October 5 2011 Impact Conversation Series Todays Discussion Primary Care A booming market The National Conversation State of the Debate in Colorado APN amp PA Survey Findings Planning now for new solutions ID: 1038146
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1. Scope of Practice:Colorado and the Current DebateOctober 5, 2011Impact Conversation Series
2. Today’s DiscussionPrimary Care: A booming marketThe National ConversationState of the Debate in ColoradoAPN & PA Survey FindingsPlanning now for new solutions2
3. Primary Care: A booming market
4. On the Horizon: Primary Care NeedIn Colorado 500k more “newly insured”How much care will they seek?Where will they seek care?4175,000153,000214,000
5. Gaps in Primary Care5
6. Who Can Practice Primary Care?6
7. Scope of Practice7Cost-effective care & providers, accessTraining & complexity of care
8. Progression of the Debate8Cultural
9. The National Conversation
10. The Importance of Frame of ReferenceNursing PerspectivePhysician PerspectiveIOM PerspectiveGrowing literature: plenty for everyone10
11. National-level reform11Mid-to-long range changeImmediate term changeFederal roleState role
12. The Promise of Medical HomesReduced costsImproved care qualityReduced medical errorsHigher patient satisfactionFewer health disparities12
13. The Promise DeferredNot today or tomorrow Require transformationWorkforce as members of “care teams”Technology is not “plug and play”Health care neighborhoodsPayment reform13
14. Accountable Care OrganizationsA model for reforming health care delivery and paymentIntegrated care deliveryPayments linked to cost-reducing quality benchmarksPerformance measurement14
15. Scope of Practice: Market Dynamics15
16. State of The Debate in Colorado
17. Our Primary Care Workforce17NOTES: Estimates do not include non-primary care practitioners.*Colorado providers include practicing/working providers only.SOURCES: GAO, Peregrine, DORA, Colorado Office of Demography, CHI)
18. State Role: Leverage PointsPractice Acts (legislative decisions)Medicaid payment structureInsurance regulation18
19. 19CO
20. Scope of Practice: APNs20Pre-20082008200920102011
21. APN & PA Workforce Surveys
22. Colorado NPsNOTE: The total of all specialties sums to more than 100% because each respondent could select more than one specialty.SOURCE: 2010 Colorado Advanced Practice Nurse Workforce Survey, Colorado Health Institute, Q14, Q15, Q24
23. NPs: Many recent graduates23
24. NPs: A homogenous professionNOTE: The total of all specialties sums to more than 100% because each respondent could select more than one specialty.SOURCE: 2010 Colorado Advanced Practice Nurse Workforce Survey, Colorado Health Institute, Q14, Q15, Q2424
25. NPs: Age and career cycle25
26. NPs: Policy opinions26
27. Colorado PAs27*PAs were classified as primary care if they practiced family/general medicine, general internal medicine, general pediatrics or prevention/wellness at least 50% of their practice time during a typical work week. SOURCE: CHI: 2011 Physician Assistant Workforce Survey, Q24, Q17, Q1. 43% of PAs57% of PAs
28. PAs: Increasingly educated28SOURCE: CHI: 2011 Physician Assistant Workforce Survey, Q24, Q2, Q13
29. PAs: Policy opinions29SOURCE: CHI: 2011 Physician Assistant Workforce Survey, Q8
30. What the surveys tell us:Important primary care providersMeeting higher education standardsSome of the same issues as physiciansNP issues: Reimbursement, institutional policies, physician conveningsPA issues: Reimbursement and Medicare scope30
31. Planning now for new solutions
32. The late stages of the debate32
33. Are the Changes Enough?Calls for Disruptive InnovationClinician-led teams, practicesTelehealthLeveraging new practitioners: Community health workers/patient navigators/care managers?33Innovation
34. Options Moving ForwardAligning financial structures & institutional policiesPaying for valueBuilding consensus: NPATCHSupport for loan forgivenessEvaluate Community health worker models34