPCA’s SEARCH program • Offers exposure to CHCs • 70% of students continue working with populations in need • Boosts job satisfaction for CHC providers • Strengthens partnerships with academic institutions Hostetler

8. Utilizing Mid-Level Providers Historically used at CHCs • Oregon’s ratio of physician to mid-level • Currently 1:1 • May evolve to 1:3 or more Hostetler

9. Utilizing Mid-Levels (cont’d) • Training curriculum needs to improve • To “hit the ground running” • Example: Pacific University PA program • Primary care home model = more patients per provider team Hostetler

10. Primary Care Home Model Physicians in “medical home” demonstration projects report job satisfaction rates going up tremendously. --Patient-Centered Primary Care Collaborative Hostetler

11. How the Primary Care HomeCan Help • Issues with current primary care model • Pressures of the 10 – 15 minute visit • Negatively impacts patient outcomes • Provider satisfaction: More than money Hostetler

12. 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 Hostetler

13. Challenges, Barriersand Competing Priorities 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 Hostetler

14. Challenges, Barriersand Competing Priorities (cont’d) Clinic level: • Capturing data • Spreading leadership and buy-in throughout the clinic • Finding resources • Allowing providers time to lead Hostetler

15. Key Issues for Payment Reform • 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 Hostetler

16. Exciting Developments • Policy alignment and opportunity • Oregon’s initiative is improving: • Provider satisfaction • Basic patient satisfaction • Some clinical quality indicators Hostetler

17. Thank You! Contact Information Craig Hostetler Executive Director Oregon Primary Care Association Phone: 503-228-8852 Email: chostetler@orpca.org Hostetler