DISCLOSURES REFLECTIONS OBJECTIVES. We Owe a Debt of Gratitude to a Wonderful Task Force

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1 DISCLOSURES REFLECTIONS VISION OF PEDIATRICS 2020 NOVEMBER 17, 2011 I have no relevant financial relationships with the manufacturers of any commercial products and/or providers of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation. OBJECTIVES Review history of Vision of Pediatrics 2020 Discuss the eight megatrends identified by the Vision 2020 Task Force Envision the profession of pediatrics in 2020 ADVISORY COMMITTEE TO THE BOARD ON STRATEGIC PLANNING (ACBOSP) ACBOSP agreed that the Board should act as change agents to provide direction to other AAP entities regarding VOP The following were identified through the discussion for consideration and action: Use January Board Planning Session to work through megatrends Committees, councils, sections, and task forces should select and address megatrends in Add the VOP in some way to the AFC Explain the AFC icon regarding its role in change acceleration Create a measure of organizational alignment on the AAP BSC around the icon/vop 2020 for AAP entities Define the role of the AAP in leading/implementing change and positioning the membership to do the same Assure role of the AAP as implementer. We Owe a Debt of Gratitude to a Wonderful Task Force John Duby (Chair) Jeff Kaczerowski (Vice chair) Marty Michaels Danielle Laraque Renee Jenkins Christoph Diasio Maria Britto Amy Jost-Starmer Laurel Leslie

2 Great Consultants Ed Schor David Bergman Bonita Stanton Paul Wise And Outstanding Facilitation/Staff Support Kenneth M. Slaw, PhD Anne Gramiak, MPH Susan Flinn, MA (contract writer) Contributors From the AAP Office of Executive Director/Executive Staff John Forbes, MBA Fan Tait, MD Jon Klein, MD Lynn Olson, PhD 8 Pediatricians and Change "Rather than taking an overall leadership role in the continuous improvement of the health care delivery system, too many medical professionals either ignore the problems of the system in order to concentrate in their own specific practices or focus their energies and talents on protecting the status quo." -George Halvorsan, Chairman and CEO, Kaiser Permanente The Megatrends Inform The AAP Agenda For Children Globalism Workforce HIT Patient/Societal Demographics Disaster Preparedness Delivery System Medical Knowledge Consumerism The Eight Megatrends 1. Changing demographic and clinical characteristics of children and families 2. Burgeoning health information technology 3. Ongoing medical advances 4. Alterations in health care delivery system(s) 5. Growth of consumer-driven healthcare 6. Dynamics of pediatric workforce 7. Disasters (environmental, infectious, man-made) 8. Globalism Summary: Children Major Trends: Modest growth in number of children Declining portion of population Substantial immigrant growth Growing poverty levels

3 SUPPLY During the last decade, there have been increases in the numbers of medical students and residents who are choosing general pediatrics and pediatric subspecialties American Board of Pediatrics ( Linda Althouse Summary Major Trends Greater proportion of women Increase in part-time work Decrease in hours worked Fewer solo-two person practice Slow to change: Underrepresented minorities Status of Pediatric Workforce Career Trends Among Graduating Pediatric Residents Career Choices Educational Debt Starting Salaries Job Search Experience Satisfaction with Pediatrics The current pediatric workforce is not meeting the primary care, subspecialty, or surgical needs to provide quality health care for our country s children. Key reasons include the geographic maldistribution of physicians, an increase in the number of chronically ill children, and an increasingly diverse patient population. from AAP ACBOE (Advisory Committee to the Board on Education) November 2008 Changing demographic and clinical characteristics of children and families Embrace and improve cultural effectiveness in practice Prevention: Bright Futures in 98% of member practices Accelerate transformation and recognition of medical homes Burgeoning health information technology Model Pediatric Electronic Health Record (HER) Patient and family access to health information Registries

