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PAs transforming health through patient-centered, team-based medical practice

PAs transforming health through patient-centered, team-based medical practice. Agenda. 1. Healthcare Landscape. 2. Physician Assistant Overview. 3. AAPA & PA Foundation Overview. 2. Changing U.S. Healthcare Landscape.

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PAs transforming health through patient-centered, team-based medical practice

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  1. PAs transforming health through patient-centered, team-based medical practice

  2. Agenda 1 Healthcare Landscape 2 Physician Assistant Overview 3 AAPA & PA Foundation Overview 2

  3. Changing U.S. Healthcare Landscape Shift from fee-for-service to fee-for-value healthcare delivery model. Accelerating reforms at the national & state levels. New competitive structures – industry consolidation, vertical integration & new entrants. Consumer-centric healthcare markets.

  4. Market & Government Driving Reform GDP Spending Uninsured How We Stack Up A 2011 World Health Organization study indicates the U.S. spends a higher proportion of its GDP on health care than any other country, but ranks 37th out of 191 countries based on 5 KPIs. Current healthcare expenditures are 18% of GDP and are expected to rise to 20%. On the Rise Medicare and Medicaid spending is now at 21% of the federal budget. Expectations are it will rise to 25% in the next few years. Disturbing Trend 48 million uninsured today… projected to grow to 55 million. Of the 48 million, 80% are citizens of the U.S.; approximately 8 million are currently covered by Medicaid. Uninsured are twice as likely to be unhealthy and over 30% have a chronic condition. Source: World Health Organization Source: Kaiser Family Foundation Source: Kaiser Family Foundation

  5. The Solution: Patient Protection & Affordable Care Act Lifetime/Annual Caps Banned Health insurance providers will no longer be allowed to set financial limits on payouts. Guaranteed Coverage & Individual Mandate Requirement that everyone must purchase health insurance (unless otherwise covered) & they have to be issued a policy regardless of rating, pre-existing conditions, or age. Health Insurance Exchange States have the option to create their own or adopt the federally-run exchange. The HIE is an alternative marketplace for individuals & small business to purchase insurance. Business Health Insurance Tax Companies with 50 or more employees with at least 1 full-time employee must provide health insurance or pay fines. Preventative Services Certain preventative services will be considered “essential” and will be offered free of co-pays or deductibles. Medicaid Expansion States that chose to participate will change eligibility for individuals within 133% - 400% of the federal poverty level.

  6. Value-Based Healthcare Today: Fee-for-Service Future: Fee-for-Value Episodic Care Models Condition Care Models Population Care Models Transactional Models • Partial Population • Frail elder • High risk • Poly-chronic • Full Population • Globally capitated models • Medicare shared savings ACO • Dermatologists • Ophthalmologists • Dentists • Etc. • Orthopaedics • CV Surgery • General/specialty surgery • Oncology • Diabetes • Asthma • Chronic/end-stage renal Source: Oliver Wyman Example Model Types

  7. Primary care Urgent care Specialist care Hospital emergency services Diagnostic imaging/lab Home care Behavioral health OT/PT Hospital OR/ICU Ambulatory surgical center Skilled nursing Hospice & palliative Accountable Care Organizations – Responsible for the Whole Patient … and for managing clinical risk for all healthcare consumption across ambulatory, acute, post-acute, and other settings. Source: Oliver Wyman

  8. The Trillion Dollar Question Accountable Care . . . . Organizations • High quality care • Efficient delivery • Coordination of activities • Measurable results • Patient-centric • Whose “Home” / “Organization” • Hospital? • Doctor? • Payer? • Government? • Third party? Source: Oliver Wyman

  9. Shift to Consumer-centric Healthcare Markets Patient-Centered Care “Team-Based, guided, and coordinated” Healthcare today “Complex, fragmented and under performing” Source: Oliver Wyman

  10. New Delivery Models Provider Models Payer Models Open Heart ED Intervention Orthopedics Radiation Oncology Cardiology Cancer Surgical Oncology Provider-Led Manager Crowd sourced tools CKD Frail Elder Risk Assessment Provider Transparency Diabetes Wellness Wellness Payer-Led Model Monitors/ Sensors Social Media Ancillary products Risk Financing Financial Mgmt. Biometrics Information Goods Network Wellness Minute Clinics Retail-Led Manager Coaches Lifestyle Retail/ Shopping Coaching Convenience Minute Clinics Retail/New-Co Models Apps Source: Oliver Wyman

  11. Experience Expertise Partners Physician Assistant Overview 11

  12. What is a PA? A physician assistant (PA) is nationally certified and state licensed to practice medicine as part of a physician-led team. PAs are educated at the graduate level and practice in nearly every medical specialty and setting. • What do PAs do? • Conduct physical exams • Diagnose and treat illnesses • Order and interpret tests • Counsel on preventive healthcare • Assist in surgery • Write prescriptions • Make rounds in nursing homes and hospitals • Obtain medical histories * PAs’ responsibilities correspond to their supervising physicians’ practice.

