2015 AH​​P Briefing Book - American Osteopathic Association

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November 19-21, 2015
FAIRMONT SCOTTSDALE PRINCESS
Thursday—November 19, 2015
Location: East Pool
6:30 PM
AHP Welcome Reception
John Becher, DO—President, American Osteopathic Association (AOA)
Friday—November 20, 2015
Location: Palomino 6 & 7
7:30 – 8:30 AM
Breakfast
8:00 AM
Opening Remarks
John Becher, DO—President, AOA
8:15 AM
Importance of Communication in Leadership
Alan Parisse—Leadership, Communication and Change Management Expert
Moderator: Pam Kolinski—President, Advocates for the American Osteopathic Association
9:15 AM
Pharmaceutical Pricing, Transparency and Access to Care
Robert McElderry—Regional Director of State Government Affairs, Purdue Pharmaceuticals
Robert Popovian—Senior Director of Advocacy & Professional Relations, Pfizer
Moderator: Ronald R. Burns, DO—Chair, AOA Department of Professional Affairs
10:15 AM
Break
This program is made possible through generous contributions from the AOA,
Purdue Pharma L.P., GlaxoSmithKline, Pfizer Inc. and the American Osteopathic Foundation.
10:30 AM
Building a Culture of Excellence
Robert Spector—Author of International Best Seller, The Nordstrom Way
Moderator: John Bulger, DO—President, American College of Osteopathic Internists
11:30 AM – 1:00 PM
LUNCH SESSION
Location: Palomino 6 & 7
12:15 PM
Addressing Our Evolving Profession
Valerie Bakies Lile, CAE —President, Society of Osteopathic Specialty Executives
David Walls—President, Association of Osteopathic State Executive Directors
Carisa Champion, OMS VI—Student Representative, AOA Board of Trustees
Johnny Dias, DO—Member, AOA Bureau of Emerging Leaders
Robert Juhasz, DO—Immediate Past President, AOA
William Mayo, DO— Chair, AOA Department of Educational Affairs
Moderator: Adrienne White-Faines—Chief Executive Officer, AOA
1:30 PM
Promoting Osteopathic Medicine and Advocating for Sound Health Policy
Amy Showalter—The Showalter Group, Inc.
Moderator: Shannon Scott, DO—President-elect, Arizona Osteopathic Medical Association
2:30 PM
Break
2:45 PM
Partnering for Public Health
Kenya McRae—Vice President, Research & Development, AOA
Moderator: Geraldine O’Shea, DO—Chair, AOA Department of Research and Development
3:30 PM
Delivering Healthcare Better, Faster, Cheaper
Joe Flower—Healthcare and Technology Futurist
Moderator: David Tannehill, DO – 2nd Vice President, Missouri Association of Osteopathic Physicians
and Surgeons
4:30 PM
Adjourn
This program is made possible through generous contributions from the AOA,
Purdue Pharma L.P., GlaxoSmithKline, Pfizer Inc. and the American Osteopathic Foundation.
Saturday—November 21, 2015
Location: Palomino 6 & 7
7:00 – 8:00 AM
Breakfast
7:45 AM
Advocating for Osteopathic Equivalency: Unifying Our Public Policy Voice
Anthony Dekker, DO—Physician, Northern Arizona VA Health Care System
John J. Kowalczyk, DO—President, Osteopathic Physicians and Surgeons of California
Ray Quintero—Senior Vice President, Public Policy, AOA
Moderator: Joseph Giaimo, DO—Chair, AOA Department of Governmental Affairs
8:45 AM
Lessons in Partnership and Leadership
Carey Lohrenz—First Female U.S. Navy F-14 Tomcat Fighter Pilot
Moderator: Michael K. Murphy, DO—Chair, AOA Bureau of State Government Affairs
9:45 AM
Break
10:00 AM
Addressing Physician Workforce Issues through State GME Funding
Kayse Shrum, DO—President, Oklahoma State University Center for Health Sciences
Nicole Heath Bixler, DO, MBA—President-elect, Florida Osteopathic Medical Association
Steven Bander, DO—Vice President, Texas Osteopathic Medical Association
Charlie Alfero—Director, New Mexico Primary Care Training Consortium
Moderator: Ernest Gelb, DO—Chair, AOA Department of Affiliate Relations
11:00 AM
Osteopathic Market Research and Messaging
Charlie Simpson—Chief Communications Officer, AOA
Sheridan Chaney, Director, Media Relations, AOA
Moderator: Joseph M. Yasso, DO—Chair, AOA Department of Business Affairs
11:40 AM
Closing Remarks
Joseph Yasso, DO— Chair, AOA Department of Business Affairs
11:45 AM
Adjourn
This program is made possible through generous contributions from the AOA,
Purdue Pharma L.P., GlaxoSmithKline, Pfizer Inc. and the American Osteopathic Foundation.
Advocacy for Healthy Partnerships
November 19-21, 2015
Fairmont Scottsdale Princess – Scottsdale, AZ
Attendee List
Charlie Alfero, MA, Executive Director, New Mexico Primary Care Training Consortium
Philip Atwood, Chief Information Officer, American Osteopathic Association
John Bailey, DO, 1st Vice President, Missouri Association of Osteopathic Physicians and Surgeons
Joel Baker, DO, Vice President, Iowa Osteopathic Medical Association
Valerie Bakies Lile, CAE, Executive Director, American College of Osteopathic Obstetricians and
Gynecologists
Steven Bander, DO, Vice President, Texas Osteopathic Medical Association
Terrance Barkan, CAE, Founder & Chief Strategist, GlobalStrat
John Becher, DO, President, American Osteopathic Association
Tim Bell, DO, Board Member, Tennessee Osteopathic Medical Association
Pamela Bennett, BSN, RN, CCE, Executive Director, Patient and Professional Relations, Purdue Pharma L.P.
Nicole Bixler, DO, MBA, FACOFP, President-elect, Florida Osteopathic Medical Association
Brian Bowles, Med, Executive Director, Missouri Association of Osteopathic Physicians and Surgeons
Devin Anna Bradford, Executive Director, Tennessee Osteopathic Medical Association
John Bulger, DO, President, American College of Osteopathic Internists
Ronald Burns, DO, Executive Committee of the AOA BOT MemberAmerican Osteopathic Association
Val Carr, Director, Executive Administration American Osteopathic Association
John Casey, DO, Co-Chair, Bureau of Emerging Leaders, BOT, New Physician Representative, American
Osteopathic Association
Carisa Champion, JD, OMS VI, Co-Chair, Bureau of Emerging Leaders, BOT, New Physician
Representative, American Osteopathic Association
Sheridan Chaney, Director of Media Relations , American Osteopathic Association
Alice Chen, DO, Advisor, Bureau of Emerging Leaders, American Osteopathic Association
Rajesh Chundu, OMS II, Student, Midwestern University - Arizona College of Osteopathic Medicine
R. Scott Cook, DO, President, American Osteopathic Academy of Sports Medicine
Greg Cox, DO, Legislative Committee, Missouri Association of Osteopathic Physicians and Surgeons
Alissa Craft, DO, MBA, Vice President, Accreditation, American Osteopathic Association
Kathleen Creason, MBA, Executive Director, Osteopathic Physicians & Surgeons of California
Victoria Damba, DO, Legislative Chair, Missouri Association of Osteopathic Physicians and Surgeons
Jeff Davis, DO, President-elect, Missouri Association of Osteopathic Physicians and Surgeons
Kevin de Regnier, DO, FACOFP dist, President, American College of Osteopathic Family Physicians
Joan DeCamp, Office Manager, New York State Osteopathic Medical Society
Anthony Dekker, DO, Physician, Northern Arizona VA Health Care System
Angela DeRosa, DO, MBA, CPE, Secretary/Treasurer, Arizona Osteopathic Medical Association
Johnny Dias, DO, Member, Bureau of Emerging Leaders, American Osteopathic Association
Anthony DiMarco, DO, President-elect, Pennsylvania Osteopathic Medical Association
Brian Donadio, DO, FACOI, Executive Director, American College of Osteopathic Internists
Samantha Easterly, OMS II, Student Chapter President, Midwestern University - Arizona College of
Osteopathic Medicine
Diana Ewert, MPA, CAE, Vice President, Affiliate Relations, American Osteopathic Association
Penny Fioravante, Executive Director, West Virginia Osteopathic Medical Association
Michael Fitzgerald, Executive Director, American Academy of Osteopathy
Joe Flamini, MBA, FACHE, Chief Operating Officer, National Board of Osteopathic Medical Examiners
Joe Flower, Speaker, Keppler Speakers
Jackie Freiberg, Speaker, Keppler Speakers
Rodney Fullmer, DO, MBS, Member Bureau of Emerging Leaders, American Osteopathic Association
Cathy Galligan, RN, MM, CPA, Chief Operating Officer, American Osteopathic Association
Ernest Gelb, DO, Executive Committee of the AOA BOT Member, American Osteopathic Association
Jennifer George, Membership & Communications, Texas Osteopathic Medical Association
Michael Geria, DO, Executive Vice President, American College of Osteopathic Obstetricians and
Gynecologists
Joseph Giaimo, DO, Executive Committee of the AOA BOT Member, American Osteopathic Association
Christine Giesa, DO, President-elect, American College of Osteopathic Emergency Physicians
Ellice Goldberg, DO, President-elect, Colorado Society of Osteopathic Medicine
Richard Goldberg, DO, Secretary/Treasurer, American Osteopathic College of Physical Medicine and
Rehabilitation
Lisa Gouldsbrough, DO, FAAP, President, Maine Osteopathic Association
Barbara Greenwald, Executive Director, New York State Osteopathic Medical Society
Donald Grewell, Executive Director, Montana Osteopathic Medical Association
James Griffin, DO, President, Rhode Island Society of Osteopathic Physicians and Surgeons
Samyuktha Gumidyala, Affiliate Specialist, American Osteopathic Association
DeGail Hadley, DO, President-elect, Mississippi Osteopathic Medical Association
Maria Harris, MS, Executive Director, Virginia Osteopathic Medical Association
Caleb Hentges, OMS II, Student Government President, Midwestern University - Arizona College of
Osteopathic Medicine
Breanne Hirshman, OMS III, National Chair, American Association of Colleges of Osteopathic Medicine
Robert Hostoffer, DO, President, Ohio Osteopathic Association
Carol Houston, BS, Executive Director, American Osteopathic College of Radiology
Jamie Hueston, Executive Director, Alabama Osteopathic Medical Association
Patricia Hunt, DO, Vice President, New York State Osteopathic Medical Society
Kathie Itter, Executive Director, Washington Osteopathic Medical Association
Lana Ivy, MBA, Executive Director, Oklahoma Osteopathic Association
Robert Juhasz, DO, Immediate Past President, American Osteopathic Association
Nathan Knackstedt, DO, President-elect, Kansas Association of Osteopathic Medicine
Pam Kolinski, President, Advocates for the American Osteopathic Association
John Kowalczyk, DO, President, Osteopathic Physicians & Surgeons of California
Kim Kuman, Administrative Assistant, American Osteopathic Association
Mario Lanni, DSc, Executive Director, Pennsylvania Osteopathic Medical Association
Michelle Larson CAE, CME, Associate Executive Director, Florida Osteopathic Medical Association
Jeffrey LeBoeuf, CAE, Executive Director, American Osteopathic College of Occupational and Preventive
Medicine
Cindy Lee, DO, Vice President, Alaska Osteopathic Medical Association
Herman Lee, OMS II, Student, Midwestern University - Arizona College of Osteopathic Medicine
Carey Lohrenz, Speaker, Keppler Speakers
Lisamarie Lukas, MS, Director, Reputation Management, American Osteopathic Association
Mimms Mabee, DO, MPH, AOCOPM, US Army, American Osteopathic College of Occupational and
Preventive Medicine
Robert Maurer, DO, Executive Director, American Osteopathic Society of Rheumatic Diseases
William Mayo, DO, Executive Committee of the AOA BOT Member, American Osteopathic Association
