The Future of Health Care in Pennsylvania Event – September 22, 2009 Developing Leaders in Health Care Quality and Safety Information on Health Care Reform in PA

The Future of Health Care in Pennsylvania Event – September 22, 2009 Developing Leaders in Health Care Quality and Safety Information on Health Care Reform in PA The American Recovery and Reinvestment Act of 2009: at the PA State Level On February 17, 2009, Obama signed into law the American Recovery and Reinvestment Act of 2009 or Stimulus Plan The state of Pennsylvania is receiving approximately $16 billion from this plan $4 billion has been specifically set for healthcare http://recovery.pa.gov/portal/server.pt/ http://recovery.pa.gov/portal/serve r.pt/ Key Facts about Health Care Reform in PA Prescription for Pennsylvania (Rx for Pennsylvania) In January of 2007, Governor Edward Rendell released Pennsylvania’s health care reform tactic – Prescription for Pennsylvania This plan consists of a set of integrated and practical strategies to increase the competitiveness of Pennsylvania businesses and the health and well-being of residents The hope is also for it to expand access to affordable health care coverage, improve the quality of care our residents receive and to get health care costs under control for employers and employees Rx for Pennsylvania focuses on three areas: affordability, access, and quality – all factors that drive costs in PA On average $7.6 billion per year is spent in Pennsylvania due to prolonged hospital stays because of either lack of chronic care management, never events, readmissions, or hospital-acquired infections Rx for Pennsylvania’s aim is to tackle and 900200.00001/11920453v.1 diminish these costs by establishing such plans as chronic care, Pay for performance, Healthcare workforce aid, and Pennsylvania Health Information Exchange (http://www.gohcr.state.pa.us/prescription-for-pennsylvania/Rx-for-Pennsylvania.pdf) Chronic Care Initiative In May 2007 the Pennsylvania Chronic Care management, reimbursement, and cost reduction commission was created under Rx for Pennsylvania According to the executive Summary of the commission’s strategic plan, Chronic disease patients account for 80% of all health care costs and hospitalizations, 76% of all physician visits and 91% of all filled prescriptions In 2005, the costs related to hospitalizations due to chronic diseases were well over $1 billion dollars www.RxforPA.com Chronic care management is an issue for both patients who are ill informed about living with their condition and providers who are often poorly compensated by insurers, third party administrators, and the government’s reimbursement models The chronic care initiative in Pennsylvania is a combination of the Edward H Wagner, M.D., M.P.H., chronic care model, and the patient-centered medical home model, that gives caregivers incentives for managing their patients’ chronic diseases and hiring more staff, as well as making patient education more accessible The plan is slowly being implemented in stages across the state, starting in the Southeastern region, and is focused on diabetes and pediatric asthma Currently, in the programs first year, Philadelphia Inquirer reports that, out of the 32 practices enrolled in the program, 44% of the 15,000 diabetic patients they treated achieved better blood sugar levels, up 10% from last year As this program continues to progress there is expected to be 400 primary care providers covering 750,000 patients ( http://www.philly.com/inquirer/front_page/20090516_Pa health-care_innovation_shows_results.html, http://www.gohcr.state.pa.us/prescription-for-pennsylvania/Rx-for-Pennsylvania.pdf, http://www.gohcr.state.pa.us/prescription-forpennsylvania/Rx-for-Quality.pdf) Pay For Performance Prior to the push of Rx for Pennsylvania, the health care payment systems in place did not focus on high quality evidencebased healthcare deliverance According to Rx for Pennsylvania documents, health care payment systems were set up in a way that allowed for: 900200.00001/11920453v.1 • • • • Under Fee-for-Service, the more doctor visits reported, the more doctors earn Hospitals are paid for treating hospital-acquired infections (HAIs), which are avoidable Health care providers are paid for “Never Events” (operating on the wrong limb, the wrong patient, leaving foreign objects in a patient after surgery, etc.) and then are paid to remediate the situation Health care providers who provide excellent, efficient, evidence-based care may receive less compensation than those who provide excessive and potentially harmful care Under Rx for Pennsylvania, payment systems shift to a pay for performance model, where physicians are given incentives to give quality care by following evidence based standards and procedures and not paying for medical errors and poor quality care (http://www.gohcr.state.pa.us/prescription-for-pennsylvania/Prescription-for-Pennsylvania.pdf) Pennsylvania Health information Exchange (PHIX) According to the executive order signed by Governor Edward Rendell on March 2008, the purpose of the PHIX governance structure is to perform activities necessary to develop, implement, and manage a statewide health information exchange and other health information technology initiatives within the Governors Prescription for Pennsylvania Having a centralized location for patient information will allow physicians to access, recent laboratory tests, radiology exams, hospital discharge notes and medications prescribed, allowing them to make more quality decisions and keeping them from ordering duplicative tests that may have been recently preformed, thereby reducing costs (http://www.state.pa.us/papower/cwp/view.asp?A=11&Q=472622&tx=1, http://www.rxforpa.com/assets/pdfs/PHIX.pdf) Health systems Industry The average age of both physicians and nurses in Pennsylvania is almost 50 years of age This shows that Pennsylvania healthcare workforce is comprised of mostly older Americans In urban counties, there are 2.35 physicians per 1,000 residents and in rural counties; the ratio is 1.37:1,000 There is also an apparent skew of diversity within the current healthcare workforce 