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    Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates stand head and shoulders above the competition.

    Contact us at PHA email and be sure to visit us at PHA Website

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Patient Protection and Affordable Care Act (PPACA) Impact on the Future Healthcare Workforce

Patient Protection and Affordable Care Act (PPACA) Impact on the Future Health Care Workforce

With the landmark ruling upholding the Patient Protection and Affordable Care Act, it is not surprising to see the wide variety of reaction.  As noted in this local piece, healthcare systems see it as a step in a direction that they were already taking and nurse leaders are happy with the ruling since it elevates the profile of RNs in the new models of care that are evolving.  The one comment that caught my eye was the physician who wonders how the influx of new patients will be incorporated into an already overburdened health system.

In response to the physician – who is likely already overwhelmed with meaningful use, ICD-10/11 requirements and general management of a small business – there are a number of provisions that impact primary care, being the first stop in the food chain.  Specifically, the provisions address:

  • Free preventative care
  • Funds to community health centers
  • Community care transitions programs
  • Value-based purchasing
  • New models of primary care delivery – ACO, PCMH

While it is important to note these initiatives, the better question is what type of workforce provisions exist to execute them in these five states that are projected to have the highest healthcare job growth rate?  Through several additional actions, the law recognizes the importance of primary care physicians, nurse practitioners, physician assistants and other healthcare personnel via the following:

  • Creation of new primary care residency slots
  • Expansion of the National Health Service Corp
  • Tax benefits for working in rural areas
  • PA training in primary care
  • NP training
  • Nurse Practitioner led clinics
  • Funding for healthcare IT and other health profession training

Having just enough time to provide a brief snapshot, it is well worth your time to listen to Joanne Spetz, labor economist and professor at the UCSF Center for the Health Professions, discuss the Patient Protection and Affordable Care Act (PPACA) impact on the future healthcare workforce in the video below.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

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Engaging Patients in the Advanced Practice Nurse Led Medical Home

Engaging Patients in the Advanced Practice Nurse Led Medical Home

Is it any coincidence that the American Medical Association annual meeting came to a close earlier this week…only to be followed by a close start to the American Academy of Nurse Practitioners annual event?  I hope not.  Despite being conducted more than six years ago, this study’s findings continue to ring true:  Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care and the need to use scarce human healthcare resources has resulted in increased emphasis on primary healthcare.  Key to the findings were the fact that scope of practice, emphasizing the importance of role clarity and trust and ideological differences regarding disease prevention/ health promotion all remain integral to the evolution of collaborative relationships between physicians and nurse practitioners.

While these collaborative relationships have been important in the past, they are being pushed to the forefront as we hurdle to the finish line, eagerly anticipating which parts, if any, of the Patient Protection and Affordable Care Act (PPACA) will make it across the finish line.  As Michelle Papachrisanthou, RN, MSN, CPNP, DNP-S, outlines in her article, The DNP and the Healthcare Home, “an estimated 30% increase in U.S. medical school enrollment would be needed for the physician population to meet the population growth, aging and other healthcare factors that the United States faces. This equates to a shortage of 124,000 physicians by the year 2025. Moreover, the population is projected to grow by more than 50 million between 2006 and 2025 to 350 million. When universal healthcare is added to the above equation shortages, we are now an additional 31,000 providers short.”  Recognizing the need for primary care, the Centers for Medicare & Medicaid Services (CMS), recently announced a new initiative that will provide funds to eligible hospitals to increase the availability of clinical training settings that will bolster the skills and supply of APRNs.

With a requirement for participating organizations to deliver fifty percent of clinical training in non-hospital settings in the community, CMS appears to agree with Dr. Papachrisanthou’s assertion that, “the DNP emphasis on primary care and its streamlined clinical focus promotes itself as a solution to lead the way for healthcare homes and the future of healthcare.”  In addition, she points out that scope of practice and prescriptive authority still preclude some states from participating and must be amended for true transformative change.  Forging a step in the right direction, the National Committee on Quality Advancement (NCQA) began recognizing nurse led medical homes in 2011.  As witnessed in the video below, Nurse Practitioner led medical homes fill a mission-critical void by successfully engaging chronically ill patients that suffer from a myriad of psycho-social issues.  Marry this concept with technology that allows the providers to extend their engagement beyond the walls of the clinic…and we begin to see opportunity for marked improvement.  With record numbers of uninsured patients – most evident in the Southwest – poised to descend on the emergency department, isn’t it time for your organization to consider nurse led medical homes?

