Panelists at a recent solutions forum featuring healthcare leaders, major U.S. retailers, policymakers, consumer advocates and others unanimously agreed nurse practitioners must play a critical role in filling the healthcare gap, and that there is strong evidence they are fully capable of doing so. With a critical shortage of primary care physicians, an aging workforce, millions of newly insured patients and rising costs, the forums top thinkers offered specific solutions to eliminating barriers to APRN practice and concrete ways to moving the goal of APRN role expansion forward.
We are headed towards a much more personalized healthcare system, keynote speaker Mark McClellan, MD, PhD, senior fellow and director of the Health Care Innovation and Value Initiative, Brookings Institution, said, explaining personalized healthcare means a team delivery approach that is more convenient and customized to individual patients. None of that is going to happen, none of those quality improvements are going to happen without a much greater reliance on nurses who, after all, have been playing that kind of critical role in our healthcare system for a long time, he said.
More than 250 people attended the event hosted by the Center to Champion Nursing in America/AARP Public Policy Institute, Cigna and United Health Group, held in Washington, D.C., and via online webcast Sept. 17. The audience included leaders and representatives from nursing organizations, healthcare organizations, colleges, universities and businesses insurers, as well as nurses and nursing students.
McClellan said continuing pressure exists for real healthcare reform in the U.S. which is more than just expanding coverage and providing better access to services. Reform is also about finding ways to deliver care much more effectively to address the gaps in access that still occur, and to address the rising healthcare cost pressures, he said.
McClellan added time has been spent on coverage expansions and now, I think its time to focus more directly on getting the regulatory and the financing policies in place that align these public and private programs with better care at a lower cost.
To accomplish this larger goal, McClellan proposed some specific actions, including the following.
— Remove restrictions on nursing practices and telemedicine.
— Implement shifts in payments to the case or episode level that are based on better results and lower costs, not just on more services and not just fee-for-service payment.
— Enable, and in fact, even force more of the resources for care delivery to go to programs involving nurses that are leading to better outcomes at a lower cost.
— Provide transparency about the quality of healthcare and the costs of alternative ways consumers can get care, along with opportunities for consumers to share in the savings of less expensive care.
All of this gets us to healthcare that is truly innovative, personalized and prevention-oriented, McClellan said. All of this depends on a stronger role for nurses.
Thought leaders build a case
The AARP Public Policy Institute has created solution forums as a way to bring together thought leaders to talk about healthcare challenges, insights and ideas, Susan Reinhard, PhD, RN, FAAN, senior vice president and director of AARP Public Policy Institute and chief strategist for the Center to Champion Nursing in America, said.
Moderated by Susan Dentzer, senior policy adviser, Robert Wood Johnson Foundation, and Reinhard, the first group of thought leaders focused on how they are using RNs and APRNs in their organizations and the barriers they encounter when trying to expand the nurses roles and responsibilities.
Panelists Trish Anen, MBA, RN, vice president, clinical services, Metropolitan Chicago Healthcare Council; Kevin Ronneberg, MD, medical director, Target; Andrew Sussman, MD, president, CVS Minute Clinic; Randall Krakauer, MD, vice president, national medical director of medical strategy, Aetna; and Mary Picerno, RN, CNO and premium solutions lead, Cigna, identified barriers theyve encountered, including the various and inconsistent rules and regulations in states regarding scope of practice; issues with payment for services; restrictions with the use of telehealth and other forms of delivering healthcare more efficiently; and the primary care shortage.
When asked by Dentzer what they could accomplish, either within their own organizations or perhaps even together, to move the goal of APRN role expansion forward, the five panelists suggested some concrete actions, including the following.
— Converse with consumers and business representatives so they are educated about expanding APRN roles and can raise their own concerns and possible solutions.
— Create nurse residency programs and incentives to encourage nurses into advanced practice.
— Make healthcare decisions based on evidence-based data.
— Get organizational champions to create cultures of dialogue within their own organizations.
— Focus on the entire provider teams roles, engagement and involvement when determining care and patient outcomes.
— Communicate to all interested parties and all parties that are important that is, government, health plans, medical societies and hospitals about the intersection of quality and cost in healthcare programs.
— Present nurses and APRNs as a solution to problems or issues as often as possible so there is transparency to consumers, legislators, employer groups and healthcare organizations, as to their expanding roles and scope of practice.
— Develop ways in which innovative healthcare delivery models and opportunities for leadership are recognized, rewarded and structured so they can be implemented to provide the best care at the lowest cost.
— Assess and determine periodically what progress has been made and changes that have occurred.
Thought leaders propose solutions
Moderated by Reinhard, the second panel discussion focused on barriers at the state and federal levels and possible solutions. Based on their experiences, panelists John Rowe, MD, professor, Columbia University Mailman School of Public Health; Tara Isa Koslov, JD, deputy director, Office of Policy Planning, Federal Trade Commission; Micah Weinberg, PhD, senior policy adviser, Bay Area Council; Frederick Isasi, JD, MPH, director of health division, National Governors Association Center for Best Practices; and Elaine Ryan, vice president of State Advocacy and Strategy Integration, AARP, highlighted some of the challenges at the state and federal level, including the significant variations in how APRNs are being used in the U.S.; the many obstacles in state laws, in regulation and in payment that many lawmakers dont even know exist; and the influence of and resistance of some physician groups and physician organizations on the state and federal level.
Based on their own experiences and professional perspectives, the five panelists discussed some solutions, including the following.
— Leverage specific strategies at the state level that embrace the role of APRNs, drive down cost and meet the workforce challenges and community needs.
— Communicate state by state to policymakers, governors and state legislators on what is happening in healthcare and the importance of modernizing state laws and policies that allow APRNs to practice to the full extent of their education.
— Recognize and highlight the patient-centered care that RNs and APRNs provide.
— Use the power of consumers, businesses, forward-thinking healthcare leaders and lobbyists to push policymakers to understand healthcare issues and make the necessary decisions.
— Create a broader coalition of change by bringing together nurses and other healthcare providers, caregiving organizations, businesses and other stakeholders, as in the action campaigns.
— Advocate with and for consumers, patients and caregivers to put patients first and provide accessible, quality and cost-effective care.
— Recognize corporate America is going to play a significant role in healthcare transformation.
— Ground all healthcare discussions in evidence-based data.
— Incorporate team-based care, making sure all team members are practicing to the top of their license.
McClellan said healthcare is going to be different in the future. Really the only question is how soon is that future going to get here, he said. Better care at a lower cost doesnt happen automatically in healthcare. These realities are what made the solutions forum such an important event, he said. Its important to identify effective and practical ways to promote rapid movement on reforms in care involving nurses.
Videos of the keynote address and the panelist presentations are available for viewing at http://campaignforaction.org/2014SolutionsForum.