ACA and Future Policy
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Transcript of ACA and Future Policy
ACA and Future Policy
Elena Rios, MDNational Hispanic Medical Association
October 2013
Demographics
Demographics
Key Trends Minorities face health care disparities in America
By 2042, over half of Americans will be minority populations Latinos – immigrants, mixed families with strong cultural values -will be 1 out of 4
Americans
Our nation is undergoing a major transformation: Cultural Competence & language requirements in hospitals/clinics and for future
providers in medical education and public health Health care reform expands health care coverage to Hispanics and African
Americans and increases the need for education and outreach efforts Quality value payments for coordinated patient centered care Disparities in obesity and chronic disease for minority populations remain high New demand for community-based health prevention and research
NHMA/NHHF seeks to cultivate public and private partnerships to make a positive impact promoting prevention awareness & good will in new and growing Latino communities and markets around the nation
Social Determinants of Health
• SES – Education– Income– Residential segregation
• gradient of health outcomes and risk behaviors• occupation, culture, social network and cohesion,
correctional systems, legal policies, mental health and psychosocial factors, and forms of discrimination
Residential Segregation
• The fundamental cause of racial/ethnic health disparities in the U.S.
• Environmental hazards, reduced access and quality of health care, increased violence and crime, and poorly built environments in which there is less access to supermarkets providing fresh fruits and vegetables, greater access to fast foods, and less recreational facilities than non-segregated neighborhoods, substandard housing.
Societal Costs
• Safety net providers (clinics, ED) more costly treatment than preventive and primary care
• Poor have more severe disease with complications and comorbidities
• Potentially preventable hospitalizations• Premature deaths, loss in productivity• Individuals, families, communities, employers,
health plans, and governmental agencies, health insurance companies, businesses
Societal Costs
• To date, estimated societal costs tend to underestimate the economic impact of health disparities by excluding costs to employers due to a larger pool of unhealthy workers and broader societal impacts such as decreased tax revenue because of lower productivity and increased insurance premiums as risk pools deteriorate.
• With increased minority population, global competition is at stake for the US.
ACA, Disparities & Access
Increased newly insured patients unfamiliar with healthcare, behavioral healthcare, oral healthcare and healthy living concepts
Increased outreach and education especially to young adults and increase awareness about healthcare
Increased communications – information on websites, social media, media, appointment systems, grievances, complaints with billing and subsidies/discounts
Hispanic family-focused health information, coalitions, organizations, leaders
Health Insurance Marketplace
States/Federal Facilitated Grants to develop outreach with navigators that is culturally and
linguistically appropriate; enrollment counselors; brokers Qualified healthplans - limited participation Essential community provider - safetynet Standards for benefits – presented in a culturally and
linguistically appropriate manner, health literacy Subsidies 100-400%FPL ($23K -$96K) individuals/families,
small businesses to get tax credits CBO Estimates by 2022, 25M Americans in the marketplaces
Essential Benefits – transition policies needed Ambulatory care services Emergency Hospitalization Maternity/newborn Mental Health/Substance abuse disorders Prescription medications Rehabilitative and habilitative Laboratory Preventive services and chronic care management Pediatric, including oral, vision care
Health Policy Trends
Health insurance will be more prevalent in shopping centers, pharmacies, stores
Home health, adult day care, PCMH – coordinated care, outpt care will increase
Community prevention care programs Govt Hearings/document best practices Medical care use – population health, health
planning needed
Uninsured Populations Policy
Need health insurance education in govt programs for mixed families– adult education programs, job training, CBOs, mental health, Medicaid, clinics, nutrition/farmers markets, schools
Small business programs, faith-based, media campaigns
Funding to public hospitals, clinics
Public-Private Partnerships are the Future (social enterprise) Government procurement needs to link to
public sector markets and solution economy or social innovation
Example: Sec Clinton announced the USAID impact investment approach to development assistance, matching private sector funding
Health insurance, pharmacies Corporations need healthy employees
ACA, Disparities & Quality
National Strategy for Quality Improvement in Health Care Priorities that have the greatest potential for improving
health outcomes, efficiency, and patient-centeredness of health care, for all, including vulnerable populations
Quality measures – Medicare/Medicaid hospitals, physicians
