Looking At Articulation Through a New Lens: Opportunities and Obligations Oklahoma Articulation...

Looking At Articulation Looking At Articulation Through a New Lens: Through a New Lens:

Opportunities and ObligationsOpportunities and Obligations

Oklahoma Articulation SummitNovember 1, 2010

Katherine Vestal PhD, FAAN, FACHE

True Confessions…

3x5 Card for My Talk

• Setting Context: Define what is articulation, what are the needs and challenges for articulation, and give some thoughts on how we pursue articulation.

• Understanding Drivers. Describe how Healthcare Reform will drive needs for enhanced, effective articulation.

• Confirming a Tool. Discuss the role healthcare education can have on enhancing articulation.

• Moving Forward. Develop a “first crack” at a blueprint for action.





The Different Lenses of Reality:Each has a Unique Point of View

• The lens of the educators and institutions• The lens of legislators and government• The lens of healthcare provider organizations• The lens of payer organizations• The lens of the public and recipients of services• The lens of the professions/providers• The lens of economic realities

The Challenge: We are Not Always Speaking the Same Language

But What if We Did? And How Do We Get There?

Understanding Articulation

Articulation refers to the process of comparing the content of courses that are transferred between educational institutions . In other words articulation is the process by which one institution matches its courses or requirements to coursework completed at another institution. Students use course articulation to assure that the courses they complete will not have to be repeated at the institution to which they are transferring. Course articulation can be done on an ad hoc basis, or pursuant to existing course-to –course comparison data, or based on formal articulation agreements.

What We Should Agree On…

• We must have a well educated workforce in the numbers needed for the state

• Demand for all providers in the healthcare workforce will dramatically increase by 2025

• Competencies for care providers will expand and increase due to population needs

• Educational capacity must increase by finding new ways to fund, and provide clinical and other learning experiences

What We Should Agree On….

• Financial burdens for students and lack of efficient and effective articulation must be resolved

• Measuring work experience and testing for competencies is not consistent nor predictable

• Increasing shortages of workers and faculty may find some solutions through better articulation

• Articulation between public and private programs, and multi-regional programs is especially difficult

Current Issues and Obstacles

• Within a single education system the articulation of prescribed courses is usually more coordinated

• Students attempting to articulate often repeat a lot of course and clinical work

• Regents and institutional policies may impede articulation

• Universities may not recognize tech center credits• Allied health professions and nursing all have so many

levels that it is hard to articulate even within the professional groups

Questions to be Answered…

• How can education and delivery settings work together to support training and articulation of education programs?

• How do we start earlier to promote the health professions to K-12 students and prepare for their new learning expectations?

• How can newer technologies and non-traditional educational resources be utilized for clinical education?

• How can we ensure upward career preparation and mobility to support the workforce demands?

Questions to be Answered• What are the unique articulation issues by each

profession and how will those be resolved?• What are the common articulation issues and how will

they be leveraged for resolution?• Who has the decision making power? Who has input?

Who has a veto?• How will the blueprint for action be developed?• How will the time frames be set?• How will progress- to- plan be measured ?• Are there consequences for success or lack of success

in implementing the plan?

The Lens of the Healthcare Industry

• The healthcare providers are grappling with current clinical and economic pressures

• They are planning for the implementation of healthcare reform with all of its ramifications

• All plans are influenced by the economic realities and the need to find solutions that will ensure future sustainability

Given Health Reform …How Can We Predict Future Needs?

• Health professions workforce is very clinically diverse and reflects the economic vitality of a region and the needed numbers are staggering

• Preparing the next generation of providers must include nurses, doctors, dentists, therapists, imaging and laboratory experts, respiratory therapists, speech and nutritional professionals, and many others

• Faculty for all disciplines must be available

Healthcare Reform 2010

This was historic legislation that has massive changes in it

The strong and varied reactions were to be expected

Health Reform Legislation

Look at the environment for the last historic changes in health financing:

- Medicare - Medicaid

Past Health Legislation

• The bill is far from perfect, but it is a major first step for:

• The American people• The American economy• Health care providers

• None of the above could tolerate continuing with our current system

The Patient Protection and Affordable Care Act

• Insurance reforms• Increased coverage• Insurance exchanges• More Medicaid eligibility – 100% Federal

• Improved Medicaid physician compensation

What is in it for The American People and their Caregivers?

• CLASS Act• Insurance mandates• Opportunities for demonstrations:– IT– Malpractice– Care integration– Quality

What is in it for the American People and their Caregivers?