Sherry McAuliffe, MBA, CAE, Vice President, Client and Member Services, American Osteopathic
Association
Bob McElderry, Regional Director, State Government Affairs, Purdue Pharma
Kenya McRae, JD, PhD, Vice President, Research & Development, American Osteopathic Association
C. Clark Milton, DO, President, West Virginia Osteopathic Medical Association
Michael Murphy, DO, FACOFP, dist, Chair, Bureau of State Government Affairs, American Osteopathic
Association
Sean Neal, Director, OPAC, American Osteopathic Information Association
Kristin Nelson, DO, President, Arizona Osteopathic Medical Association
Donald Nelson, DO, President, American Osteopathic College of Pathologists
Doris Newman, DO, FAAO, President, American Academy of Osteopathy
Kris Nicholoff, JD, Executive Director, Michigan Osteopathic Association
Chelsea Nickolson, DO, MBA, Co-Chair, Bureau of Emerging Leaders, BOT, New Physician
Representative, American Osteopathic Association
Geraldine O'Shea, DO, Executive Committee of the AOA BOT Member, American Osteopathic
Association
Lorin Pankratz, Executive Director, South Dakota Osteopathic Association
Alan Parisse, Speaker, Keppler Speakers
Lee Parks, DO, Immediate Past President, Missouri Association of Osteopathic Physicians and Surgeons
Mark Pelikan, DO, President, Missouri Association of Osteopathic Physicians and Surgeons
Robert Popovian, PharmD, MS, Senior Director, US Government Relations, Pfizer Inc.
John Prestosh, DO, FACOEP, President, American College of Osteopathic Emergency Physicians
Sherri Quarles, Chief Operating Officer, Associate Executive Director, American Academy of Osteopathy
Ray Quintero, Senior Vice President, Public Policy, American Osteopathic Association
David Reynolds, Executive Director, Texas Osteopathic Medical Association
Janet Ricks, DO, President, Mississippi Osteopathic Medical Association
Stephen Scheinthal, DO, President, American College of Osteopathic Neurologists and Psychiatrists
Nicholas Schilligo, MS, Associate Vice President, State Government Affairs, American Osteopathic
Association
Peter Schmelzer, CAE, Executive Director, American College of Osteopathic Family Physicians
Martin Scott, DO, Board Member, American Osteopathic Society of Rheumatic Diseases
Shannon Scott, DO, President-elect, Arizona Osteopathic Medical Association
R. Taylor Scott, DO, Member, Michigan Osteopathic Association
Louisa Sethi, BA, Member, Bureau of Emerging Leaders, American Osteopathic Association
Steven Sherman, DO, MS, President, New York State Osteopathic Medical Society
Amy Showalter, Speaker, The Showalter Group, Inc.
Kayse Shrum, DO, President, Oklahoma State University Center for Health Sciences
Gregg Silberg, DO, Executive Director, Wisconsin Association of Osteopathic Physicians and Surgeons
Charlie Simpson, Chief Communications Officer, American Osteopathic Association
Robert Spector, Speaker, Keppler Speakers
James Swartwout, MA, Senior Vice President, Accreditation and Education, American Osteopathic
Association
David Tannehill, DO, 2nd Vice President, Missouri Association of Osteopathic Physicians and Surgeons
Frank Tursi, DO, Executive Committee of the AOA BOT Member, American Osteopathic Association
Lee Vander Lugt, DO, Executive Director, American Osteopathic Academy of Orthopedics
Norman Vinn, DO, Executive Committee of the AOA BOT Member, American Osteopathic Association
Janice Wachtler, BAE, CBA, Executive Director, American College of Osteopathic Emergency Physicians
David Walls, Executive Director, Osteopathic Physicians and Surgeons of Oregon
Michelle Walters, DO, President, American Osteopathic College of Radiology
Jeffrey Weaver, OD, Vice President, Certifying Board Services, American Osteopathic Association
Pete Wertheim, Executive Director, Arizona Osteopathic Medical Association
Susan Wesserling, MBA, Executive Director, American College of Osteopathic Neurologists and
Psychiatrists
Angela Westhoff, MA, Executive Director, Maine Osteopathic Association
Krystal White, MBA, Program Manager, Affiliate Affairs, American Osteopathic Association
Adrienne White-Faines, MPA, Chief Executive Officer, American Osteopathic Association
Ed Williams, PhD, Executive Director, Mississippi Osteopathic Medical Association, Louisiana Osteopathic
Medical Association
Reatha Williams, DO, President, Louisiana Osteopathic Medical Association
Robert Williams, MS, Executive Director, Kansas Association of Osteopathic Medicine
Jon Wills, Executive Director, Ohio Osteopathic Association
Stephanie Wilson, Executive Director, American Osteopathic College of Physical Medicine and
Rehabilitation
Marsha Wise, BS, Executive Director, American Osteopathic College of Dermatology
Laura Wooster, MPH, Vice President, Government Relations, American Osteopathic Association
Joseph Yasso, DO, Executive Committee of the AOA BOT Member, American Osteopathic Association
George Zimmerman, DO, President, American Osteopathic Academy of Orthopedics
Importance of …
Communication
in Leadership
Alan Parisse
MBA, CSP, CPAE
www.parisse.com
© 2 0 1 5 Alan J.
Parisse
17:1
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© 2 0 1 5 Alan J.
Parisse
17:1
www.parisse.com
© 2 0 1 5 Alan J.
Parisse
“Good Evening”
© 2 0 1 5 Alan J.
Parisse
Why Not
© 2 0 1 5 Alan J.
Parisse
“SNOW”
www.parisse.com
© 2 0 1 5 Alan J.
Parisse
1912
 Big League Baseball 1908 - 1916
 50 plus marriage
 2 daughters
 5 grandchildren
 Businessman, banker & rancher
 Councilman & Mayor
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
1974
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
www.parisse.com
© 2 0 1 5 Alan J.
Parisse
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© 2 0 1 5 Alan J.
Parisse
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© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
COSTS
HEALTH CARE
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
EXPANDING DEFINITION
WHAT OTHER …?
 2% Better - maybe
 $100X more
 Demand!
Tech. Advances
 Legal Issues
 Costs
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
EMPLOYERS
© 2 0 1 5 Alan J.
Parisse
AFFORDABLE CARE ACT
© 2 0 1 5 Alan J.
Parisse
FACILITIES
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
BOOMER BOOM
© 2 0 1 5 Alan J.
Parisse
TICKING
© 2 0 1 5 Alan J.
Parisse
@ 65 – 80% CHRONIC
 Hypertension
 Arthritis
 High Cholesterol
 Heart Disease
 Diabetes
 Cancer
© 2 0 1 5 Alan J.
Parisse
Cyber-Confusion
Cyber-Condria
© 2 0 1 5 Alan J.
Parisse
NOT JUST OLD
www.parisse.com
© 2 0 1 5 Alan J.
Parisse
17 to 24
75%
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
WHY?
 Obesity
 Drugs
 Booze
 Aptitude
www.parisse.com
© 2 0 1 5 Alan J.
Parisse
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© 2 0 1 5 Alan J.
Parisse
WHY THAT STORY?
www.parisse.com
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Parisse
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Parisse
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Parisse
ONE MORE CHALLENGE
www.parisse.com
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Parisse
ONE MORE CHALLENGE
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Parisse
THIS IS YOUR TIME!
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© 2 0 1 4 Alan J.
Parisse
BE LOFTY
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© 2 0 1 2 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
WHEN EXPERTS
AND LEADERS
DON’T SELL …
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Parisse
DON’T LISTEN
© 2 0 1 5 Alan J.
Parisse
WON’T TAKE MEDS
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Parisse
DEFINITION
WORD PROBLEM
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
DEFINITION
REST OF SELL
2. Give up property for valuable
consideration.
5. Persuade to a course of action.
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
REST OF SELL
1. Deliver or give up in violation of duty,
trust or loyalty.
REST OF SELL
3. Deliver into slavery for money.
To betray.
© 2 0 1 4 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
REST OF SELL
4. Dispose of or manage for profit …
REST OF SELL
6. Impose upon, deceive or trick.
instead of in accordance with justice
or duty.
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
OUR DEFINITION
OUR DEFINITION
Inspiring others to choose to do what
they ought to do …
Particularly when they …
are not inclined to do it.
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
ESTABLISH CREDIBILITY
www.parisse.com
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Parisse
HOW TO LITERATURE
 Building Trust
 Mentoring
 Coaching
 Collaborating
 Giving Credit Away
 Being Vulnerable
www.parisse.com
© 2 0 1 5 Alan J.
Parisse
NO ONE WAY
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
FLEXIBILITY
 Situation
 People
 Urgency
 Expectation
© 2 0 1 5 Alan J.
Parisse
© 2 0 1 5 Alan J.
Parisse
FOCUS
© 2 0 1 5 Alan J.
Parisse
PICK ONE
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Parisse
DIAGNOSE
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Parisse
LISTEN
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Parisse
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Parisse
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Parisse
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Parisse
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GETTYSBURG ADDRESS
© 2 0 1 5 Alan J.
Parisse
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Parisse
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© 2 0 1 4 Alan J.
Parisse
4 SECOND TEST
21994195141
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Parisse
2199 – 419 - 5141
© 2 0 1 5 Alan J.
Parisse
1492 – 911 - 1945
© 2 0 1 5 Alan J.
Parisse
1492
911
© 2 0 1 5 Alan J.
Parisse
1945
© 2 0 1 5 Alan J.
Parisse
YES BUT …
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© 2 0 1 5 Alan J.
Parisse
YEAH BUT!
© 2 0 1 5 Alan J.
Parisse
Chronic Pain in the U.S.
Institute of Medicine of the National Academies (2011)
ACCESS TO PAIN TREATMENT VS.
ABUSE OF PRESCRIPTION
MEDICATION
American Osteopathic Association
Advocacy for Healthy Partnerships
• Relieving Pain in America: A Blueprint for Transforming
Prevention, Care, Education and Research (2011)
• Estimated “about 100 million” adult Americans experience
chronic pain
• Estimated cost ranges between $560 – $635 billion
annually
IMS Institute for Health Informatics (2012)
Robert McElderry
• 241 million prescriptions for opioids
• ~75 million unique persons received an opioid prescription
• ~15-16 million persons on opioid analgesics at any given
time
Prescription Drug Abuse
• Prescription drug abuse is a major public health issue in
the United States.
• More than 2,000 teens begin abusing prescription drugs
each day.
• As many as 1 in every 5 teens in America say they have
taken a prescription drug that was not prescribed for
them.
ONDCP 2011 Plan
Epidemic: Responding to America’s Prescription
Drug Abuse Crisis
Research and Developmental Goals
• Expedite research and priority New Drug Application reviews
by FDA on the development of treatments for pain with no
abuse potential as well as on the development of abusedeterrent formulations of opioid medications and other drugs
with abuse potential (NIDA/FDA)
• Continue advancing the design and evaluation of
epidemiological studies to address changing patterns of abuse