 

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

 Contact us at PHA email and be sure to visit us at PHA Website

Innovating with Patient-Centered Medical Homes and Accountable Care Organizations to Improve Healthcare

Innovating with Patient-Centered Medical Homes and Accountable Care Organizations to Improve Health Care

With the close of the third National Accountable Care Organization (ACO) Summit in Washington, DC last week, it got me thinking about the Patient Centered Medical Home (PCMH) and ACO models.  Specifically, what are the differences and which is more appropriate for the future delivery of healthcare?

As defined by the four primary care societies (AAFP, AAP, ACP, AOA), the Patient-Centered Medical Home is as an approach to providing comprehensive primary care as a health setting that facilitates a continuous relationship between patients, the patient’s family when appropriate, and the patient’s personal primary care physician.  The joint principles supporting this model include:

  • Personal physician – serves as the primary contact and coordinator of care for a patient.
  • Physician directed medical practice – is led by the personal physician who directs the practice team to ensure continuous, comprehensive patient care.
  • Whole person orientation – in which the personal physician arranges and oversees care throughout patients’ various stages of life.
  • Care is coordinated and/or integrated – by the personal physician in connection with specialists and across settings facilitated by information technology and other appropriate tools.
  • Quality and safety – serve as primary guideposts for all aspects of a patient’s medical care.
  • Enhanced access – using tools such as open scheduling, extended hours, and various modes of communication between patients and providers.
  • Payment – is value driven and reflective of case mix, enhanced technologies, quality improvements, and shared savings achieved by successful patient management.

In keeping with these principles, the medical home goal is to deliver coordinated care in a seamless and efficient manner, thereby improving quality and reducing cost.

MedPAC has defined accountable care organizations (ACOs) as a set of providers associated with a defined population of patients, accountable for the quality and cost of care delivered to that population.  While the population is larger and generally involves multiple practices, similar intent remains for the ACO to reduce cost through enhanced preventative care, disease management and improved quality through coordination of care.  In order to manage a population effectively, ACO governance models often include not only physician members, but also, hospital or physician hospital organization (PHO) and/or payer representatives.  Structured purposefully in opposition to fee-for -service (FFS), ACO members are rewarded for efficiency in the form of a shared bonus.  If, on the other hand, an ACO underestimates the cost of operation, the providers will earn less, thereby becoming ‘accountable’.

Healthcare is, and likely will continue to be, a local service.  Determining whether a PCMH or ACO is more appropriate will be fueled by the local physician community’s appetite for and ability to change. Establishing clear goals with corresponding metrics, creating a path for process improvement and developing appropriate financial incentives will be integral  to driving this process forward.  In the absence of interoperable data, both organizational models must also find creative solutions for their health technology constraints.

As we prepare to learn the fate of the Patient Protection and Affordable Care Act, we find ourselves with the potential to transform care delivery through healthcare information technology, innovative team approaches and other new models of care.  With more than 500 physician practices in the United States, the metamorphosis to medical homes or ACOs will be a monumental undertaking.  Will it fundamentally improve care?  Listen in to find out more….

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Moving mHealth to the Next Frontier: Aligning Patients, Physicians, Healthcare Providers & Payers

Moving mHealth to the Next Frontier:  Aligning Patients, Physicians, Healthcare Providers & Payers

“Health data is no longer a government initiative. It is an American initiative.”  Such were the words spoken by U.S. Chief Technology Officer, Todd Park, at this week’s Health Datapalooza.  Organized by the Robert Wood Johnson Foundation, the California Healthcare Foundation and HHS, more than one hundred applications and websites, all powered by open data, took center stage at the exposition.

