Designing New Programs in Response to the Patient Protection and Affordable Care Act

Presented at:NASW/Texas 36th Annual State Conference

Rhonda G. Patrick, LCSW, MPA

Overview of the Patient Protection and Affordable Care Act (PPACA)

PPACA Post Supreme Court Decision PPACA Impact on Social Work Practice Defining Social Work Entrepreneurship Becoming a Social Work Entrepreneur Designing Programs in Response to PPACA

Using a Social Work Entrepreneurship Philosophy

Final Thoughts

Key Elements of Potential Interest to Social Work◦ Individual Mandate◦ Medicaid Expansion◦ Quality/Health Systems Performance◦ Prevention/Wellness◦ Long-term Care◦ Medicare◦ Workforce ◦ Community/School Health Programs◦ Trauma Care◦ Disaster Response◦ American Indians

Key Elements of the Supreme Court Ruling◦ Anti- Injunction Act

Not a tax, therefore not an issue◦ Constitutionality of Individual Mandate

The penalty is a tax and as such within constitutional rights of congress

◦ Severability Since mandate upheld, not an issue

◦ Medicaid Expansion Can’t require states, and if they refuse can penalize

by withholding current funding.

Types of Practice Arenas◦ Micro Social Work

Direct Care Services in Health and Behavioral Health Care and other Social Services

◦ Macro Social Work Policy Development and Analysis (Social, Economic,

Programmatic) Advocacy Program Design Development- Funding HR- Workforce Development &

Benefits/Compensation Compliance/Accountability IT- EMR and Information Management Systems

What the Experts Are Saying◦ Robyn Golden- Rush University Medical Center

Fragmentation Move from episodic acute care to incentivized

comprehensive care Care Coordination Model Medical Homes Workforce Development

What the Experts Are Saying◦ Social Work Today

Expansion of home and community based services Chronic disease prevention Wellness programs Workforce development Increased access by more people Integration of health and behavioral health CLASS- Keeping elders in community Community and Consumer Education

What the Experts Are Saying◦ CSWE

Workforce Expansion and Development Healthcare Coordination Prevention and Wellness Community and Family Health Research Aging Needs

What the Experts Are Saying◦ NASW

Parity Prevention Voluntary Medicaid Expansion Health Exchanges (Collins 2012)

What Others Are Saying◦ Workforce Organizations

Physicains Nurses Allied Health Care Professionals

◦ Social Work Education Focus on Workforce Expansion (Very Conservative) Fairly Quite Considering- Nursing

◦ Think Tanks 250,000-400,000 a year this decade

What is an entrepreneur?◦ An entrepreneur is an enterprising individual who builds capital

through risk and/or initiative.◦ 1964: Peter Drucker: An entrepreneur searches for change, responds to

it and exploits opportunities. Innovation is a specific tool of an entrepreneur hence an effective entrepreneur converts a source into a resource.

◦ 1971: Kilby: Emphasizes the role of an imitator entrepreneur who does not innovate but imitates technologies innovated by others. Are very important in developing economies.

◦ 1975: Albert Shapero: Entrepreneurs take initiative, accept risk of failure and have an internal locus of control.

◦ Joseph Schumpeter (1930): An entrepreneur is a person who is willing and able to convert a new idea or invention into a successful innovation. Entrepreneurship is the pursuit of opportunity without regard to resources currently controlled.◦ New Products◦ New Product Methods◦ New Markets◦ New Forms of Organizations

◦ The capacity and willingness to undertake conception, organization, and management of a productive venture with all attendant risks, while seeking profit as a reward.

What is a Social Work Entrepreneur?◦ There is no definition.◦ Social Worker- Social Justice and Human Rights

Perspective◦ Change Agents/Action Oriented/Relationship

Focused

Can one be a Social Work Entrepreneur?◦ Reconciliation of the relationship between profit

and caring.◦ How do we define profit?◦ Individual shift◦ Profession shift

A social work entrepreneur is a social worker with the capacity and willingness to undertake conception, organization,

and management of a productive venture, without regard to resources currently controlled, while seeking profit as a reward to create new products, new

product methods, new markets, and new forms of organizations.

What are the knowledge, skills, and attitudes necessary to be a Social Work Entrepreneur?◦ The capabilities of innovating, introducing new

technologies, increasing efficiency and productivity, or generating new products or services, are characteristics of entrepreneurs. Entrepreneurs are catalysts for economic change. Research has found entrepreneurs to be highly creative with a tendency to imagine new solutions by finding opportunities for profit or reward.

A social entrepreneur is motivated by a desire to help, improve and transform social, environmental, educational and economic conditions. Social entrepreneurs seek to develop innovative solutions to global problems that can be copied by others to enact change.

A serial entrepreneur is one who continuously comes up with new ideas and starts new businesses. In the media, the serial entrepreneur is represented as possessing a higher propensity for risk, innovation and achievement.

A lifestyle entrepreneur places passion before profit when launching a business in order to combine personal interests and talent with the ability to earn a living. A lifestyle entrepreneur intentionally chooses a business model intended to develop and grow their business in order to make a long-term, sustainable and viable living working in a field where they have a particular interest, passion, talent, knowledge or high degree of expertise.

A cooperative entrepreneur doesn't just work alone, but rather collaborates with other cooperative entrepreneurs to develop projects, particularly cooperative projects. Each cooperative entrepreneur might bring different skill sets to the table, but collectively they share in the risk and success of the venture.

Key Philosophy… NEVER CHASE MONEY!!!◦ Design Sound Programs First- The money will

follow. Be willing to put in the time… “you get out

what you put in” Starting from scratch or redesigning

existing programs?◦ Benefits of Starting From Scratch◦ Risk of Starting From Scratch◦ Benefits of Redesigning◦ Risk of Redesigning

Basic Program Design Format◦ Preliminary Steps- Immersion

Needs Assessment◦ Using Logic Models- Organizing and Prioritizing the

Information◦ Identifying Social Problems

Social Condition vs. Social Problems◦ Selecting the Appropriate Intervention Strategy

Using Evidence Based Practice Political Economy

◦ Setting Goals and Objectives◦ Evaluating

Triple AIM (Access/Service Provision, Consumer Response, Cost Containment)

Funding- Lets Talk About Money…◦ Corporate Structure

For Profit vs. Non Profit◦ Making Money vs. Finding Money

Income Generating Options Fee For Service Sponsorships

Grant Options Governmental Foundations/Charities Donors

Types of Programs- Breakout Discussion◦ Get into small groups◦ Based on information you have heard today,

using the assigned ACA category, think about what types of entrepreneur opportunities you can create in your communities.

◦ Pick one idea as a group and discuss how you might make that happen.

The Social Work Reinvestment Act (SWRA): Why we should support it…

SWRA will fund demonstration grants to address relevant, “on the ground” realities experienced by our nation’s social workers. These competitive grant programs will prioritize activities in the areas of workplace improvements, research, education and training, and community-based programs of excellence. This investment will be returned many times over both in support of ongoing efforts to establish the most effective social work solutions and in direct service to the growing numbers of individuals, families, and communities in need.

http://www.socialworkreinvestment.org/Default.aspx

Final Questions Website for Handouts and other resources

www.rgpatrick.com