(CDC/FDA/NIDA)
• Provide guidance to the pharmaceutical industry on the
development of abuse-deterrent drug formulations and on
post-market assessment of their performance (FDA)
http://www.whitehouse.gov/sites/default/files/ondcp/issues-content/prescription-drugs/rx_abuse_plan_0.pdf
Sources of Abused Drugs
People who abuse opioid analgesics report obtaining
them from a variety of sources.
Other source
7.1%
WA
ME
MT
ND
OR
Got from drug
dealer or stranger
4.4%
Took from friend or
relative without
asking 4.8%
Obtained free from
friend or relative
55%
Status of State Prescription Monitoring Programs
(PMPs)
MN
ID
NH
WI
SD
NY
MI
WY
PA
UT
CA
IL
CO
Bought from friend
or relative
11.4%
AZ
NJ
DE
MD
VA
KY
NC
TN
AR
SC
MS
Prescribed by one
doctor 17.3%
IN
MO
OK
NM
OH
WV
KS
MA
CT
IA
NE
NV
TX
AL
GA
LA
AK
FL
HI
CDC NCIPC. November 2011
VT
PMP existing & enacted legislation
States with enacted PMP legislation,
but program not yet operational
States with legislation pending
Public Policy Considerations
• Mandates for use of state PMPs
• Pain Clinic legislation/regulation
• Executive orders banning or limiting choice
• Pharmacy opioid dispensing limitations
• State regulated or legislated guidelines on prescribing
• CDC development of recommended guidelines
RI
CDC FUNDING HELPS STATES COMBAT
PRESCRIPTION DRUG OVERDOSE EPIDEMIC
Agency commits $20 million to advance prevention on multiple fronts
16 States are receiving grants:
• Enhancing prescription drug monitoring programs (PDMPs).
• Putting prevention into action in communities nationwide and
encouraging education of providers and patients about the risk of
prescription drug overdose.
• Working with health systems, insurers, and professional providers to
help them make informed decisions about prescribing pain
medication.
• Responding to new and emerging drug overdose issues through
innovative projects, including developing new surveillance systems or
communications campaigns.
What Can Industry Do
• New innovative technologies to address the ways in
which opioids can be manipulated and/or tampered are
being developed.
CDC: Understanding Epidemic
To help prevent prescription drug overdose, states can advance the
promising strategies below to ensure the health and wellbeing of their
residents.
• Consider ways to increase use of prescription drug monitoring
programs
• Consider policy options relating to pain clinics to reduce prescribing
practices that are risky to patients.
• Evaluate state data and programs and consider ways to assess
Medicaid, workers' compensation programs, and state-run health
plans to detect and address inappropriate prescribing of painkillers.
• Identify opportunities to increase access to substance abuse
treatment and consider expanding first responder access to naloxone.
• Implement and promote evidence-based opioid prescribing.
• Work with health care providers and other prescribers to ensure
appropriate opioid prescribing.
• Evaluate the impact of state opioid prescribing standards and update
them as needed.
Common Tampering Methods
and Routes of Abuse
Tampering Methods
Routes of Administration
(nonmedical use)
Katz N et al. Tampering with prescription opioids: nature and extent of the problem, health consequences, and solutions.
Am J Drug Alcohol Abuse. 2011; 37:205-217.
Opioid Abuse-Deterrent Properties
Formulation
Physical/Chemical
Barriers
Approved Opioid Analgesics with ADP*
Technology
•
•
Physical Barriers: can prevent chewing, crushing, cutting, grating, or grinding.
Chemical Barriers: can resist extraction of the opioid using common solvents like water,
alcohol, or other organic solvents.
Physical and Chemical Barriers: can change the physical form of an oral drug rendering it
less amenable to abuse.
•
Agonist/Antagonist
Combinations
•
•
Antagonist added to interfere with, reduce, or defeat the euphoria associated with abuse.
Antagonist may be sequestered and released only upon manipulation of the product.
•
E.g. Antagonist is not clinically active when the product is swallowed but becomes
active if the product is crushed and injected or snorted.
Aversion
•
Substances can be combined to produce an unpleasant effect if the dosage form is
manipulated prior to ingestion or a higher dosage than directed used.
Delivery System
(including depot
injectable formulations
and implants)
•
Certain drug release designs or the method of drug delivery can offer resistance to abuse.
•
E.g., sustained-release depot injectable formulation that is administered
intramuscularly or a subcutaneous implant can be more difficult to manipulate.
Prodrug
•
Lacks opioid activity until transformed in the gastrointestinal tract can be unattractive for
intravenous injection or intranasal routes of abuse.
Combination
•
Two or more of the above methods can be combined to deter abuse.
FDA Draft Guidance for Industry Abuse-Deterrent Opioids — Evaluation and Labeling. January 2013.
Formulation
Active Ingredients in Drug Products
Physical/Chemical • ER: hydromorphone; oxycodone; oxycodone + APAP;
Barriers
oxymorphone; tapentadol
Agonist-Antagonist • ER: morphine + naltrexone; oxycodone + naloxone
Combinations
• IR: buprenorphine + naloxone
Aversion
• --
Delivery System
• --
Prodrug
• --
Combination
• IR: oxycodone (physical) + aversive agent
* Not all have Abuse-Deterrence Label Claims
Alexander, L. et al. Development and impact of prescription opioid abuse deterrent formulation technologies. Drug Alcohol Depend. (2014),
http://dx.dio.org/10.1016.j.drugalcdep.2014.02.006 (2014)
Opioids with ADP in Development
2015 ADP Legislation
WA
Formulation
Physical/Chemical
Barriers
Active Ingredients in Drug Products
•
ER: hydrocodone; levorphanol; morphine; oxycodone;
oxymorphone; tapentadol
Agonist-Antagonist
Combinations
•
ER: oxycodone + naltrexone (sequestered)
Aversion
•
•
IR: oxycodone + aversive agent
IR: oxycodone + aversive agent + APAP
Delivery System
•
ER: hydromorphone
MT
MN
ID
Prodrug
ER: hydrocodone; hydromorphone
IR: hydrocodone; hydromorphone
Combination
•
IR: oxycodone (physical) + aversive agent
New Chemical Entity
•
•
MOR agonist with slow crossing of BBB
Non-opioid
“in Development,” as used here, includes drug substances or products that are the subject of preclinical development,
Investigational New Drug applications, New Drug Applications, or Abbreviated New Drug Applications
RI
PA
IL
CO
KS
OK
NM
WV
MO
KY
SC
AR
AL
GA
LA
AK
FL
HI
ADP Legislation Introduced
ADP Legislation Passed
ADP Study Bills
VA
NC
TN
MS
TX
OH
IN
NH
MA
CT
IA
UT
AZ
•
•
MI
NE
NV
NY
WI
SD
WY
CA
ME
VT
ND
OR
NJ
DE
MD
Summary
• Products with abuse deterrent properties will need to be
widely used to have a significant public health impact
• Abuse deterrent technologies are part of a
comprehensive intervention strategy to promote safe
prescription opioid use
•
Additional components including governmental,
community, and educational initiatives will need to be
addressed
• Public and private-sector policies should be
implemented that encourage the use of abuse-deterrent
products when appropriate, including the availability of
these products on drug formularies.
Evolution Needed to Preserve
Biopharmaceutical Innovation
Evolving the Discussion of
Pharmaceutical Pricing to a
Cost-Value Proposition
Price
Dr. Robert Popovian, Pharm.D., MS
Sr. Director, US Government Relations
Pfizer Inc.
Cost
Value
How Are Medicines Priced?
Evolution Needed to Preserve
Biopharmaceutical Innovation
Benefit
Insurance Coverage
how well it works
how safe it is
Budget Impact
how much it lengthens life
Price
Cost
Value
its side effects
Co-pay
its impact on quality of life
its impact on work productivity
other available treatments
Access to Patient Assistance
its potential to reduce health costs
Prices Reflect The Medicine’s Benefit, While Considering Affordability
4
Do Prices of Medicines Change Over Time?
Does Anyone Pay List Price for Their Medicine?
Prices and Discounts Change Over Time As More Is
Known About the Treatment and Alternatives
Commercial | Medicare Part D Insurers
• Price = discounts + fixed prices
• OOP = zero or copay or coinsurance
Learn how a medicine affects health over time
Other treatments become available
new indications,
Loss of patent
new formulations,
new medicines or
new patient
treatment
generic copies
populations
alternatives
ability to offset
generic alternatives
other costs
Public Payers
Medicaid
• Price = 23% rebate + discounts + CPI guarantees
• OOP = zero or copay
Insured Patient (87%)*
Private Payers
•Price = discounts + fixed prices
•OOP = copay or coinsurance
•May have access to manufacturer assistance programs
Uninsured Patient (13%)*
•Access to manufacturers assistance programs
5
Does Anyone Pay List Price for Their Medicine?
* Kaiser Family Foundation, “State Health Facts: Health Insurance Coverage of the Total Population.” http://kff.org/other/stateindicator/total-population/
6
Evolution Needed to Preserve
Biopharmaceutical Innovation
Price
Cost
Value
Are Biopharmaceuticals Bankrupting Patients?
Who is Being Impacted by Specialty Drugs Costs?
Will Biopharmaceuticals Bankrupt the US Economy?
What About the Expensive Oncology Medicines?
Spending on Cancer Medicines
Represents Less Than 1% of Overall
Health Care Spending
Cancer Medicines Represents
1/5 of Total Spending on Cancer
Treatment
Cancer Medicines as a Portion of Total
U.S. Health Care Spending, Billions, 2012
Total U.S. Cancer Care Spending, 2011
$2,800
billion
Total Health
Care Spending
$124 billion
IMS Institute for Healthcare Informatics, Declining medicine use and costs: for better of worse? A review of the use of medicines in the
United States in 2012. May 2013. And Martin AB, et al. National health spending in 2012: rate of health spending growth remained low for
the fourth consecutive year. Health Affairs, January 2014 (33):1, 67-77.
Inpatient
43%
Pharmaceuticals
20%
Other
Categories
37%
K. Fitch et al. “Benefit Designs for High Cost Medical Conditions.” Milliman Research Report. April 22, 2011. p. 11. .
16
How About Those Expensive Drugs
Being Development?
Cost Sharing Highest for Biopharmaceuticals
Medicare
Out of Pocket
Avalere study projects
that the 10 breakthrough
drugs currently in
developmental pipeline
will cost US government
nearly $50 billion over
the next decade = 0.38%
of Medicaid and
Medicare spending for
that period of time
http://avalere.com/expertise/managed-care/insights/thefuture-cost-of-innovation-an-analysis-of-the-impact-ofbreakthrough-the
Insurance Exchange “Silver” Plan
Total
Pharmacy
Hospital
40%
Professional/Other
72%
54%
19%
12%
Pharmacy
9%
Hospital
Actuarial Value
Impact of Health Insurance Marketplace on Participant Cost Sharing for Pharmacy Benefits, Milliman May 2014
National Health Expenditures 2014 and KFF Jul 2014, How much is enough Out of Pocket Spending for Medicare Beneficiaries
Evolution Needed to Preserve
Biopharmaceutical Innovation
Price
Cost
Value
Value of Medicine
71%
70%
Value of Medicines: Statins
Value of Medicines: Vaccines
Statin therapy has significantly reduced cardiovascular events in wide range of patients
Since the introduction of vaccines, many infectious diseases have virtually become
eradicated
559
Age-Adjusted Death Rate per 100,000
for Heart Disease
Social Health
Value
191
1960
1970
1980
