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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