4 Ongoing medical advances The future is here AAP drives a proactive agenda for preparing members for new advances Delivery of Point of Care information Accelerate preparation of members for translational impacts of Epigenetics (geneenvironment interaction) Alterations in health care delivery system Family centered medical home = quality Demonstrate return on investment $$ Continue to promote children on the national agenda Current Context: Growth of Consumer Driven Health Care Growing public desire for a more accountable and transparent US health care system. Eight of 10 Americans regularly access online resources for health information. Widespread use of the Internet allows consumers to compare, coordinate, and purchase health services. Many consumers with Internet access base their health decision-making on medical information available online. Internet-acquired health knowledge is often not objective because it may be decontextualized and, th f il i d t d Growth of consumer-driven health care Improve AAP interface with parents/consumers Improve AAP member practice interface with patients/consumers Formalize youth/family involvement in AAP Accelerate AAP media strategy/capacity Envisioning Possible Futures and Strategies for Leading Change Focusing our attention: The Growth of Consumer-Driven Health Care What are the challenges and opportunities related to this megatrend in your local practice setting? (discuss with neighbor)

5 Envisioning Possible Futures and Strategies for Leading Change Envisioning Possible Futures and Strategies for Leading Change Diving Deeper: What possible futures do you envision? What is the best case scenario? What is the worst case scenario? What gaps exist between our current work and this vision of the future? Who are our partners for making this vision happen? Best Case Scenarios Families easily gain access to high quality, valid health information Families connect with providers using communication technology, improving quality of care Publicaly shared data incentivizes practices to improve quality Worst Case Scenarios Patient misinformation leads to poor decisions and health outcomes Practices do not invest in consumer services Practice data is misrepresented for marketing campaigns to drive patient business FAMILY INVOLVEMENT Family Advisory Committee National Committee for Quality Assurance (NCQA) Surgeon General Patient satisfaction and Part IV of Maintenance of Certification (MOC) Dynamics of pediatric workforce Catalyze movement into pediatric workforce (primary care and subspecialty) Address financial barriers in the career path Support members needs and encourage development of new care models, e.g. care coordination and medical home Promote/facilitate relationships between pediatric subspecialists and primary medical home Disasters (environmental, infectious, man-made) Pediatric practice preparedness and response Transportable health data Role of AAP in disaster response Family preparedness Globalism Export key child health/system models and experts Create mechanisms for bidirectional information/learning exchange for US and international pediatricians Help international colleagues improve child health in their country

6 Vision of Pediatrics 2020 Task Force Directive Review data from internal/external experts as to the most powerful forces likely to change or influence the future of pediatrics Identify the forces most likely to influence the future and construct scenarios Identify gaps between current AAP activity and desired AAP activity to best address scenarios Make recommendations to the Board as to what changes in AAP might yield greatest return in mission and member value based on future scenarios 31 Project Timeline Phase 1 (July, 2008-February, 2009) Internal/External Data gathering Member Survey Literature Review Interviews Phase 2 (March-May, 2009) Creating/Refining Scenarios Phase 3 (June-August, 2009) Mapping Scenarios to AAP Phase 4 (September-December, 2009) Validity Testing and Final Recommendations Phase 5 (January 2010-November 2010) Presentation to the Board 32 Review of Trend Data Pediatric Literature Futures Science Literature Visioning Exercises Completed by Other Organizations AAP Member Surveys and Focus Groups 30 Interviews with Thought Leaders Inside/Outside of Pediatrics i.e. Parent organizations 33 Scenario Planning Trend forces were ranked and analyzed Impacts of key trends and trend interactions were imagined Stories or scenarios were written for best case, worst case, and most likely case Scenarios were analyzed for convergent or synergistic transformative events 34 Essential Transformations Needed To Thrive in 2020 and Beyond Pediatric Primary Care Practices Are True Medical Home Practices Essential Transformations Needed To Thrive in 2020 and Beyond Primary and Subspecialty Practices Are Centers of Communication, Education, and Connectivity for Parents/Families/Patients Best Practices in Quality Form the Nucleus of Future Primary and Subspecialty Pediatric Care 35 The Pediatric Team is the Primary Unit of the Future Workforce Pediatrics Is a Global Profession 36