1990
2000
2007
Economic
Value
Medicines Are The ONLY Healthcare Intervention
That Can Reduce Overall Costs
Potential Long Term
Solutions
Providing Access, Protecting Innovation
& Driving Value
Meanwhile Steps We Can Take
To Help the Small Number of
Patients Impacted…
Promoting Transparency
As consumers become more responsible for their own healthcare coverage selection,
information must be available to them to make informed decisions. This information should
include content via website or link to the following sources of information:
Understanding Insurance Coverage
A growing share of health plans incorporate
pharmacy deductibles
Rational Insurance Design:
Beginning in 2016 in CO:
Processes and
Utilization
Management
Provider &
PharmacyNetworks
Formulary and
Benefits
Healthcare Costs
and Outcomes
Consumer
Experience
• Coinsurance for Rx can only be
used in 75% of an issuer’s plans
designs per metal tier
• For the remaining 25% of plan
designs offered by an issuer on a
metal tier, flat copays must be
used for Rx
– Max copay is 1/12 of the plan’s
annual OOP maximums
– At least 1 of these copay only
plans must not subject drugs to
any deductibles
24
Don’t Manipulate Drug Costs
Due to Site of Care!
Administrative Burden is REAL!
How Much Did the U.S. Spend on Healthcare Billing &
Insurance-related Administrative Costs in 2012?
$471 Billion
BMC Health Services Research
Medical Economics, Health Law & Policy, The prior authorization predicament. July 8, 2014. http://medicaleconomics.modernmedicine.com/medicaleconomics/content/tags/insurance-companies/prior-authorization-predicament?page=full
http://assets.fiercemarkets.com/public/healthcare/bmc-billing-costs.pdf
Support Precision & Personalized Medicine In
Transforming Care
Improve Patient Adherence
the right medicine → to the right patient →
at the right time.
• 49–$840/month: Extra Medicare costs associated
with poor medication adherence (per beneficiary)
12-50% of new drugs in the pipelines are
reportedly personalized medicines
21st Century Cures
Bruce Stuart, F. Ellen Loh, Pamela Roberto and Laura M. Miller. Increasing Medicare Part D Enrollment In Medication Therapy
Management Could Improve Health And Lower Costs. Health Affairs, 32, no.7 (2013):1212‐1220.
27
Embrace Data
“In God we trust; all others bring (real world) data.”
W Edwards Deming
•
•
•
•
•
Encounter Data or Claims Data
Patient vital signs (e.g., Fitbit)
Evolving Point of Service Data Access & Analytics
Patient Experience Data
Emersion and Interoperability Among All Healthcare
Segments and Disease States
• Patient Outcomes
• Physician embracing data and ability to assimilate,
analyze and utilize data
Help Patients Access Needed Medicines
• Limiting Patient Out of
Pocket Exposure
• Access to Industry Support
Programs
MOST IMPORTANTLY
Building a Culture of Customer Service
Nordstrom
by the
Numbers
Founded in 1901
Fourth-generation family-run
129 full-line stores in 39 states + 3 provinces
194 Nordstrom Rack stores
5 Trunk Club Clubhouses
2 Jeffrey Boutiques in NYC and Atlanta
Online customers in 98 countries
$13.1 billion in sales in 2014
$1.32 billion in net earnings
The Nordstrom of…
•
•
•
•
•
•
Hot tubs
Tanning salons
Collision repair
Tree farms
Plumbers
Awards stores
•
•
•
•
•
•
Dentists
Beverage dist.
Health care
Software
Sex shops
Garbage
What does that mean?
Complete, unwavering,
uncompromising commitment
to create a personalized
experience, every time.
Every interaction, every
touchpoint, is an opportunity
to create a meaningful moment,
an emotional, enduring connection—
a relationship.
In every interaction,
ask these questions:
Who in this room is in your
Customer Service department?
Am I enhancing the customer experience in a meaningful way?
Am I creating loyalty by satisfying the customer?
Am I contributing to the financial health of our organization?
Customer Service
begins with every
person in this room.
Why is customer service
generally terrible?
Welcome to the
Customer Service
Department!
Because organizations
are structured to make life
easier for the organization
—not for the customer.
“We need to think differently about how
to serve the customer. The customer
remains the best filter we have in every
decision we make as a business.”
Because most
organizations
focus on practices,
not on values.
− Blake Nordstrom
or standards
Values: principles
of behavior; one’s
judgment of what is
important in life.
Every successful and enduring
organization adheres to a set of
values that are non-negotiable.
“Your beliefs become your thoughts,
Your thoughts become your words,
Your words become your actions,
Your actions become your habits,
Your habits become your values,
Your values become your destiny.”
“Culture trumps strategy.
You need strategy and execution,
but if you’re not aligned with shared
values, that is not sustainable.”
− Howard Schultz,
Chairman & CEO, Starbucks
− Mahatma Gandhi
The Nordstrom Way:
Stay true to your culture.
Attract people who share your cultural values.
Teach them how you conduct your business.
“People always ask me, how do you teach
core values? The answer is, you don’t.
The goal is not to convince people to share
your core values. The goal is to attract people
who already share your core values.”
− James Collins,
Author of Built to Last & Good to Great
The
VALUES
Model
Respect
Trust
Communication + Collaboration
Awareness
Innovation + Adaptation
Competition + Compensation
Guided by these values every
organization—including yours—
can deliver faster, smarter, and
more personalized service.
Selfless Service
Loyalty
Fun
Respect
“All I’m askin’ is for a
little respect…”
− Aretha
Franklin
Trust
“Trust is the glue of life. It’s the
most essential ingredient in
effective communication. It’s
the foundational principle that
holds all relationships.”
− Stephen Covey
Author, The 7 Habits of Highly Successful
People
“A good store manager must be able
to trust others—because it’s impossible to
micromanage one of our stores; there are
too many moving parts.”
− Bruce Nordstrom
Communication
+
Collaboration
“The single biggest problem in
communication is the illusion that
it has taken place.”
“I’ve never learned anything
while I was talking.”
− George Bernard Shaw,
Irish playwright & Co-founder of the London
School of Economics (1905-1998)
− Larry King
talk show host
Collaboration
“After mutual respect and
understanding are achieved,
it is possible to establish real,
sincere relationships, which are
the foundation of a solid longterm collaboration.”
− Ron Garan, astronaut
Awareness
“It’s a matter of paying attention,
being awake in the moment,
and not expecting a payoff.”
− Charles de Lint, author
“Russell Wilson has an uncanny
sense of awareness of what’s
around him. I don’t know how you
coach it; it’s just an awareness
that all great players have. He
just has it at a higher level.”
− Bill Belichik, Patriots coach
“Personal ownership by all of our people has been
key to our success, and our company’s ability to
persevere even through the toughest of times.”
− Blake Nordstrom
Innovation
+
Adaptation
“Innovation distinguishes
between a leader
and a follower.”
− Steve Jobs
Change is Constant
Over the next 5 years, Nordstrom
will invest $1.2 billion in capital
on technology—particularly on
its mobile platform.
TextStyle Share
Smart mirror in dressing rooms designed by eBay
Nordstrom uses
technology not to
replace salespeople,
but to give them
additional tools to
make more money.
“I’ve been up against
tough competition all my
life. I wouldn’t know how
to get along without it.”
“I’ve been up against tough
competition all my life. I
wouldn’t know how to get
along without it.
−Walt Disney (1901-1966)
Competition
“Our employees must have a competitive
spirit, because we start comparing them the
day they walk in the door. That’s one of the
best ways we know how to improve. If we
have competitive people, we can
accomplish something.”
−Walt Disney (1901-1966)
− James Nordstrom
Selfless Service
“You’re gonna
have to serve
somebody…”
− Bob Dylan
How are you giving
service to your clients,
stakeholders, and
your community—
virtual and literal?
Loyalty
“Some companies demand loyalty from
personnel, but we felt that loyalty should
first come from us to them. Loyalty is
something earned, not expected.”
− Elmer Nordstrom
Nordstrom has more than
62,000 employees. For 20
years in a row, it has been
selected as one of “The
Best Places to Work in
America”.
38% of Nordstrom’s $13 billion
in sales comes from customers
who belong to the company’s
loyalty program.
Loyalty program members
“visit” Nordstrom 2X as
much as non-members and
spend 3X as much money.
Fun
The sale is never over:
Cultivate, nurture and
sustain the relationship
“Today was good.
Today was fun.
Tomorrow is
another one.”
− Dr. Seuss’s The Cat in the Hat
Are you
having fun?
The
VALUES
Model
 Respect
 Trust
 Communication and Collaboration
 Awareness
 Innovation and Adaptation
 Competition and Compensation
 Selfless Service
 Loyalty
 Fun
Be nice!
Promoting Osteopathic
Medicine and Advocating for
Sound Health Policy
American Osteopathic Association
Advocacy for Healthy Partnerships
November 19-20, 2015
What Is The Most Influential
Type of Communication?
1. Constituent meeting
2. Constituent phone call
3. Constituent letters – (personal, nonform)
The more things change, the
more they stay the same . . .
“The Habits of Effective State Advocacy Groups”
The Showalter Group, Inc.
www.showaltergroup.com
“What’s the most effective at influencing the
content, versus the passage, of legislation?”
Congressional Staff Members
Content
Passage
Grassroots campaign
32%
59%
Lobbying by executives
38%
33%
Use of professional lobbyist
53%
21%
-- Michael D. Lord
Babcock Graduate School of Management, Wake Forest University
“How do you prefer to learn about
issues from advocacy organizations?”
1.
2.
3.
4.
•
•
•
Constituent meetings
65%
Lobbyist meetings
60%
Roundtables/briefings
51%
Website
50%
***********************************
Podcasts
3%
Webinars
2%
The Policy Council
The Fortune “Power 25”
Influence Inventory
The Persuasion Tactics that
Change Legislators’ Minds
Dr. Kelton Rhoads
Amy Showalter
Copyright The Showalter Group, Inc.
The Five Tactics that Predict if a
Legislator will Change His or Her Mind
1.
2.
3.
4.
5.
Legislator margin of victory
Lobbyist similarity
Number of FTF meetings
Number of key influentials
Maximum PAC contribution
Amyism #64
Competitive Advantage: "You will not win
more issues, gain more grassroots
participation, or raise more PAC money by
doing things 'reasonably well most of the
time.' You can't dabble in excellence."
Which Groups Are Most Effective?
•
•
•
•
•
•
•
•
Republicans
NFIB
NRA
U.S. Chamber
AARP
AIPAC
ATLA
CUNA
Heritage Foundation
•
•
•
•
•
•
Democrats
NRA
AARP
AIPAC
PhRMA
AFL-CIO
U.S. Chamber
National Journal
Congressional “Insiders” Poll
Amyism #61
National Journal “Insiders Poll”
• “Don’t pull punches”
• “Enemies fear them, allies respect
them”
• “Foot power and financial firepower”
• “Constituents from home are head and
shoulders above other interest groups”
Advocacy vs. Persuasion: "Advocacy is not
persuasion. One is the activity, the other is the
result. Just like spending a lot of time at your
doctor’s office doesn’t make you a