  13. PA Vital Statistics 50 Number of states authorizingPA prescribing privileges 94,507 Number of certified PAs in 2013, according to the National Commission on Certification of Physician Assistants 1967 Year the first three PAs graduated from Duke University $90,873 Median annual income from primary employer for full-time clinically practicing PAs* in 2010. Projected Growth of PAs in Clinical Practice With a projected growth of 39 percent, the Bureau of Labor Statistics predicts physician assistants will be the second-fastest-growing health profession in the next decade (after home health aides). 83,600 Employment in 2010 108,300 Projected employment in 2020 *Excludes self-employed and part-time PAs Source: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, Physician Assistants, on the Internet at http://www.bls.gov/ooh/healthcare/physician-assistants.htm (visited Dec.20, 2012).

  14. Growth of the PA Profession • The PA profession has doubled every decade since the 1980s. Number of Practicing PAs • The Association of American Medical Colleges estimates that there could be as many as 135,000 PAs by the year 2020.

  15. PA Profession Ranks High in Today’s Economy Forbes.comranked physician assistant in its list of best master’s degrees for jobs three years in a row. CNNMoney.com ranked PA as number two on its Best Jobs in America list in 2009 and 2010. The profession continues to rank high. U.S. News & World Reportranked the PA profession as one of the 50 best careers of 2011. Kiplinger’s named PAs one of the “great careers for your future.” “HHS continues to invest in the PA workforce through various programs, many spearheaded by the Health Resources and Services Administration. The Affordable Care Act builds on these efforts through … payment increases to primary care PAs.” – HHS Secretary Kathleen Sebelius, Oct. 5, 2012

  16. Clinical Profile

  17. Addressing Health Disparities & Underserved Populations

  18. Practice Profile 94,000 Practicing PAs

  19. Multiple settings, multiple population segments, multiple team members

  20. How One Becomes a PA • There are 176 accredited PA educational programs in the United States. • Most PA programs award a master’s degree. • PAs are required to complete: • More than 400 hoursin basic sciences • 75 hours in pharmacology • 175 hoursin behavioral sciences • Nearly 580 hoursof clinical medicine • The average length of a PA program is 27 months long.

  21. After Graduation • PAs are required to pass a national certifying examination administered by the National Commission on Certification of Physician Assistants. • PAs must earn and log 100 hours of continuing medical education every two years. • PAs must take a recertification examination every six years (every 10 years starting in 2014). • To be able to practice, PAs must have a state license and work with a physician. • The current six-year time period between recertification exams will be extended to 10 years to better reflect PA competence in practice.

  22. PA Utilization Shifting to a value-based, outcomes-centric health delivery model is more than using terms such as integrated delivery model or forming an ACO. Demand is high for PAs, but not all health systems use them efficiently. Ongoing research & data analysis continue to prove the economic & clinical outcome value of PAs. True integration calls for all healthcare professionals being able to function at the top of their license.

  23. PAs Positioned Well for the Future The landmark Patient Protection and Affordable Care Act, which has implications across every health delivery setting, includes specific provisions for PAs. U.S. faces an insufficient number of physicians, with projections indicating that supply will be unable to keep pace with demand; by 2025, a shortage of 124,000 primary care physicians is anticipated. A component of the law identifies PAs as necessary to help mitigate the expected doctor shortage. The language specifies support for PA education in primary care, and fully integrates PAs in the new Independence at Home demonstration project. Cost bonus incentives for PA use in the primary care setting with certain Medicare codes from 2011-2015.

