RECOMMENDED ACTIONS FOR HEALTH CARE REFORM IN ALASKA Kenneth W. Kizer, MD, MPH Alaska State Hospital and Nursing Home Association Fairbanks, AK September 9, 2010

2 Panel Objective To consider some preferred strategies and actions for health care reform in Alaska.

3 Foundational Assumptions and Beliefs 1.To be successful, health care reform must address the root cause problems – not just the symptoms. (Some of these problem may be external to the health care sector.) 2.The disproportionate growth of health care spending is not sustainable, and thus, maintaining the status quo is not a realistic option. 3.The PPACA will significantly increase demand for health care services, but is less likely to significantly “bend the cost curve” in the next 10 years. 4.The federal government will become a larger purchaser of health care in Alaska at the same time that it must become much more aggressive about controlling the rate of growth in government health care spending.

4 Foundational Assumptions and Beliefs 5.Achieving the desired degree of coordination of services and quality improvement will require much greater collaboration between and among providers. 6.Implementation of PPACA’s delivery system change and cost control strategies will require a robust supporting infrastructure that includes many things, including IT, human capital management, joint decision making, a performance management system, strong clinical leadership, training, and effective governance. 7.The health care workforce problems, especially physician shortages, are likely to worsen in Alaska as the demand for health care services increases. 8.Expanded use of non-physician caregivers supported by organized systems of care utilizing HIT and other advanced technologies will be necessary.

5 Recommended Strategies 1.Be very clear about the problems that need to be fixed – i.e., what needs to be reformed. (PPACA includes an array of intended solutions that may or may not be the right ones for Alaska’s problems.) 2.Articulate a clear vision for health care reform in Alaska - and the values upon which it is based. 3.Build clinical leadership capacity in the state. 4.Plan for considerably expanded use of non- physician caregivers that are supported by organized of care utilizing HIT and other advanced technologies. 4.Plan for considerably expanded use of non- physician caregivers that are supported by organized systems of care utilizing HIT and other advanced technologies.

6 A Disruptive Innovation for the Health Care Workforce Problem….

7 The Doctor of Nursing Practice  The Doctor of Nursing Practice (DrNP/DNP) – a new type of independent licensed practitioner having prescribing and admitting privileges  Pioneered at Columbia University’s Advanced Practice Nursing project  1 year advanced didactic training and 1 year patient care residency after the Masters degree  Competency-based educational approach with heavy emphasis on chronic disease management skills  Columbia graduated first class of DrNPs in 2005  NBME offered first national certifying exam in 2008  >70 schools currently moving to accept DNP students

8 Recommended Strategies 5. Aggressively pursue efforts to align hospitals and their medical staffs. Alignment is taken to mean the intentional congruence of goals, priorities, structures and processes to achieve mutual benefit, and requires: Clearly defined expectations Clearly defined expectations A shared understanding of what is needed to accomplish the expectations and a coherent plan for doing so A shared understanding of what is needed to accomplish the expectations and a coherent plan for doing so A supporting infrastructure to operationalize the plan A supporting infrastructure to operationalize the plan A performance management system with performance measures linked to strategic goals A performance management system with performance measures linked to strategic goals

9 Panel….