neurosurgeon, advocating doesn’t make you
persuasive."
What Do “Doctors That Do” Do?
•
•
•
•
•
Demonstrate positive engagement trends
Show up
“Show they know”
Motivate colleagues
Have grit
Show Up = Engage in Vivid
Communications
Why is FTF the gold
standard for persuasion?
Proximity Power
1.
2.
3.
4.
5.
6.
Easier to capture the target's attention.
Easier to monitor target's comprehension.
Easier to counter negative feedback.
Easier to 'read' nonverbal behaviors.
Establishes a personal relationship.
Demonstrates you're willing to.
make the effort.
Courtesy Dr. Kelton Rhoads
Be Seen Often
Bob Bonifas
Aurora, IL
NFIB Small Business Champion
“You have to become known, and become
their friend, because they don’t want to make
their friends mad. You cannot just come in
when you have a problem.”
Showing You Know: The
Credibility Formula
Credibility = Expertise + Trust
"If you want to make a change, you'll have to
get out of Facebook and get into
somebody's face."
-Thomas Friedman
Expertise
“. . .so first and foremost, know your topic.
Certainly know it as well or more than the
member to who you are talking.”
Former U.S. Senator John Breaux, D- LA
Expertise - Know Your Stuff,
Know Your Story, Know
Yourself
Know Your Stuff
Does strong argument always influence?
• Evidence
– Local v. national
– Big vs. small numbers
• What is the other side saying?
Identity – Affirming
Scientific Research
Legislators and “CPA”
• Does strong argument always influence?
– Distracted?
– Rushed?
– Personally involved in the issue?
“Involved and has the ability to think”
Rate the Research
•
•
•
•
Boring?
Persuasive?
Valid?
Convincing?
•
•
•
•
Should Continue?
Systematic?
Biased?
Rigorous?
Identity – Affirming
Scientific Research
• We use heuristics (Eagly & Chaiken, Petty &
Cacciopoppo)
• Does it conform to my expectations?
• We downgrade validity of disconfirming
evidence (Lord, Ross, & Lepper)
Identity – Affirming
Scientific Research
• Evaluation also based on membership in
social groups
• Gender identity confirmation
Know Your Story
“…transition from “scientific finding” to
“accepted fact” will be more swift when
research
a) affirms important social identities
b) “looks like” science
-Journal of Political Psychology
Volume 27, No. 6
“What We Value Values Us: The Appeal
of Identity-Affirming Science”
Narrative’s Amazing Impact
•
•
•
•
Read in half the time
Yields twice the memorability
Long-term memory is enhanced
Your prospect self persuades
Courtesy Kelton Rhoads, PhD
Copyright Kelton Rhoads, 2002
Read Time
Know Yourself
What’s your expertise?
Subtle tactics to “show you know”
Memory
Engage in PEER Communications
1in·flu·ence
“Son, don’t act like you’ve never
been there before.”
-Paul Brown
noun
\in-flü-ən(t)s
“an ethereal fluid held to flow from
the stars and to affect the actions
of humans”
-www.merriam-webster.com
The Parity Influence Challenge
Know the Code
• “I vote with you most of the time.”
• “Your organization sure sent the right
person to talk to me.”
• “You make some good points.”
• “I’ll vote for you if my vote is the only vote
you need to pass it.”
Prepare for Parity Influence
“Powerful people respect peer communicators. No matter
the position or title of your grassroots volunteer, whether a
physician, CEO, or non-profit executive, he or she is the
underdog when communicating with a lawmaker. Grassroots
influencers need to be nimble and ready to engage in peer
level communications by asserting themselves when a
legislator is trying to influence them.
So watch carefully for signs of skillful counter-influence in
your direction, and if you detect it, politely but firmly continue
to press your case. It’s not over till it’s over.”
-Kelton Rhoads, PhD
Amyism #73
“A recognized, manipulative
influence tactic is a failed influence
tactic.”
— Kelton Rhoads, PhD
Unbiased Information
Trust
Trustworthy =
1.
2.
3.
4.
5.
Integrity
Lack of bias
Self control
Similarity
Disconfirmation
One Sided v. Two-Sided
Messages
Two sided messages are significantly effective “even when one way
mass media usage has been conducted. “ The two sided argument is
more effective with:
•
Higher intelligence groups
•
Groups initially opposed to the point of view presented in the
communication
•
Groups subsequently exposed to propaganda
-Faison
“People are able to detect the temporary
depletion of the other’s self-control. This
perception of depletion, in turn, influences the
amount of trust of this person. These
associations held when controlling for liking,
closeness, perceived other mood and
tiredness, and the participants’ mood.”
- “If You Are Able to Control Yourself, I Will Trust You: The Role of Perceived Self-Control in Interpersonal Trust” Righetti
& Finkenauer, Journal of Personality and Social Psychology
Trust & Similarity
“A person like me” –
22% in 2003
47% in 2009
Edelman Trust Barometer
2003 & 2009
Trust
Similar Others at the Political Rally
(Suedfeld, Bachner and Matas)
“A person like me” –
62% in 2014
Edelman Trust Barometer
2014
Similar Others
Petitions at the Political Rally
70%
50%
40%
30%
20%
33%
10%
Dissimilar Dress
Similar Dress
-Suedfeld, Bachner, and Matas
Meta-Analysis of Similarity
1.
2.
3.
4.
Attitude
Morality
Socio-economic status / background
Appearance
Kelton Rhoads, Ph.D.
www.workingpsychology.com
Values and
Priorities
Eyes Up: Know Their Values
“Understanding someone’s moral system is
one of the best ways to persuade. Being
validated as a moral person makes you feel
like a hero, doesn’t it?”
-Kelton Rhoads, PhD
Shared Values = Shared Admiration
“I have a very different impression of Hillary Clinton today, and it’s a very
favorable one indeed. Her command of the facts and answer to our questions
were thoughtful, well-stated, and often dead-on.”
-Richard Mellon Scaife
“Rosy Words for Clinton by 90’s Nemesis”
New York Times
Trust through Disconfirmation
1. Lead with the negatives
2. Steal thunder
3. Suffer
Suffering
Steal Thunder
Motivating Osteopathic
Physician Engagement
Amyism # 70
Volunteers: “No matter what you want from
your work – a vibrant grassroots program, a big
PAC bank account, or victories in the legislature --- it all comes from other people.”
Don’t Breathe Your Own Exhaust
“Rosalind was so intelligent that she rarely
sought advice. And if you’re the brightest
person in the room, then you’re in trouble.”
-James Watson
"Can't act. Can't sing. Balding. Can dance a
little."
In a now-famous exchange, Decca Records exec Dick Rowe turned Epstein down flat,
informing him that: ”Guitar groups are on the way out, Mr. Epstein.”
General Nathaniel Greene
Kate Hanni
Live to Tell: Grit
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Bob Benham – 120 meetings (and counting) and “countless” phone calls
Bob Bonifas – 100 meetings in Washington, D.C.
John Boyd – 26 years
Patrice Dell – 2 years
Kim Delevett – 4 years and 18 meetings
Kate Hanni – 4 years and over 300 meetings
Amy Kremer – 53 tea parties
Vince Larsen – 3 years
Cathy Pickett – 4 years
Dr. Gary Smith – 6 years
Bob Stone – 2 years and 2 months
Joel Ulland – 2 years
Dona Wells – 16 meetings
Brad Neet – 1 year
Live to Tell: Grit
Live to Tell: Grit
“My skill is being unstoppable. Most people would
give up. But not me. I could see myself doing it for
the rest of my life.”
— Kate Hanni
Grit vs. smarts
Live to Tell: Grit
Live to Tell: Grit
Industrial strength grit
Don’t ruminate, activate!
Live to Tell: Grit
Optimize
“I heard the bullets
whistle, and believe me,
there was something
charming in the sound.”
“1776” - David McCullough
MOVING FORWARD IN THE SPIRIT OF
COLLABORATION & PARTNERSHIP
Kenya McRae, VP of Research & Development
American Osteopathic Association
Advocacy for Healthy Partnerships – November 20, 2015
Presentation Overview
Power of Collaborating
Continuum of Collaboration
Audience Participation
Requirements of Collaboration
Action Cycle When Planning Collaborations
AOA and Collaborations
Power of Collaborating
• Address unmet and/or escalating community need
• Expand reach and/or range of services / programs
• Improve the quality of services / programs
• Develop a stronger / more effective "voice"
• Improve programmatic outcomes
• Serve more and/or different clients / audiences
Power of Collaborating
• Achieve administrative efficiencies
• Maximize financial resources
• Leverage complementary strengths and/or assets
• Advance a shared goal
• Respond to a community need
• Respond to a funding opportunity
• Competition for funding, donors and/or clientele
Source: Center for Nonprofit Excellence (thecne.org)
Collaboration Continuum
Cooperation
Coordination
Collaboration
• Short term
• Informal
• No clearly
defined
mission,
structure or
planning effort
• No risks
• More formal
• Focused interaction
around specific
effort or program
• Some planning and
division of roles
• Sharing of some
resources
• Rewards shared
• New structure with full
commitment to
common mission
• Comprehensive
planning
• Well-defined
communication
channels
• Vested resources &
reputation
• Shared results &
rewards
Source: Collaboration Handbook: Creating, Sustaining, and Enjoying the Journey by
Michael Winer and Karen Ray. Retrieved from:
http://www.fieldstonealliance.org/client/articles/Article-4_Key_Collab_Success.cfm
Exercise:
Identify one of your own collaborations
and explain why it falls into one of the
categories across the continuum.
Evidence its not working
KEY SOURCES OF CONFLICT
RECOMMENDATIONS
Lack of clarity in roles and
expectations
During formation of a collaboration, the
lack of clarity in procedures can lead to a
host of problems that will affect its future.
• Detailed information
No progress
Has a detailed chronogram been
prepared for activities with specific
timeframes? Are there differences among
the participating agencies that keep the
group from reaching an agreement?
• Remind participants of consistent level
of commitment
Power Imbalance
Power struggles can inhibit progress in
achievement of goals.
• Be honest and realistic about the
possibility that an excess or lack of
power may cause conflict
• Defined purpose & rules
• Clarify and negotiate
• Constantly review the purpose and set
goals
• Power imbalance may be due to various
circumstances
Requirements
Mutual respect, understanding and trust
Group composition reflective of key stakeholders
Vested interest / shared interdependence
Compatible missions and values
Decision-making guidelines, accountability, policies
on roles, management, conflicts/grievances
Shared stake in process and outcome
Flexibility
Communication (open, frequent, informal and
formal)
Funding
Must Haves
Memorandum of Understanding (Agreement)
Evaluation plan (outcomes, indicators, timeframe)
Plan for sustainability
Action Cycle
County Health Rankings http://www.countyhealthrankings.org/roadmaps/action-center
AOA’s Role in Collaborating?
 Starting a Movement
Research on the profession
Other
collaborations
AOA’s role
(Convenes research)
Grant making
Securing grants
(AOA-sponsored, other
entity-sponsored &
matching)
(AOA connects constituents to
opportunities & applies for
grants)
Pain management
OMM/OMT
Osteopathic
philosophy
AOA RESEARCH FOCUS
AREA
BROAD SCOPE/DEFINITION OF THE FOCUS AREA
MUSCULOSKELETAL INJURIES & 
PREVENTION
Influence of OM on

