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APAMSA 2011 National Conference Prescription for Change

Alice Hm Chen, MD, MPH Associate Professor of Medicine UCSF/San Francisco General Hospital

A New Vocabulary
HEALTH EXCHANGES
TEACHING HEALTH CENTERS

BUNDLED PAYMENTS
DEPENDENT COVERAGE PREMIUM CREDITS

DONUT HOLE

ARRA

CER
MEDICAL LOSS RATIOS

HITECH
VALUE-BASED PURCHASING MEDICAID EXPANSION

EHR
ACA

HIGH RISK POOL

CCHIT

INDIVIDUAL MANDATE

ESSENTIAL HEALTH BENEFITS

Public Knowledge
% Americans who got the right answer
Number of correct answers

1 1 3 9 8 8 14 7 17 6 23 5 16 4 10 3 6 2 1 2 0 2 0 5 10 15 20 25

Pop Quiz: Assessing Americans Familiarity with the Health Care Law, Kaiser Family Foundation, February 2011

Overview
The present: access, cost, quality The future: health reform Opportunities for physician leadership Words of advice

Access
2007
45.6 million (15.3%)

2008
46.3 million (15.4%)

2009
50.7 million (16.7%)

Cost

2008

$2.3 trillion 16.2% GDP

2010(p) $2.5 trillion 17.3% GDP

Health Care Costs 101, April 2010 California HealthCare Foundation

health-care costs are the key to our fiscal future. Peter Orzag, Director of the White House Office of Management and Budget

Quality
Infant Mortality (deaths per 1,000 live births) 1 2 3 4 5 6 Singapore Bermuda Sweden Japan Hong Kong Macau 2.31 2.46 2.75 2.79 2.92 3.22

40 Taiwan 41 Isle of Man 42 Italy 43 European Union 44 Cuba 45 United States

5.35 5.37 5.51 5.72 5.82 6.26

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

Iron Triangle to Triple Aim


ACCESS ACCESS

QUALITY

COST

Key Health Reform Provisions


Insurance companies

cannot turn away patients with medical conditions or take away medical coverage after someone becomes sick to insurance coverage

32 million people who are

currently uninsured will have insurance health insurance

Everyone is required to have Businesses must provide

No annual or lifetime limits Children can stay on their

parents insurance until 26

health insurance for their employees, or else pay into a pool paid on quality, not quantity

Incentives for primary care

Doctors and hospitals will be

Medicaid Expansion
Universal Medicaid eligibility for <133% FPL
Elimination of

categorical eligibility Estimated 16 million covered Undocumented excluded Legal immigrants excluded 5 years

X X X X X X X SCA
CHCF Medi-Cal Facts and Figures September 2009

Medicaid Eligibility for Working Parents by Income, January 2009


VT WA MT OR SD ID WY NV CA NE KS IA IL MO IL KY OK TN AR MS TX AK HI LA FL AL GA SC IN ND MN WI MI PA OH NJ MA NY CT RI NH ME

UT

CO

WV VA NC

DE MD DC

AZ

NM

<50% FPL (13 states)

US Average = 68% FPL


*The Federal Poverty Line (FPL) for a family of four in 2009 is $22,050 per year. SOURCE: Based on a national survey conducted by the Center on Budget and Policy Priorities for KCMU, 2009.

50-99% FPL (20 states) 100% + FPL (18 states including DC)

HITECH

$27 billion

Opportunities: Credibility

Opportunities: Community Partnerships


2.3 million Californians with subsidies 65% people of color 32% limited English speaking 1.6 million Californians with Medicaid 79% people of color 51% limited English speaking

Opportunities: Leadership
All of the great leaders have had one characteristic in common: it was the willingness to confront unequivocally the major anxiety of their people in their time. This, and not much else, is the essence of leadership. - John Kenneth Galbraith, The Age of Uncertainty

Some Advice
Read widely Learn another language Understand the big picture Hone your communication skills Work collaboratively, collectively Be the best clinician you can be

Some Advice
Chance favors only the

prepared mind. (Louis Pasteur )


Hard work Attention to detail Hard work Mastering content Hard work Communication skills Hard work

Character, not circumstance,

makes the person. (Booker T. Washington)


Character counts Integrity Reliability Perseverance Dedication Selflessness Excellence Patience

Some Advice
Mentoring is a brain to pick, an ear to listen, and a

push in the right direction. (John C. Crosby)


Make them want to mentor you. Be prepared, be engaged Be proactive, show initiative Be a problem-solver, not a problem-maker

Seek a diversity of mentors, role models, peer support Remember to mentor!

Some Advice
The value of identity of

course is that so often with it comes purpose. (Richard Grant)


Know yourself. Pay attention to what

Life is a journey, not a

destination. (Ralph Waldo Emerson)

Its OK to take time

makes you excited, makes you want to go the extra mile, makes you fulfilled.

off depends on what you do, how you use it. fun.

Its OK if your family wants

Remember to have

you to go into medicine as long as in the end, you want to, too.

Last Words
The purpose of life is to be useful, to be responsible, to be honorable, to be compassionate. It is, after all, to matter: to count, to stand for something, to have made some difference that you lived at all. - Leo Rosten