  24. PAs in Value-Based Healthcare • More than four decades of research are available: • PAs substitute for doctors at approximately 85% of the range of primary care tasks • PAs produce approximately 2.4 times their salary in revenue • PAs are equally productive in outpatient visits • Opportunity cost of producing a PA is approximately 20% of a doctor • PA produces approximately 5 years of healthcare services to society before a doctor is functioning independently from postgraduate training

  25. PAs in Consumer-Centric Care Outlook for traditional players in a value-based population management ecosystem Source: Oliver Wyman

  26. PAs Expanding Access to Care • . . . “with an aging population and more chronic disease, the medical profession needs all the help it can get,” says Dr. J. Lloyd Michener, professor and chairman of the department of community and family medicine at Duke. “PAs are a critical member of the health team.2011http://www.foxbusiness.com/personal-finance/2011/01/21/pas-play-pivotal-role-health-care-reform/#ixzz2YfM6Y6CZ • Approximately 10 percent of physicians practice in rural areas, where approximately 20 percent of the U.S. population lives. Rural residents are also limited by lack of transportation, extreme weather, social isolation and poverty. Therefore, access to care is a major concern in most rural areas. Fortunately, PAs are helping to extend care to areas most in need: About 17 percent of PAs practice in rural areas. AAPA 2011

  27. Coordinating Care and Saving Health Care Dollars PA Home Visit Program Reduces Hospital Readmissions • PAs made house calls on days 2 and 5 following hospital discharge • Study followed 26 months of readmissions • 30-day readmissions were reduced by 25% for patients receiving PA home visits • Most common intervention: medication adjustments – diuretic agents, meds for hypoglycemia, and antibiotics.

  28. Take Care Clinics Expand Scope of Health Care Services to Include Chronic Condition Management and Additional Preventive Health Offerings DEERFIELD, Ill., April 4, 2013 - Access to health care services is an ongoing challenge to the U.S. health care system. With a physician shortage, aging population, a growing prevalence of chronic diseases and up to 30 million people projected to gain insurance coverage in 2014 through the Affordable Care Act, the issue will become even more critical – and may further impact both patients and the health care system at large…. Take Care’s board-certified nurse practitioners and physician assistants deliver patient-centric care, driving patient satisfaction rates that are consistently greater than 90 percent. PAs in New Health Delivery Models

  29. About AAPA • Founded in 1968, AAPA is the national professional society for physician assistants. • AAPA represents a profession of more than 94,000 certified PAs. Approximately 47,000 PAs are members of AAPA, including 10,400 students. • The Academy educates the general public about the PA profession, ensures competency of PAs through active involvement in the accreditation of PA programs, provides continuing education & conducts PA-related research. • AAPA works in cooperation with its sister organizations: • NCCPA – certifying body for PAs • PAEA – PA academic educational programs • ARC-PA – educational accrediting body Vision PAs transforming health through patient-centered, team-based care. Mission Providing innovative solutions that empower our members to connect, enhance their careers and improve patient health.

  30. About the Physician Assistant Foundation • The Physician Assistant Foundation is the philanthropic arm of the American Academy of Physician Assistants. • Foundation Initiatives • Student Scholarships • Caring for Communities Award • Innovations in Health Care • Community-based Project Grants • Research Fellowship • Leadership Development • Health Policy Fellowships • Global Outreach • Matching Grants • Pre-PA Minority Student Scholarships

  31. Effective and Productive Partnerships 50 State Chapters & DC Chapter 5 Federal Service Chapters 25 Specialty Organizations 17 Special Interest Groups & 8 Caucuses

  32. Collaborative Relationships • Nursing: advanced practice nurses, ANA, ACNP-AANP • Physician organizations: AAFP,ACP, AAP, AMA, SHM, AAOS, AAO-HNS, AOA, ACS • Retail: CVS MinuteClinic, Walgreens Take Care Clinic, RiteAid NowClinic • Health Systems & Payers: Johns Hopkins, Cleveland Clinic, Geisinger, United, Aetna • Professional organizations (AMGA, NGA) as well as patient & disease groups • Government agencies: HHS, CMS, CDC, DOL, VA, OIG

  33. . 2012 - Unprecedented Year: 40 States Made PA-Positive Changes to State Law State made PA-positive changes to law in last 12 months No positive change in State law in last 12 months

  34. AAPA & PAF Strategic Commitments To the Profession To Members To Staff & Volunteers Foster PA Excellence – through integrated professional development & coordinated advocacy Optimize PA Practice – identify, evaluate & promote best practice models that increase PA impact on health, maximize PA value & enhance PA satisfaction Grow the PA Profession – elevate PA roles, recognition & respect and support increasing the number & diversity of PAs Create & Deliver Value Offer an Essential Digital “Home” Be Fiscally Responsible & Transparent Provide Meaningful Volunteer Opportunities Make AAPA a Great Place to Work

  35. For more information please contact: Lisa Gables Executive Director – PA Foundation Chief Development Officer - AAPA Phone: 571.319.4502 Email: lgables@aapa.org Or visit our website at www.aapa.org

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