Designing New Programs in Response to the Patient
Protection and Affordable Care Act
Presented at:
NASW/Texas 36th Annual State Conference
Rhonda G. Patrick, LCSW, MPA
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Overview of the Patient Protection and
Affordable Care Act (PPACA)
PPACA Post Supreme Court Decision
PPACA Impact on Social Work Practice
Defining Social Work Entrepreneurship
Becoming a Social Work Entrepreneur
Designing Programs in Response to PPACA
Using a Social Work Entrepreneurship
Philosophy
Final Thoughts
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Key Elements of Potential Interest to Social
Work
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Individual Mandate
Medicaid Expansion
Quality/Health Systems Performance
Prevention/Wellness
Long-term Care
Medicare
Workforce
Community/School Health Programs
Trauma Care
Disaster Response
American Indians
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Key Elements of the Supreme Court Ruling
◦ Anti- Injunction Act
 Not a tax, therefore not an issue
◦ Constitutionality of Individual Mandate
 The penalty is a tax and as such within constitutional
rights of congress
◦ Severability
 Since mandate upheld, not an issue
◦ Medicaid Expansion
 Can’t require states, and if they refuse can penalize by
withholding current funding.
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Types of Practice Arenas
◦ Micro Social Work
 Direct Care Services in Health and Behavioral Health
Care and other Social Services
◦ Macro Social Work
 Policy Development and Analysis (Social, Economic,
Programmatic)
 Advocacy
 Program Design
 Development- Funding
 HR- Workforce Development & Benefits/Compensation
 Compliance/Accountability
 IT- EMR and Information Management Systems
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What the Experts Are Saying
◦ Robyn Golden- Rush University Medical Center
 Fragmentation
 Move from episodic acute care to incentivized
comprehensive care
 Care Coordination Model
 Medical Homes
 Workforce Development
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What the Experts Are Saying
◦ Social Work Today
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Expansion of home and community based services
Chronic disease prevention
Wellness programs
Workforce development
Increased access by more people
Integration of health and behavioral health
CLASS- Keeping elders in community
Community and Consumer Education
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What the Experts Are Saying
◦ CSWE
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Workforce Expansion and Development
Healthcare Coordination
Prevention and Wellness
Community and Family Health
Research
Aging Needs
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What the Experts Are Saying
◦ NASW
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Parity
Prevention
Voluntary Medicaid Expansion
Health Exchanges (Collins 2012)
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What Others Are Saying
◦ Workforce Organizations
 Physicains
 Nurses
 Allied Health Care Professionals
◦ Social Work Education
 Focus on Workforce Expansion (Very Conservative)
 Fairly Quite Considering- Nursing
◦ Think Tanks
 250,000-400,000 a year this decade
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What is an entrepreneur?
◦ An entrepreneur is an enterprising individual who builds capital through
risk and/or initiative.
◦ 1964: Peter Drucker: An entrepreneur searches for change, responds to it
and exploits opportunities. Innovation is a specific tool of an entrepreneur
hence an effective entrepreneur converts a source into a resource.
◦ 1971: Kilby: Emphasizes the role of an imitator entrepreneur who does not
innovate but imitates technologies innovated by others. Are very important
in developing economies.
◦ 1975: Albert Shapero: Entrepreneurs take initiative, accept risk of failure
and have an internal locus of control.
◦ Joseph Schumpeter (1930): An entrepreneur is a person who is willing and
able to convert a new idea or invention into a successful innovation.
Entrepreneurship is the pursuit of opportunity without regard to resources
currently controlled.
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New
New
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Products
Product Methods
Markets
Forms of Organizations
◦ The capacity and willingness to undertake conception, organization, and
management of a productive venture with all attendant risks, while
seeking profit as a reward.
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What is a Social Work Entrepreneur?
◦ There is no definition.
◦ Social Worker- Social Justice and Human Rights
Perspective
◦ Change Agents/Action Oriented/Relationship
Focused
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Can one be a Social Work Entrepreneur?
◦ Reconciliation of the relationship between profit
and caring.
◦ How do we define profit?
◦ Individual shift
◦ Profession shift
A social work entrepreneur is a social
worker with the capacity and willingness to
undertake conception, organization, and
management of a productive venture,
without regard to resources currently
controlled, while seeking profit as a reward
to create new products, new product
methods, new markets, and new forms of
organizations.
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What are the knowledge, skills, and attitudes
necessary to be a Social Work Entrepreneur?
◦ The capabilities of innovating, introducing new
technologies, increasing efficiency and productivity,
or generating new products or services, are
characteristics of entrepreneurs. Entrepreneurs are
catalysts for economic change. Research has found
entrepreneurs to be highly creative with a tendency
to imagine new solutions by finding opportunities
for profit or reward.
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A social entrepreneur is motivated by a desire to
help, improve and transform social, environmental,
educational and economic conditions. Social
entrepreneurs seek to develop innovative solutions to
global problems that can be copied by others to
enact change.
A serial entrepreneur is one who continuously comes
up with new ideas and starts new businesses. In the
media, the serial entrepreneur is represented as
possessing a higher propensity for risk, innovation
and achievement.
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A lifestyle entrepreneur places passion before profit when launching
a business in order to combine personal interests and talent with the
ability to earn a living. A lifestyle entrepreneur intentionally chooses
a business model intended to develop and grow their business in
order to make a long-term, sustainable and viable living working in
a field where they have a particular interest, passion, talent,
knowledge or high degree of expertise.
A cooperative entrepreneur doesn't just work alone, but rather
collaborates with other cooperative entrepreneurs to develop
projects, particularly cooperative projects. Each cooperative
entrepreneur might bring different skill sets to the table, but
collectively they share in the risk and success of the venture.
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Key Philosophy… NEVER CHASE MONEY!!!
◦ Design Sound Programs First- The money will
follow.
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Be willing to put in the time… “you get out
what you put in”
Starting from scratch or redesigning existing
programs?
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Benefits of Starting From Scratch
Risk of Starting From Scratch
Benefits of Redesigning
Risk of Redesigning
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Basic Program Design Format
◦ Preliminary Steps Needs Assessment
Immersion
◦ Using Logic Models- Organizing and Prioritizing the
Information
◦ Identifying Social Problems
 Social Condition vs. Social Problems
◦ Selecting the Appropriate Intervention Strategy
 Using Evidence Based Practice
 Political Economy
◦ Setting Goals and Objectives
◦ Evaluating
 Triple AIM (Access/Service Provision, Consumer Response,
Cost Containment)
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Funding- Lets Talk About Money…
◦ Corporate Structure
 For Profit vs. Non Profit
◦ Making Money vs. Finding Money
 Income Generating Options
 Fee For Service
 Sponsorships
 Grant Options
 Governmental
 Foundations/Charities
 Donors
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Types of Programs- Breakout Discussion
◦ Get into small groups
◦ Based on information you have heard today, using
the assigned ACA category, think about what types
of entrepreneur opportunities you can create in
your communities.
◦ Pick one idea as a group and discuss how you
might make that happen.
The Social Work Reinvestment Act (SWRA): Why
we should support it…
SWRA will fund demonstration grants to address relevant, “on
the ground” realities experienced by our nation’s social
workers. These competitive grant programs will prioritize
activities in the areas of workplace improvements, research,
education and training, and community-based programs of
excellence. This investment will be returned many times over
both in support of ongoing efforts to establish the most
effective social work solutions and in direct service to the
growing numbers of individuals, families, and communities in
need.
http://www.socialworkreinvestment.org/Default.aspx
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Final Questions
Website for Handouts and other resources
www.rgpatrick.com