7 Pediatric Primary Care Practices Are True Medical Home Practices 80+% of Primary Care Pediatricians are providing a true medical home by 2020 Synergistic partnerships between Primary Care Pediatricians and Pediatric Medical and Surgical sub specialists create integrated systems of care coordination and communication for children with special health care needs the Nucleus of Future Primary and Subspecialty Care 80%+ of AAP members select, purchase, adapt, and implement, EMR that meets AAP standards for child health care quality by %+ of members are engaged in Meaningful quality improvement study by 2020 AAP and its members at the forefront of integrating 50 new medical advances into practice Practices Are Centers of Parent/Family/ Patient Communication, Education, and Connectivity The Pediatric Team is the Primary Unit of the Future Workforce Families are fully integrated into our work Family input and involvement become central in the design, implementation, and evaluation of practice systems and resources AAP is a household name 39 AAP leading the way in developing and improving new models of team care delivery AAP is an essential professional affiliation for the professionals that work on pediatric teams and comprise the medical home A robust, diverse, and engaged future workforce 40 Pediatrics Is a Global Profession AAP fostering and connecting with Centers of Excellence in specific areas of pediatrics around the world Connecting pediatricians around the world through global virtual communities Why Many Struggle With Change! Having no powerful guiding coalition Underestimating the power of a vision Under-communicating the vision Permitting obstacles to block the vision Allowing too much complacency Failing to create short-term wins Declaring victory too soon Neglecting to anchor changes in the new culture 41 42

8 Critical Steps To Leading Change BY JOHN P. KOTTER CREATE A SENSE OF URGENCY CREATE A GUIDING COALITION DEVELOP A VISION AND A STRATEGY COMMUNICATE THE CHANGE VISION EMPOWER WORKFORCE FOR BROAD- BASED CHANGE GENERATE SHORT-TERM WINS CONSOLIDATE GAINS AND PRODUCE MORE CHANGE ANCHOR NEW APPROACHES IN THE CULTURE 43 How Best to Move Forward? CREATE A GUIDING COALITION Who will own and drive change? COMMUNICATE THE CHANGE VISION How can the VOP 2020 Findings be best utilized? EMPOWER WORKFORCE FOR BROAD-BASED CHANGE How can you and your staff be empowered to move with speed, innovation? 44 Now In A Journal Near You!! Pediatrics in the Year 2020 and Beyond: Preparing for Plausible Futures Amy J. Starmer, John C. Duby, Kenneth M. Slaw, Anne Edwards, Laurel K. Leslie, and Members of the Vision of Pediatrics 2020 Task Force. Pediatrics 2010:126: Peering Into the Future: Pediatrics in a Changing World Laurel K. Leslie, Kenneth M. Slaw, Anne Edwards, Amy J. Starmer, John C. Duby and Members of the Vision of Pediatrics 2020 Task Force. Pediatrics 2010:126: Now In A Journal Near You!! Vision of Pediatrics 2020: The AAP's Role in Maintaining Focus and Creating the Future Marion Burton Pediatrics 2010; 126: Vision of Pediatrics 2020: Lessons Learned From A Christmas Carol Bonita Stanton Pediatrics 2010; 126: Envisioning Possible Futures and Strategies for Leading Change Moving Forward: What are the specific next steps to implement this vision What resources do we need? How committed are we to moving forward? Discussion A true leader is one who designs the cathedral and then shares the vision that inspires others to build it. Jan Carlzon 48

9 AAP is Well On Its Way Changing Demographics Mental Health/EBCD (Early Brain and Child Development) Initiatives Health Equity/Literacy Immigration Issue HIT Creation of CHIC (Child Health Informatics Center) Medical Advances Creation of PSATT (Provisional Section on Advances in Therapeutics and Technology) Epigenetics discussion Health Delivery System Medical Home ACOs (Accountable Care Organizations) AAP is Well On Its Way cont. Consumerism Healthychildren.org Officyte pilot for consumer-facing practice websites Work Force of Future New national Affiliate Membership for Physician Assistants Disasters Improved response planning/implementation Fund raising success Globalism International Planning Session Neonatal Resuscitation Program (NRP)/Helping babies Breathe International Member Pilots GOALS: STATE LEVEL ACCESS ACCOUNTABLE CARE ORGANIZATIONS (ACO S) AND STATE GOVERNMENT QUALITY BRIGHT FUTURES, HEALTH INFORMATION EXCHANGE, ACO S, NCQA, MOC FINANCE MEDICAID, CHIP, EXCHANGES, PRIVATE INSURANCE CHICKEN AND EGG Pediatric Workforce and Maldistribution Health Care Financing System Patient Centered Primary Care Collaborative ( Capitation: Salaried for primary care physicians AAP RESOURCES Section on Administration and Practice Management Council on Community Pediatrics Council on Clinical Information Technology Child Health Informatics Center David T. Tayloe, Jr., MD, FAAP Past President, American Academy of Pediatrics Goldsboro Pediatrics, PA 2706 Medical Office Place; Goldsboro, NC Fax