management of
MUSCULOSKELETAL
INJURIES & PREVENTION
(from sport injuries in children
to degenerative joint disease
in adults).
Evaluating the effect of OM on mobility of
populations affected by degenerative joint disease.
OSTEOPATHIC PHILOSOPHY

Impact of OSTEOPATHIC
PHILOSOPHY on physician
training, patient health
outcomes, quality of care and 
patient satisfaction.
Examining osteopathic philosophy and DO-patient
engagement with clinical outcomes and quality of
care.

Measuring the impact of OM in addressing the
prevention and/or treatment of sports injuries in
various populations.
Utilizing quality measures to determine the impact of
the osteopathic approach on patient outcomes and
satisfaction.
Examining measurable differences in the delivery of
care and patient outcomes between osteopathic
physicians and other healthcare providers
AOA RESEARCH FOCUS
AREA
OMM/OMT
Impact of Osteopathic
Manipulative Medicine (OMM)
and Osteopathic Manipulative
Treatment (OMT).
BROAD SCOPE/DEFINITION OF THE
FOCUS AREA

Evaluating the benefits of OMM & OMT on
validated and clinical outcomes.

Describing the underlying basic science of
OMM & OMT and its impact on patient.
CHRONIC DISEASES & CONDITIONS • Specific attention to chronic diseases with high
Effect of OM on prevention,
public health impact and for which “osteopathic”
diagnosis and/or treatment of
approaches can lead to improvements in patient
CHRONIC DISEASES &
outcomes and reduction in healthcare costs.
CONDITIONS
PAIN MANAGEMENT

Osteopathic approach to chronic
PAIN MANAGEMENT (patient
outcomes, enrich quality of life,