• MEDPAC to IMAC• Does coverage happen?• More Medicaid vs. No pay• Insurance company responses• Transparency and accountability requirements• Medicare penalties• Fraud and abuse monitoring• Disproportionate share cuts

Challenging Issues from Reform

Key Drivers for Health Care Reform

Reform expands Government into all aspects of the Health Care industry

Health Care Reform Implementation Timeline

• Slow growth, deteriorating payer mix, reduced reimbursement and local battles for market share

• Payers scramble to manage risk profile of insured and increase rates• Physicians accelerated move to employment (large multispecialty

clinics and hospitals)• Weaker hospitals weaken further and/or are consolidated• IT, Clinical Quality programs, strong balance sheets, and physician

referral channels enable strongest health systems to grow and manage change


• Rapid coverage expansion occurs, led by Medicaid• New federal money = demand growth• Hospitals reliant on DHS (disproportionate share) funding suffer• Capacity constraints emerge – primary care, ED, discretionary specialty

services• Insurance market evolves toward regulated public utility model• Employers >50 employees must provide insurance or pay a penalty (in

Mass. they provide it)• Employers >200 employees must provide insurance


• Budget pressures drive rate regulation, risk shifting and increased government involvement

• Capacity constraints drive innovation – e-visits, use of physician extenders, alternative medicine, etc

• Hospital and insurer payment rates become public record• New payment structures (bundling, ACOs) reward performance

across the system of CARE• Sophisticated health systems able to thrive in a more regulated,

budget-driven market


• ACOs will be run by large well-capitalized hospital systems (with a few large multispecialty clinic exceptions )

• Academic Medical Centers will need to partner with large hospital systems (symbiotic)

• Ins. Companies will sell underwriting and claims management services to providers

• ACOs will start with Medicare then go commercial

Successful Care Delivery Model

In addition to new rule-making authority and regulatory oversight for providers and employers, there are issues that remain unaddressed:

•32 million Americans insured, but by 2019 CBO projects 22M Americans will remain without coverage – primarily illegal immigrants (Supports some Exempt Status)•Baby Boomers flip to Medicare, Uninsured convert to Medicaid and Insurance Exchanges, and Commercial cost shifting ends•Outcome: Capital constraints (invest in ambulatory not inpatient)•Physician payments increase for PFPs (10% for Medicare and Medicaid mandated to reimburse at Medicare rates) but CBO cost estimates still include significant reductions in physician reimbursement (routinely deferred)•True cost reductions, quality improvements and efficiencies will come from implementation of pilots (ACOs, Insurance Exchanges, Demonstration Projects, etc)•Increased oversight and bureaucracy (3 year review of exempt status)

Key Challenges of Health Care Reform

Incomplete Picture

Likely Implications

• Consolidation in the markets to Sophisticated Integrated Delivery Systems

• For every Kroger and Delta, you will have a Whole Foods and Southwest

Healthcare Reform Will Stimulate Innovation

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We Cannot Afford to Fail….

The Lens of the Educational System

The Lens of Healthcare Education• Need to expand capacity to educate the healthcare workforce• It is not just about shortages but rather sustainability• It is about the optimally prepared providers in the workforce• Will need diverse state level partnerships• Requires a state wide clinical placement system that is both

centralized and electronic..• Requires the use of technology for simulation learning but to what

extent?• Utilization of Virtual health care facilities ( second life)• Bringing the business and delivery community to develop

integrated plans with broad coalitions to build alliances• Building on the strengths of community college education as a

gateway to the 4 year programs and graduate education• Customizing of rural and urban education needs and resources

Nursing Education: Is there a Radical Road to Transformation

• Currently 3 routes to RN with one licensing examination• Education makes a difference in how nurses practice• All entry at BSN with MS at 10 years(Carnegie Foundation/Benner)• California collaboration between 2 and 4 year programs• Pennsylvania program to increase BSNs• AONE practice and education partnership• National Advisory Council on nurse education policy advisors to

increase BSNs to 2/3 ( now 47%)• Over 600 RN-BSN articulation agreements to prepare nurses at the

BSN level• Many statewide articulation agreements • Is this really radical??? Radical enough??

Is This the Goal for Oklahoma?• Development of a statewide plan for nursing and allied

health education that would result in an articulated statewide system permitting entry and exit of personnel at a variety of levels and improving inter-institutional efforts to share educational resources. The groups cluster into at least seven disciplinary clusters ... nursing, clinical laboratory, dental auxiliaries, dietetics/nutrition, rehabilitation therapies, radiological science and respiratory therapy programs (and maybe more). There must be Articulate models in each discipline with signed transfer agreements, development of model and core curricula, design for graduate follow up, manpower models , and cooperation among disciplines. No more ad hoc evaluations…written agreements are known in advance

Doing the Impossible: The New Hoover Dam Bridge

• And they said it couldn’t be done……

Challenges to Execution of the Bridge

• Requires agreements between 2 states• Agreement on a burning platform• Appropriation of a lot of money• Cross disciplinary expertise with research expertise

to partnering on a new bridge that had never been done before

• Need a comprehensive planning strategy• Vital for transportation, water, and vitality of several

states

A Call to Action: A Blueprint for Execution

• What should the new world be?• What is the real gap?• How Motivated are we to complete tasks?• What Resources are needed to move forward?• How can we Mobilize the multiple factions?• What are the key policy issues?• Strategies to move forward and act…fast

Blueprint Will Be A Complex Grouping of Inter-Related Activities

The Blueprint will be Made Even More Complex as We Truly Move Forward

So Why Must We Complete the Picture?

… Because We Cannot Afford to Fail

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Looking At Articulation Through a New Lens: Opportunities and Obligations Oklahoma Articulation...

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