As Derek Newell,  CEO of Jiff,  illustrated in a recent Forbes article, mHealth has the ability to revolutionize healthcare delivery by providing the following:

  • Improved access to care
  • Improved patient engagement
  • New provider of business models
  • Reduced medicare fraud
  • Improved patient safety

Absent Medicare fraud, I daresay that without patient engagement…the other four will likely fail in this business model. And while I applaud the pioneering  efforts of this growing movement, I also wonder what will it take for patients to truly embrace these applications?

One innovative solution, mRx, has been developed by Happtique, the first mobile health store for healthcare professionals by healthcare professionals.  Utilizing the mRx technology, physicians can ‘prescribe’ apps and send them directly to the patients’ mobile devices, thereby increasing the likelihood of download and implementation.

While drawing a causal relationship between patient and provider is critical, is it not equally important for the patient to be incentivized to adhere to the ‘prescribed therapy’?  According to Joanne Wu, MD, MPH, the answer is a resounding yes.  In her article, Rewarding Healthy Behaviors—Pay Patients for Performance, Dr. Wu asserts that rewarding clinicians in the form of pay-for-performance (P4P) has produced lackluster results due to the challenge of patient behavior modification.  Instead, she proposes that patients be rewarded for achieving evidence-based health goals.  Rewards would be issued in the form of discounts towards co-payments for doctor’s visits, procedures, and medications, thereby potentially reducing cost and compliance issues.

There is no denying that the efforts of the Healthcare Data Initiative Forum III, aka Healthcare Datapalooza, are  truly innovative.  And now that the data has been liberated, shouldn’t we be turning our attention to how it is being utilized?  While the definition of the provider role is changing, it remains the fulcrum for healthcare service delivery.  With  the development of certification and standardized processes, these tools could one day be required CME training for physicians, allied health and nursing personnel.  And only when the federal government and payers take an active role in the design of a payment system bearing incentives will we move mobile health to the next frontier by aligning patients, physicians, healthcare providers and payers.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Implementing Kaizen for a Lean Health Care Transformation

Implementing Kaizen for a Lean Healthcare Transformation

Having recently attended a meeting for the American College of Healthcare Executives, I had the chance to query a hospital CEO, who coincidentally happened to be a Toyota engineer in a former life, about healthcare Kaizen.  After mentioning that his team was currently engaged in a lean project, he, much to my surprise, confessed that he was not very familiar with the concept either.  Given my interest in continuous quality improvement, I decided to investigate further.

Kaizen is an ancient Japanese philosophy that strives to continually improve all aspects of a person’s life.  Recognizing the need for significant change in the late eighties, Dr. Don Berwick, former Administrator for CMS (Centers for Medicare & Medicaid Services) and Harvard Community Health Plan physician, illuminated the concept of Kaizen in an article in the New England Journal of Medicine.  As a potentially crucial concept for improving health care in the United States, Dr. Berwick writes that, “..in the discovery of imperfection lies the chance for processes to improve”.

With a variety of approaches available for organizational improvement, one may wonder, why choose Kaisen?  While Six Sigma is a mathematical process focused on eliminating statistically relevant defects, Kaizen seeks to improve all aspects of a business through process standardization, increased efficiency and waste elimination by focusing on seven core areas – overproduction, defects, unnecessary motion, inventory, space, transportation and waiting time.   Incremental and frequent improvements emanate from ‘Kaizen events’, which involve members from multiple functions and levels in the organization working together to address a problem or improve a particular process in a short time-frame.  By tackling process redesign, positive and immediate impacts can be found in the quality, cost and speed of service with corresponding results in improved customer satisfaction and patient experience.  And if you are still on the fence about the merits for your organization – be it inpatient or outpatient – you must see how the leaders at Salem Health felt about their journey to Japan to witness the Kaizen process first-hand.

Suspended in free fall – with another dismal jobs report sending the Dow careening, healthcare spending slowing, more Americans grappling with healthcare coverage/choices and the onset of value-based purchasing, the time seems ripe for the healthcare industry to usher Kaizen into their organizations.  With experts predicting that 10% of the workforce should be solely focused on working ON the business rather than IN the business, identifying the typical 30-60% of organizational effort that is waste, how will your organization bring this concept to reality for your own healthcare transformation?

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website