and demonstrate cost
effectiveness).
Understanding the effect of an integrative
holistic approach in pain management
(including, but not limited to, OMM/OMT).
Understanding patients’ decision-making in
presenting to osteopathic physicians versus
other health professionals for chronic pain
management.
AOA Making Connections
Pain Management Collaboration
Muscular Dystrophy Association
 LBP defined as pelvic and
lumbar spine up to L1
 Joint effort by MDA, AOF and AOA
 74 one-week camps across the
country between May and August.
 Camps service 40 – 100 campers
 Campers are young people
between the ages 6-17 years who
have been diagnosed with muscular
dystrophy
 Medical staff & Volunteer
Counselors
 Multi-site study which includes
osteopathic research programs
 Other areas to be addressed are
benefits of OMM/OMT, patient
satisfaction (osteopathic
philosophy), costs, quality of life
 Approximately $250K
 2-year grant
CO*RE REMS Program
 Supported by an independent educational grant from ER/LA
Opioid Analgesics REMS Program Companies (RPC).
 Delivered 48 ER/LA Opioid REMS programs and educated over
7,000 health professionals (2013-2014).
 Providing an additional 15 programs, educating an estimated
2,200 health professionals by December 2015
 Introduced program in webinar format (available for 1 year).
Launched August 30, 2015
PCORI Grant
 Grant partnership with 3 primary physician organizations
 Awareness and use of comparative effectiveness
research (CER)
Conrad Hilton Grant
Purpose:
Address the high prevalence and low provider awareness of
adolescent substance use in the US.
Educate and train 1200-1500 health care providers
 Partners: CAFP and ASAM (lead org) & other partners: AOA,
AAPA, and AANP
 Duration of project: Nov. 2015 - Mar 2017
 AOA’s responsibilities:
 Host screening of The Hungry Heart documentary
 In-person training led by subject matter expert (target: 250
learners)
 Survey to help identify learning needs/ knowledge gaps by
Dec. 1, 2015 (target: 100 respondents)
Chronic Diseases
Program on Alzheimer’s’
Disease
 Physician education
 Self-screening tool for
patients
 Resource kit for
physicians
Early Childhood Development
Joint program focused on
early childhood development.
 “All It Takes is H.E.A.R.T.”
Hug, Engage, Ask, Read,
Talk
 Introduced at OMED
 Physician/student education
 Messaging for parents
Learning more about AOA projects …
Contact: Kenya McRae
[email protected]
(312) 802-2002
Friday Folder
The DO
Family Connections
Thank you!
Advocating for Osteopathic
Equivalency: Unifying Our Public
Policy Voice
Anthony Dekker, DO—Physician, Northern Arizona VA
Health Care System
John J. Kowalczyk, DO—President, Osteopathic Physicians
and Surgeons of California
Ray Quintero—Senior Vice President, Public Policy, AOA
Moderator: Joseph Giaimo, DO—Chair, AOA Department
of Governmental Affairs
Disclosure
• Anthony Dekker, DO has presented numerous
programs on Chronic Pain Management and
Addiction Medicine. The opinions of Dr Dekker are
not necessarily the opinions of the VA, DoD, Indian
Health Service or the USPHS. Dr. Dekker does not
represent any federal agency. Dr. Dekker has no
conflicts to report.
2014 VASAM
Personal Data
• Born and Raised
Western Michigan
• MSUCOM 1978
• CCOM (MWU)
internship and FM Res
• RPSLMC Adolescent and
Young Adult Fellowship
(ACGME) 1982
• RPSLMC Fac Dev Fellow
1983
• AOBFP with CAQs in
Adolescent Med,
Addiction Med.
• ABAM
• MROCC
• 18 years academia
• 12 years Indian Health
• 4 years DoD Ft Belvoir
• 1 year VA NAVAHCS
Equivalency
Fort Belvoir Community Hospital
Addiction and Pain Medicine
•
•
•
•
•
•
2014
• No subordinates were allowed to do peer
review
• Non FM Reviewers, PIP passed 2015
• Required faculty from residency and
fellowship to provide documentation of
training
• Attempts to remove addiction and pain
medicine, adolescent medicine and BH
priveleges failed.
$44 million in DoD grants
30% of all inpatient days
Only service at FBCH to serve all five rings
Full FM and BH privileges including ICU and ED
All peer review rated superior
Command change
DoD Issues
• No knowledge of Osteopathic training despite
other DO members of the department. All
were military with military residencies.
• Refusal to recognize Osteopathic certification
and subspecialty certification.
• Chain of Command support for the new
command.
• Opportunities for Osteopathic medicine
VA issues
• 230 VA medical centers. 1700 clinics and
facilities.
• 8.6 million vets served annually
• Access to care issues
• Pain and primary care issues
• Primary Care and Osteopathic opportunities
to improve care
AOA Services
• Provide education and orientation for DO
members to advocate for privileges and
credentialing.
• Provide education to hospitals and credentialing
offices of the regulations in recognition of
Osteopathic training and certification.
• Provide advocacy for DO members in the areas of
credentials, peer review and training issues.
Indian Health Service USPHS
• Strong history of AT Still and the Wakarusa
tribe
• Many of Osteopathic principles are consistent
with American Indian and Alaska Native
thought
• High rates of musculoskeletal injuries
• Beliefs in holistic care
California’s perspective
• Contacted campuses
• Sent joint letter to UC President
• Met with legislators
• Met with UC leadership
• Considered legislation
• Investigated legal action
UC Davis School of Medicine does
not accept students from
international schools nor DO
(Doctor of Osteopathic Medicine)
visiting students.
We do not accept international
students for clinical experiences.
MD student applications Jan 16
DO student applications Apr 13
• Contacted campus
• Letter to UC President’s office
• Met with Lieutenant Governor
(UC Regent)
• Met with UC President’s office
*
MD student fees $200
DO student fees $1,040
…no medical school or clinical training
program shall deny access to elective
clerkships or preceptorships in any
medical school or clinical training
program in this state solely on the basis
that a student is enrolled in an DO
medical school…
(CA Business and Professions Code Section 2064.2)
*“We’ll work with the facility”.
“The substance of the law is on the side of
the Osteopathic student or resident in
terms of ensuring equal access to
training programs – and implicitly
requiring equal fees and equal
admission requirements”.
“However… logic and reason may not
always prevail”.
Recommendations:
• Prepare letter of protest
• Include intent to seek injunctive relief
• Introduce legislation to clarify statute
WHEREAS,
• Those b*st*rds at UC campuses have
been discriminating against DO
students
• Physician shortage
• DOs in primary care
• Single unified residency accreditation
WHEREAS,
• Many institutions providing equal
access
• California anti-discrimination law for
OMS and DOs
RESOLVED,
• Urge private and public medical
training institutions to provide equal
access to DO and MD students
• Work toward greater collaboration,
create positive partnerships
…holders of MD degrees and DO degrees
shall be accorded equal professional
status and privileges as licensed
physicians and surgeons.
(Business and Professions Code Section 2453)
• Employment
• Staff privileges
• Contracts
• Board certification
Unifying our Public Policy Voice: Strategic Objectives
Unifying our Public Policy Voice
Ray Quintero, Senior Vice President, Public Policy
Unifying our Public Policy Voice: Challenges
1) Communicating effectively our public policy work in a
digestible manner…
2) Enhancing engagement from our members to
advance our public policy agenda…
3) Remembering that sharing intel is our strength…
4) Employing varying and differing resources across
affiliates…
Influencing state and federal
public policy to ensure a health
care system optimized for
osteopathic physicians and
their patients
Targeting issues that DOs can
own and be recognized for –
our issues rather than every
other physician group’s
Utilizing lobbying and national
grassroots advocacy
engagement across the
osteopathic medical profession
to educate federal & state
policymakers
Enhancing and leveraging
strategic partnerships &
collaboration with stakeholders
to advance our priorities
Unifying our Public Policy Voice: Engagement Tactics
Utilize Grassroots Advocacy Tools
Provide Input into and/or Sign-on to Regulatory
Comment Letters
Partner in Joint State Legislative Letters and Debates
Share DO Ambassadors
Tell us About Issues and Meetings Back Home and DC
Communicate and Collaborate
Unifying our Public Policy Voice: Anticipated Outcomes
Unifying our Public Policy Voice: What's to Come?
Model Legislation -- "Osteopathic Act"
Greater DO
Engagement
Increased
Collaboration
"About DO's" -- Toolkit for Legislators
Amplified
Osteopathic
Voice
Stronger
State &
Federal
Influence
Growing Brand Visibility –
DOCTORS THAT DO
ADVOCACY FOR HEALTHY PARTNERSHIPS
KAYSE M. SHRUM, DO, FACOP
P R E S I D E NT O S U C E N T E R FO R H E A LT H
SCIENCES
Oklahoma State University College of
Osteopathic Medicine & Oklahoma
Osteopathic Association partnered
together to advocate for legislation that
would provide funding for community
hospitals creating new graduate medical
education programs
D E A N , O S U C O L L E G E O F O ST E O PATHI C
MEDICINE
V I C E P R ES I D ENT, O K L A H O MA
O S T E O PAT H I C A S S O C I AT I O N
TOGETHER PROVIDING A SOLUTION FOR
OKLAHOMA’S PROBLEM
THE 7 YEAR PLAN
• Increase the number of students in the OSU College of
Osteopathic Medicine
•
America’s Health
Rankings
•
Aging Physician
population
• Early admissions program with regional universities in
the area of proposed residency sites
•
Disparity in
physician
practice location
• Expand rural/underserved community based primary
care residency programs
• Rural medical track within our curriculum
• The Funding Need: More Rural Residencies
OKLAHOMA HOSPITAL RESIDENCY
TRAINING PROGRAM ACT 2012
• Must be a primary care residency program as
defined by the bill
• Must be located in a medically underserved
area as defined in the bill
• Hospitals must be eligible for new programs
under the rules established by CMS
OKLAHOMA HOSPITAL RESIDENCY TRAINING
ACT 2012
OKLAHOMA HOSPITAL RESIDENCY
TRAINING PROGRAM ACT 2012
• Created 127 new residency slots
• AOA accredited Family Medicine (3),
Internal Medicine (2), OB/GYN (1),
Surgery (1), Emergency Medicine (2)
• Original appropriations $3.8 million
THE CHALLENGES OF THE NEW DAY
• The state of Oklahoma experienced a budget
shortfall
• Programs were accredited
• Unified accreditation created
uncertainty
• No funding was available
from the state
SUCCESS THROUGH PARTNERSHIP &
ADVOCACY
SOLVING THE FUNDING CRISIS
• The Tobacco Settlement Endowment Trust
granted OSU a $3.8 million grant
• The Oklahoma Health care Authority
(Medicaid) provided a matching grant to bring
the total funding to $10 million
• OSU, OOA and the AOA worked together to
bring confidence around the existence of
OGME under the unified accreditation system
•
128 OSTEOPATHIC EMPHASIS GME SLOTS Accredited
and FUNDED
•
New GME slots for OSU-COM students
•
Future growth for the Oklahoma Osteopathic
Association
•
New physicians for rural & underserved Oklahomans
•
Improved healthcare outcomes for the state of
Oklahoma
Nicole Heath Bixler, DO, MBA, FACOFP
FOMA, President-Elect
November 2015 – AHP Conference


Before the 2013 Regular Legislative Session,
Governor Rick Scott proposed $80 million for
(Graduate Medical Education) Residency
Programs.
The $80 million in funding was for ACGME
Programs only (The American Osteopathic
Association was not included).


Florida had 53 accredited GME Institutions
that administered 407 Residency Programs;
16 of those institutions were solely AOA
accredited and 7 were dually accredited
Florida’s Larkin Community Hospital is the
largest teaching hospital for Osteopathic
Physicians in the United States (offering
training in 30 different specialties and
fellowships)



Original language of proposed bill in regards
to accreditation omitted the AOA/
HFAP(Healthcare Facilities Accreditation
Program) and only recognized the Joint
Commission
Reoccurring funds over budget cycle to cost
$320 million to Osteopathic Physicians
participating in AOA Osteopathic Residency
Programs
AOA accrediting body would be at a
disadvantage to the Joint Commission





At that time, was accrediting 500 facilities
nationwide and 10 in the State of Florida
Covered under CMS recognition as an
accrediting body, but if left out of Florida
Statute would require a separate application
process for each individual accreditation area
causing undue burden on the AOA/HFAP
when the Joint Commission would have been
automatically recognized
The FOMA quickly contacted the Governor’s
office to arrange a meeting on this critical
issue (no funding for Osteopathic Programs)
The Governor’s Office was under the
assumption that the AOA was already actively
in the process of unification with the ACGME
The FOMA informed the Governor’s Office
that negotiations were ongoing, but that
there was no finalized Memorandum of
Understanding






AOA President, Ray Stowers, DO
FOMA President, Greg James, DO
AOA Director, Division of State Government
Affairs, Nick Schilligo
FOMA Legislative Chair, Paul Seltzer, DO
FOMA Key Contact Physicians Program
Representative Ron Renuart, DO – Florida
House of Representatives



Success on both accounts!
Language added to the State Budget to
include the AOA and Osteopathic GME
Programs to the $80 million reoccurring
funds
Proposed legislation was amended to add the
AOA/Healthcare Facilities Accreditation
Program on equal standing as the Joint
Commission


Independent Practice of Advanced Registered
Nurses (ARNP) in Florida with complete
prescribing authority
Telemedicine and the expansion of medical
services without participating physicians
being licensed in Florida (limiting patient
protection)


