Post on 06-Apr-2018
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APAMSA 2011National Conference
Prescription for Change
Alic e Hm Chen, MD, MPH
Assoc ia te Professor of Medic ine
UCSF/ San Franc isc o Genera l Hosp ita l
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CCHITEHR
VALUE-BASED
PURCHASING
BUNDLED
PAYMENTS
DONUT
HOLE
INDIVIDUALMANDATE
MEDICAL
LOSS
RATIOS
ESSENTIAL
HEALTH
BENEFITS
HEALTHEXCHANGES
PREMIUM
CREDITS
CER
HIGH
RISK
POOL
MEDICAIDEXPANSION
DEPENDENT
COVERAGE
TEACHINGHEALTH
CENTERS
HITECH
ARRA
ACA
A New Voc abula ry
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Pub lic Knowledge
0 5 10 15 20 25
0123
4567891
22
6 10
1623
1714
83
1
% Americans who got theright answer
Numbe
rofcorrectanswers
Pop Quiz: Assessing Am ericans Familiarity with theHea lth Ca re Law, Kaiser Family Found a tion, Feb rua ry 2011
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Overview
The p resent: ac c ess, c ost, qua lity
The future: hea lth reform
Opportunities for physic ian leadership
Words of advic e
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200846.3 million (15.4%)
200950.7 million (16.7%)
200745.6 million (15.3%)
Access
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Cost
hea lth-care c osts are the key to our fisc a l future. Peter Orzag,Direc tor of the White House Offic e of Ma nagement a nd Budget
Hea lth Care Costs 101, Ap ril 2010Ca lifornia HealthCa re Found ation
2008 $2.3 trillion
16.2% GDP
2010(p ) $2.5 trillion17.3% GDP
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Quality
1 Singapore 2.312 Bermuda 2.463 Sweden 2.754 Japan 2.79
5 Hong Kong 2.926 Macau 3.22
https:/ / www .c ia .go v/ lib rary/p ublica tions/ the-world -fac tbo ok/ rankorder/2091rank.html
40 Taiwan 5.3541 Isle of Man 5.3742 Italy 5.5143 European Union 5.7244 Cuba 5.8245 United States 6.26
Infant Morta lity (dea ths per 1,000 live b irths)
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ACCESS
QUALITY COST
ACCESS
Iron Triangle to Trip le Aim
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Key Hea lth Reform Provisions
Insurance companiesc annot turn aw ay pa tientswith med ica l cond itions or
take a wa y medic alc overage a fter someonebec omes sic k
No a nnua l or lifetime limitsto insurance c overage
Child ren can sta y on the irparents insuranc e until 26
Inc entives for p rimary care
32 million peop le who a rec urrently uninsured will ha veinsurance
Everyone is required to havehealth insurance
Businesses must providehea lth insuranc e for their
emp loyee s, or else p ay intoa poo l
Doc tors and hosp ita ls will bepa id on q ua lity, not q uantity
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10/20CHCF Me d i-Ca l Fac ts and Figures Sep tember 2009
Universal Medicaideligibility for
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Medicaid Eligibility for Work ing Parents byIncome, January 2009
IL
CT
ME
NY
NH
MA
VT
PANJ
RI
AZ
WA
WY
ID
UT
CO
OR
NV
CA
MT
HI
AK
NM
MNND
IA
WIMI
NE
SD
MOKS
OHIN
IL
AR
MS
LA
KY
TNNC
VA
WV DE
MD
DC
SCOK
GA
TX
FL
AL
50-99% FPL (20 states)
100% + FPL (18 states including DC)
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HITECH
$27 b illion
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Opportunities: Cred ib ility
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Opportunities:
Community Partnerships
2.3 million Ca lifornians with sub sidies65% peop le o f color
32% limited Eng lish speaking
1.6 million Ca lifornians with Med ica id79% peop le o f color51% limited Eng lish speaking
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Opportunities: Leadership
All of the g rea t lea dershave had onec ha rac teristic inc ommon: it was the
willingness to c onfrontunequivoc a lly the ma joranxiety of the ir peop le intheir time. This, and notmuc h e lse, is the
essenc e of leadership .- John KennethGalbraith, The Age ofUncertainty
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Some Ad vic e
Read w idely
Lea rn anothe r language
Understa nd the b ig p ic ture
Hone your communic a tion skills
Work c ollabora tive ly, c ollec tive ly
Be the best c linic ian you c an be
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Some Ad vic e
Cha nc e favors only theprep ared mind . (LouisPasteur )
Hard work
Attention to deta il
Hard work
Ma stering c ontent
Hard work
Communica tion skills
Hard work
Cha rac ter, not c irc umstance,makes the person. (Booker T.Washington)
Charac ter c ounts Integrity
Reliability
Perseverance
Dedication
Selflessness
Excellence
Patience
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Some Ad vic e
Mentoring is a b ra in to p ic k, an ea r to listen, and apush in the right d irec tion. (John C. Crosby)
Make them want to mentor you.
Be prep ared , be engaged
Be p roac tive, show initiative
Be a p rob lem-solver, not a p rob lem -maker
Seek a d iversity o f mento rs, role models, peer support
Remember to mentor!
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Some Ad vic e
The va lue of ident ity ofc ourse is tha t so often w ith itc omes purpose. (Ric hardGrant)
Know yourself.
Pay a ttention to wha tma kes you exc ited , makesyou wa nt to go the extramile, makes you fulfilled .
It s OK if your family wantsyou to go into med ic ine aslong as in the end, you wantto, too .
Life is a journey, not adestination. (Ra lphWaldo Emerson)
It s OK to ta ke timeoff dep end s onwha t you do, how youuse it.
Remember to ha vefun.
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Last Words
The purpose of life is to be useful, tobe responsib le, to be honorab le, to
be c ompassiona te . It is, a fter a ll, tomatter: to c ount, to stand for
something, to have made somed ifference that you lived a t a ll.
- Leo Rosten