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 www.parisse.com © 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 www.parisse.com © 2 0 1 5 Alan J. Parisse www.parisse.com © 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. 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Parisse YES BUT … www.parisse.com © 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!