1. Designing New Programs in Response to the Patient Protection and Affordable Care Act Presented at: NASW/Texas 36th Annual State Conference Rhonda G. Patrick, LCSW, MPA

2.  Overview of the Patient Protection and Affordable Care Act (PPACA)  PPACA Post Supreme Court Decision  PPACA Impact on Social Work Practice  Defining Social Work Entrepreneurship  Becoming a Social Work Entrepreneur  Designing Programs in Response to PPACA Using a Social Work Entrepreneurship Philosophy  Final Thoughts

3.  Key Elements of Potential Interest to Social Work ◦ Individual Mandate ◦ Medicaid Expansion ◦ Quality/Health Systems Performance ◦ Prevention/Wellness ◦ Long-term Care ◦ Medicare ◦ Workforce ◦ Community/School Health Programs ◦ Trauma Care ◦ Disaster Response ◦ American Indians

4.  Key Elements of the Supreme Court Ruling ◦ Anti- Injunction Act  Not a tax, therefore not an issue ◦ Constitutionality of Individual Mandate  The penalty is a tax and as such within constitutional rights of congress ◦ Severability  Since mandate upheld, not an issue ◦ Medicaid Expansion  Can’t require states, and if they refuse can penalize by withholding current funding.

5.  Types of Practice Arenas ◦ Micro Social Work  Direct Care Services in Health and Behavioral Health Care and other Social Services ◦ Macro Social Work  Policy Development and Analysis (Social, Economic, Programmatic)  Advocacy  Program Design  Development- Funding  HR- Workforce Development & Benefits/Compensation  Compliance/Accountability  IT- EMR and Information Management Systems

6.  What the Experts Are Saying ◦ Robyn Golden- Rush University Medical Center  Fragmentation  Move from episodic acute care to incentivized comprehensive care  Care Coordination Model  Medical Homes  Workforce Development

7.  What the Experts Are Saying ◦ Social Work Today  Expansion of home and community based services  Chronic disease prevention  Wellness programs  Workforce development  Increased access by more people  Integration of health and behavioral health  CLASS- Keeping elders in community  Community and Consumer Education

8.  What the Experts Are Saying ◦ CSWE  Workforce Expansion and Development  Healthcare Coordination  Prevention and Wellness  Community and Family Health  Research  Aging Needs

9.  What the Experts Are Saying ◦ NASW  Parity  Prevention  Voluntary Medicaid Expansion  Health Exchanges (Collins 2012)

10.  What Others Are Saying ◦ Workforce Organizations  Physicains  Nurses  Allied Health Care Professionals ◦ Social Work Education  Focus on Workforce Expansion (Very Conservative)  Fairly Quite Considering- Nursing ◦ Think Tanks  250,000-400,000 a year this decade

11.  What is an entrepreneur? ◦ An entrepreneur is an enterprising individual who builds capital through risk and/or initiative. ◦ 1964: Peter Drucker: An entrepreneur searches for change, responds to it and exploits opportunities. Innovation is a specific tool of an entrepreneur hence an effective entrepreneur converts a source into a resource. ◦ 1971: Kilby: Emphasizes the role of an imitator entrepreneur who does not innovate but imitates technologies innovated by others. Are very important in developing economies. ◦ 1975: Albert Shapero: Entrepreneurs take initiative, accept risk of failure and have an internal locus of control. ◦ Joseph Schumpeter (1930): An entrepreneur is a person who is willing and able to convert a new idea or invention into a successful innovation. Entrepreneurship is the pursuit of opportunity without regard to resources currently controlled. ◦ New Products ◦ New Product Methods ◦ New Markets ◦ New Forms of Organizations ◦ The capacity and willingness to undertake conception, organization, and management of a productive venture with all attendant risks, while seeking profit as a reward.

12.  What is a Social Work Entrepreneur? ◦ There is no definition. ◦ Social Worker- Social Justice and Human Rights Perspective ◦ Change Agents/Action Oriented/Relationship Focused

13.  Can one be a Social Work Entrepreneur? ◦ Reconciliation of the relationship between profit and caring. ◦ How do we define profit? ◦ Individual shift ◦ Profession shift

14. A social work entrepreneur is a social worker with the capacity and willingness to undertake conception, organization, and management of a productive venture, without regard to resources currently controlled, while seeking profit as a reward to create new products, new product methods, new markets, and new forms of organizations.

15.  What are the knowledge, skills, and attitudes necessary to be a Social Work Entrepreneur? ◦ The capabilities of innovating, introducing new technologies, increasing efficiency and productivity, or generating new products or services, are characteristics of entrepreneurs. Entrepreneurs are catalysts for economic change. Research has found entrepreneurs to be highly creative with a tendency to imagine new solutions by finding opportunities for profit or reward.

16.  A social entrepreneur is motivated by a desire to help, improve and transform social, environmental, educational and economic conditions. Social entrepreneurs seek to develop innovative solutions to global problems that can be copied by others to enact change.  A serial entrepreneur is one who continuously comes up with new ideas and starts new businesses. In the media, the serial entrepreneur is represented as possessing a higher propensity for risk, innovation and achievement.

17.  A lifestyle entrepreneur places passion before profit when launching a business in order to combine personal interests and talent with the ability to earn a living. A lifestyle entrepreneur intentionally chooses a business model intended to develop and grow their business in order to make a long-term, sustainable and viable living working in a field where they have a particular interest, passion, talent, knowledge or high degree of expertise.  A cooperative entrepreneur doesn't just work alone, but rather collaborates with other cooperative entrepreneurs to develop projects, particularly cooperative projects. Each cooperative entrepreneur might bring different skill sets to the table, but collectively they share in the risk and success of the venture.

18.  Key Philosophy… NEVER CHASE MONEY!!! ◦ Design Sound Programs First- The money will follow.  Be willing to put in the time… “you get out what you put in”  Starting from scratch or redesigning existing programs? ◦ Benefits of Starting From Scratch ◦ Risk of Starting From Scratch ◦ Benefits of Redesigning ◦ Risk of Redesigning

19.  Basic Program Design Format ◦ Preliminary Steps- Immersion  Needs Assessment ◦ Using Logic Models- Organizing and Prioritizing the Information ◦ Identifying Social Problems  Social Condition vs. Social Problems ◦ Selecting the Appropriate Intervention Strategy  Using Evidence Based Practice  Political Economy ◦ Setting Goals and Objectives ◦ Evaluating  Triple AIM (Access/Service Provision, Consumer Response, Cost Containment)

20.  Funding- Lets Talk About Money… ◦ Corporate Structure  For Profit vs. Non Profit ◦ Making Money vs. Finding Money  Income Generating Options  Fee For Service  Sponsorships  Grant Options  Governmental  Foundations/Charities  Donors

23.  Types of Programs- Breakout Discussion ◦ Get into small groups ◦ Based on information you have heard today, using the assigned ACA category, think about what types of entrepreneur opportunities you can create in your communities. ◦ Pick one idea as a group and discuss how you might make that happen.

24. The Social Work Reinvestment Act (SWRA): Why we should support it… SWRA will fund demonstration grants to address relevant, “on the ground” realities experienced by our nation’s social workers. These competitive grant programs will prioritize activities in the areas of workplace improvements, research, education and training, and community-based programs of excellence. This investment will be returned many times over both in support of ongoing efforts to establish the most effective social work solutions and in direct service to the growing numbers of individuals, families, and communities in need. http://www.socialworkreinvestment.org/Default.aspx

25.  Final Questions  Website for Handouts and other resources www.rgpatrick.com