900200.00001/11920453v.1 (http://www.gohcr.state.pa.us/prescription-for-pennsylvania/Prescription-for-Pennsylvania.pdf) Biosciences Industry Pennsylvania is considered a national leader in the Biosciences sector Pennsylvania Bio reports that: Total Bioscience Industry (Including biotech, pharma, device, diagnostic, contract research, laboratory equipment, etc.): • • • • • 77,413 employees 339,439 total employment impact (4.38 multiplier) 1,736 establishments $5.9 billion in total wages Average employee salary of $76,306 Drugs and Pharmaceuticals • • • 22,298 employees 111 establishments Average employee salary of $98,070 Medical Device and Diagnostics • • • 20,446 employees 598 establishments Average employee salary of $54,341 Research, Testing, and Medical Laboratories • • • 32,855 employees 967 establishments Average employee salary of $75,575 Agricultural Feedstock and Chemicals • • • 1,814 employees 60 establishments Average employee salary of $69,580 NIH Funding FY 2008: Approximately $1.34 billion Two Pennsylvania universities are in the top 10 nationally: • • University of Pennsylvania University of Pittsburgh 2007 VC Funding: $787 million In the Biosciences sector the greater Philadelphia region ranks second nationally, as stated by the 2009 Milken Institute Report According to Pennsylvania Bio, this is due largely impart to the southeastern Pennsylvania region being a leader in bioscience innovation: 900200.00001/11920453v.1 • • • • • • Four general medical schools, a school of osteopathic medicine, two schools of dentistry, two schools of pharmacy, a school of veterinary medicine, a school of podiatry, and a school of optometry; The nation's finest concentration of leading medical/bioscience research institutions, including the University of Pennsylvania (#2 in the nation for NIH funding), Thomas Jefferson University, The Children's Hospital of Philadelphia, Temple University Hospital, The Wistar Institute, the Fox Chase Cancer Center, Hahnemann Hospital / Drexel University, which collectively have received more than $2.5 billion in National Institutes of Health to fund their research in 2005 In all, more than 20 universities and non-profit institutions were engaged in bioscience related research; An unparalleled center of bioscience business that is within an hour's train ride to the world's financial center in New York City and two hours to the U.S regulatory center in Washington, DC; A center for bioscience innovation within the heart of the nation's bio-pharma corridor - eight of the world's largest pharmaceutical companies are within a 50-mile radius of Philadelphia providing access to a deep talent pool and partners for our region's emerging biosciences companies; The critical business support systems required for a thriving bioscience industry, namely research parks, biotechnology incubators, business schools, contract research organizations, diagnostics and testing companies, and venture capital funds and strong public sector support; and High quality of life for families and a competitive cost of doing business, with stable real estate rates to help companies plan for growth (http://www.pennsylvaniabio.org/index.php?option=com_content&task=view&id=18&Itemid=20, http://www.pennsylvaniabio.org/index.php?option=com_content&task=view&id=1122&Itemid=337) Economic and Workforce issues In April 2004, Governor Edward Rendell created the Pennsylvania Center for Health Careers as an initiative of the Pennsylvania Workforce Investment Board This program was created to address the growing need for health care workers in Pennsylvania With the age of healthcare providers increasing, 40 years old being the average for physicians and nurses, something needs to be done to retain the younger workforce talent available who relocates or change jobs, known more commonly as the “Brain Drain” The PCHC report, The Retention of Health Care Workers in the Commonwealth, outlines the steps that have been taken to help drive the health care industry in Pennsylvania Currently: • • • Training programs have been established to teach frontline managers skills to be effective “chief retention officers” Close to 2,000 health care managers and leaders from 36 counties have completed supervisory and leadership development programs — “Improving Healthcare through Supervisory Development” and “Improving Healthcare by Building a Retention Culture” A two-day pilot program for frontline health care workers from the mid-state region, “Developing a Culturally Inclusive Workplace”, addressed the challenges of creating diverse, multi-generational work teams This program is being rolled out this summer and fall across Pennsylvania 900200.00001/11920453v.1 • Best practices for retention and other health care workforce challenges were shared during a conference, “Redefining Excellence: Pennsylvania’s Best Healthcare Practices,” held in March 2008 and attended by more than 200 nursing and health care leaders The report also mentions a set of recommendations given by PCHC”S Retention of Health Care Workers Working Group They include: • • • • • • Addressing organizational culture Addressing workers transition from education to work and advancement Ongoing staff development Ongoing leadership development Compliance with Regulations and professional codes of conduct Making Retention data available to health care organization throughout the commonwealth (http://www.paworkforce.state.pa.us/about/cwp/view.asp?a=471&Q=159512, http://www.paworkforce.state.pa.us/about/cwp/view.asp?a=471&q=152435) 900200.00001/11920453v.1 ... implement, and manage a statewide health information exchange and other health information technology initiatives within the Governors Prescription for Pennsylvania Having a centralized location for patient... nursing and health care leaders The report also mentions a set of recommendations given by PCHC”S Retention of Health Care Workers Working Group They include: • • • • • • Addressing organizational... address the growing need for health care workers in Pennsylvania With the age of healthcare providers increasing, 40 years old being the average for physicians and nurses, something needs to be done