From our past experiences, the FOMA
encourages other states to utilize the AOA
resources when facing legislative and other
challenges
Teamwork WORKS!
Recent Texas Legislature Actions
TEXAS GME
Making Some Progress Before the 2021
Crisis of Unprecedented Proportions.
2011: GME whacked in a bad budget cycle.
2013: State policy to aim at 1.1 GME slots for 1 Med
School Graduate. And a modest increase in funding that
produced 12 new residency programs,
2014-2015 Politics
The Politics, Continued….
2015 first time Texas has more medical school graduates
than available residency slots.
Former Senate Health chair Jane Nelson becomes Finance
Chair.
ROI? Texas invests $250k in each medical school
graduate.
Anesthesiologist John Zerwas appointed House Higher
Education Chair.
Oil and Gas production has been good, economy ok.
Half MS graduates leave Texas, but half of those want to
stay.
Texas is a net exporter. Cue up obligatory attacks on
Yankees and Californians.
Medicine, HRI, Hospitals realize the opportunity and build an
alliance.
No major heavy lifting on other overarching health issues, so
opportunity exists for a meaningful ask.
The Policy
The Process Rolls On: The Interim before
2017
• Senate Bill 18 passed both bodies with no opposition.
• THECB continues to distribute planning grants.
• Expands current programs, Increases number of new
programs, provide planning grants to encourage efforts
• Beyond the $53M increase in GR funds, the JUA will be utilized
to bridge the 3rd year (2 year budget cycles).
• Focus on Primary care, and other high need specialties. Ie:
Psychiatry and general surgery, areas of need – rural and
underserved.
• Another bill directs THECB to collect data on where medical
school graduates start and finish training.
Beyond
• HB 18 is a great step, but does not entirely solve the
problem.
• 3 new medical schools coming online in 2017.
• Steady funding source?
• Texas Economy?
• Many State legislative candidates promising Republican
primary voters a more austere budget.
• Challenge remains to establish new programs due to
timing and Legislative expectations.
New Mexico
Primary Care Training Consortium
(NMPCTC)
Primary Care in the Land of Enchantment
CONSORTIUM MEMBERS
ALBUQUERQUE:
The University of New Mexico Family Medicine Residency Program
SANTA FE:
The Northern New Mexico Family Medicine (1+2) Residency Program
LAS CRUCES:
The Southern New Mexico Family Medicine Residency Program
SILVER CITY:
Hidalgo Medical Services 1+2 Family Medicine Residency Program
FARMINGTON :
Presbyterian Medical Services (PMS)
ALBUQUERQUE:
First Choice Community Healthcare Clinics
ROSWELL:
Former – Eastern NM Family Medicine Program
Saturday, November 21, 2015
State Contract
Purpose:
to collaborate to expand access to and improve the quality of essential
health services in New Mexico by supporting and existing and
implementing new programs to increase primary care workforce in rural
areas.
NM Department of Health – Medical Assistance Division
• Annual
• $100,000
• Renewable
NMPCTC Collaborative Activities
• Medical Student Recruitment
• Coordinated Faculty Development
• Family Residency Support and
Expansion
• Quality Improvement
• Project ECHO – Sub-Specialty
• 2015 Summit
1
State Funding of Residents
Family Medicine Residency
Support and Expansion
Existing and Potential Locations
• Legislative Appropriation
• Medicaid Match
• Funding Family Medicine
– Adding Psychiatry
• Federally Qualified Health Centers
– PPS Payment Model – Adjustments
• Hospitals Next
• On-Hold for CMS verification
Residency Hubs
1 + 2 Locations
Rural Rotations
from Hubs
Potential
Residency Hubs
Conceptual Reach of Residency Training Hub / Spoke Model
Thank you
New Mexico Primary Care Training Consortium (NMPCTC)
Southwest Center for Health Innovation
902 Santa Rita St. (301 West College Ave. 9/1/15)
Silver City, NM 88061
www.newmexicoresidencies.org
www.facebook.com/hms.centerforhealthinnovation
@hms-chi
2
Consumer Research Objectives
Identify the problem:
Osteopathic Market Research
& Messaging
•
What unmet needs, perceptions and terminology can we build on?
•
How big is the void when it comes to awareness and understanding of DOs?
Understand the audience:
Presented at Advocacy for Healthy Partnerships
Nov. 21, 2015
•
Define the targets – what audiences are top prospects, opportunity
segments, and who is not interested?
Find the focus:
•
Market Research Process
Test/refine exploratory concepts, messages, and language
Awareness/Perceptions of DOs vs. Other Providers
HCP Brand Funnel
Chiropractor Internist
Internist
DO
Immersion
• Background research
• In-person sessions
with leadership, staff,
and agencies
• Understanding of
goals, scope,
audiences
• Finalize work-plan
Qualitative
• Deeper exploration on
critical topics
• Hear from key
constituencies
Quantitative
Analysis & Reporting
• Consumer segmentation
study to inform external
strategy
• Targeting by segments of
support
• DOs – virtual focus
groups
• Early testing of
positioning, messaging,
tone, language
• Consumers – in-person
focus groups with current
and prospective patients
• Brand benchmark survey
among members to
inform internal strategy
• Drivers of interest and
support
January 2015
February and March
April and May
Favorability
• How the story informs
communications and
development
• Facilitate conversations
that turn insights into
action
Orthopedist
Orthopedist
Family
Physician
Family
Physician
Likely to Visit
• Clear, actionable
recommendations
May and June
Chiropractor
DO
Awareness
DOs
Family
Physician
Internist
Orthopedist/
Orthopedic Surg.
Chiropractor
79%
(17% very)
98%
(72%)
80%
(21%)
93%
(29%)
95%
(40%)
Total Favorability (very + somewhat)
57%
94%
64%
77%
70%
Likelihood to Visit (very)
33%
75%
40%
47%
35%
Total Awareness (very + somewhat + not
familiar – everyone who has heard of)
Market Research Insights: What Patients Want
•
Considers alternatives to
drugs/surgery
Takes insurance
High ratings
Quickly prescribe meds
Alignment
Innovative solutions
Uses hands treat/diagnose
Consumer Targeting
Explains things
Knows your med history
•
Focuses on prevention
Has a lot of experience
Recommended
Offices nearby
Active in community
Same gender
less important
•
more important
Well educated/trained
Gaps
Whole person
Easy to get appointment
Listens/empathy
Spends enough time
Respects your decisions
Opportunity
for DOs!
Cares about you as person
Partners with you
Latest and greatest
Consumer Targeting
Goal: Identify the best segments of
patients for growth and how to target your
message and communications strategy
accordingly
Segmentation analysis is an analytical tool
used to sort people into mutually exclusive
groups or clusters based on similar
attitudes, beliefs and/or behaviors
A variety of questions were used as inputs:
• Health status
• Health conditions and behaviors
• Personal commitment/satisfaction
with health
• Attitudes and values
• Physician attributes – what is
important
• Impact of information about DOs
Consumers (n=1,012)
Unhealthy Older
Men, 7% Active Seekers,
10%
Status Quo, 30%
Invincibles, 24%
Segments: Receptivity
70%
Active Seekers
10%
60%
Active Seekers
Health Involved
Invincibles
Status Quo
Unhealthy Older Men
Strong desire to be
healthy, but grappling
with minor health
issues and bad genes.
Will take time and
explore alternatives to
feel better.
Independent streak.
Very healthy and put in
the time, energy, and
positive attitude.
Health not a priority,
because they are
young and have not yet
experienced a major
health problem.
Describe as good/fair
health, but a majority
overweight; almost all
take prescriptions.
Small segment that is
most likely to be in
fair/poor health, and
have a range of health
issues.
Most experienced with
DOs, and interested in
their approach.
Want a doctor that is
partner – involvement
from both sides.
Younger, more
ethnically diverse,
educated.
Low experience/
awareness of DOs, but
very interested in the
philosophy/training
when they are exposed
to information.
Includes/most like
current patients.
Not visiting doctors
regularly, and not that
interested in a
relationship. Does the
doc take my insurance?
Not interested in DOs;
similar training to MD’s
resonates the most.
Young, male, and
educated.
Visit PCP and specialist
recently and regularly.
Trust doctor as primary
information source.
Don’t have a lot of
experience with DOs.
Somewhat moved by
info, particularly fully
trained physicians, but
will stick to what they
know.
Older, more rural.
Experience with DOs (% visited)
Opportunity Segments
Take personal
responsibility when it
comes to their health –
it’s up to me.
Health Involved,
29%
Health motivation is to
remain independent.
Visit doctor often, but
not necessarily loyal.
50%
Unhealthy Older Men
7%
40%
Invincibles
30%
Health Involved
30%
29%
20%
Have some experience
with DOs. Like “whole
person” approach.
10%
Majority men,
Boomers; on gov
health care plans.
0%
0%
7
Status Quo
24%
10%
20%
30%
40%
50%
60%
Very Favorable towards DOs after Reading Description
70%
80%
8
Messages: Patients’ Top Choice
DO Description: Persuasion
+20 shift
+8 shift
43%
41%
33%
23%
Pre
Post
Very favorable
Very likely to visit
Shifts from pre to post by Segment
Active
Seekers
Health
Involved
Invincibles
Status Quo
Unhealthy
Older Men
Active
Seekers
Health
Involved
Invincibles
Status Quo
Unhealthy
Older Men
+21
+34
+12
+16
+3
+17
+14
+4
+7
-6
9
For DOs, Same Concept Rises to the Top
• Consumers and DOs find the same positioning most compelling
• For DOs, “Treating the Whole Person” message is both authentic and seen as the most unique
• Students like “Hands On Care,” but it does not fit for many practicing DOs
Who are Active Seekers & Health Involved?
Messaging
What is a DO? Journalist Answers…
•
•
•
•
•
•
•
Like a doctor
A kind of chiropractor
Naturopath
Osteopath
Alternative medicine
I don’t know
Blank stare
Even people who ask questions for a living
never ask, “What is a DO?”
Telling Our Story
Your Messages
Build the Story
Create a baseline of understanding
that doesn’t overwhelm the listener
• There are two types of fully licensed physicians in the US—
MDs and DOs.
• Our training and education are very similar and equally
rigorous, but DOs come at the practice of medicine from
a different philosophy.
• We tend to partner with our patients to help them get
healthy and stay well.
What Not to Say
• We take a whole person approach to
treating our patients.
• Our focus is on wellness and prevention.
• We consider the mind, body and spirit,
not just the symptoms.
• DOs are taught to see the person inside
the patient.
• We take care of people, not problems.
Change Is Hard
Avoid calling DOs “osteopaths”
• Consumers are confused and
don’t understand that DOs are
physicians
• This term does not reflect the
complete scope of medical
training osteopathic physicians
receive in the U.S.
KEEP
CALM
AND
CALL AN
OSTEOPATH
OSTEOPATHIC
PHYSICIAN
We are Osteopathic Physicians or DOs!
“That was the most awkward,
uncomfortable conversation
I’ve ever had. It felt wrong and
I hated it.
I know we need to do this for
the profession, but I can’t help
thinking people are going to
respect me less.”
—Doctor Anonymous, DO
Be a Brand Champion…
Success Stories
With patients, colleagues, media, legislators and others
• You are delivering messages, not answering questions
• Stay close to these messages because they work
• Tell people who DOs
are and what they
do, DON’T WAIT FOR
THEM TO ASK!
AOA media training rolls out in early 2016
The Worst Part About
Recovering from a Concussion
“We always look at mind, body, and
spirit,” said R. Robert Franks, an
osteopathic family physician and
spokesperson for the American
Osteopathic Association. “It’s an allencompassing pathology, and you have
to look at the complete patient …”
Circulation 2.8 million
1.8 million unique visitors
7.7 Million unique visitors
Success Stories
Ideas, questions, comments
“Dermatologists are well-known for finding and catching the
symptom that leads to the underlying diagnosis of a disease. I
think the DOs help strengthen our approach to the holistic way of
thinking about dermatologic disorders.”—Oliver Wisco, MD
Thank you!
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