experience, quality, use of info for pts and caregivers Equity of health services/disparities across health disparity
populations Patient-centered, pt satisfaction, accessibility, availability
ACA, Disparities & Quality
Reimbursement – including activities to prevent hospital readmissions – comprehensive discharge program with pt centered education and counseling
Best clinical practices that improve pt safety and reduce medical errors through evidence based medicine and Health Information Technology
H-IT : EMR and PMR to include health disparities information from provider/patient/community assessments – for example, language needs
ACA, Disparities & Quality
Center for Medicare/Medicaid InnovationPt centered medical home modelsCommunity health teams, small practice med homes
– chronic care, self managementHome health chronic care servicesBest practicesHealthcare innovation zonesPrograms that address health care disparities and
show impact
ACA, Disparities & Prevention
National Prevention, Health Promotion and Public Health Council (Fed agencies under HHS) Provide coordination and leadership at the Federal level with respect to
prevention , health promotion, public health system and integrative health care in the US
Develop a National Prevention and Health Promotion Strategy – health disparities priority
Prevention and Health Promotion Investment Fund $10B Community Transformation Plan
to promote healthy living and reduce disparities (including social determinants)
Schools, restaurants, worksites Community prevention
ACA, Disparities & Workforce
National Health Care Workforce Plan – HHS, DEd, DOL Interprofessional education, focus on primary care Nursing, oral, mental, allied, and public health workforce Geographic distribution of providers vs need
Scope of work laws – need more providers of care Diversity needs to include Recruitment K-16
Diversity to increase URM minority health professionals Cultural Competence training for all providers
Community-based participatory research, PCORI (pt centered outcomes research), evidence based needed
NHMA Vision to increase Latino Physicians – STEM Diversity Summit, Nov. 2013 Need for diversity and health professions in
the President’s STEM Initiative (recruitment counseling still needed)
OMB White House, Dept of Education, NSF, NIH, HRSA, Congress, IOM, Josiah Macy Foundation, RWJF
Career pathway program – Hispanic STEM Program from HSIs to medical school
Cultural Competence Standards
Federal Law – Title VI Medical Education – AAMC, LCME, ACGME Joint Commission NCQA NQF standards Licensing – required in CA, NJ Language Services in Medicaid – in 13 states
Cultural Competence and Quality There is excellent evidence that tracking/reminder
systems can improve quality of care, and fair evidence that multifaceted interventions, provider education interventions, and interventions that bypass the physician to offer screening services to racial/ethnic minority patients can improve quality of care. There is, however, excellent evidence for improvement in provider knowledge, good evidence for improvement in provider attitudes and skills, and good evidence for improvement in patient satisfaction. (AHRQ, Strategies for Improving Minority Healthcare Quality (Publication No. 04-E008-01, 2004)
National Physician Survey 2011
Physicians overwhelmingly want the health care system to cover the costs associated with connecting patients to services that address their social needs.
A majority of physicians surveyed say that the health of up to half their patients would improve if the health care system did a better job of addressing social needs.Source: RWJF Website – 1000 physician survey 2011.
NHMA & NHHF– Who are We?
Established in 1994 in DC, NHMA is a non-profit 501c6 association representing 45,000 Hispanic physicians in the U.S.
Mission: to empower Hispanic physicians to improve the health of Hispanic populations with Hispanic medical societies, residents, students and public and private partners.
Established in 2002, NHMA’s foundation, National Hispanic Health Foundation, a non-profit 501c3 foundation for research & education activities – affiliated with NYU Wagner Graduate School of Public Service
NHMA Board of Directors Kathy Flores, MD, Chairwoman,
Director, UCSFresno Latino Research Center
Louis Aguilar, MD, Treasurer, Tucson, AZ
Sam Arce, MD, ViceChair, NYC Jorge Girotti, PhD, Secretary, Assoc.
Dean, U of Illinois, Chicago School of Medicine
Elena Rios, MD, President/CEOWashington, DC
Raymond Arroyo, VP, Aetna David Carlisle, MD, President,
Charles R. Drew University of Medicine and Science
Emilio Carrillo, MD, MPH, Professor, Cornell Weill School of Medicine
Judy Flores, MD, Dir, Adol Health, Woodhull Med Ctr/NYU
Efrain Fuentes, EdD, Walt Disney Paloma Hernandez, MPH, CEO,
Urban Health Inc. Norma Parra, MD, med dir,
CentroMed, San Antonio Jorge Puente, MD, Regional
President of Asia, Pfizer Nelson Reyneri, VP, Liberty Power John Sanchez, MD, Young
Physicians Gerardo Lopez-Mena, MD,
Chairman, Council of Residents Alvaro Galvis, Coordinator, Latino
Medical Students Association
NHHF Board of Directors
Mark Diaz, MD Chairman, Principal, Alivio
Medical Group, Sacramento, CA Conchita Paz, MD Secretary -Treasurer,
Principal, Family Care Associates,
Las Cruces, NM Elena Rios, MD, MSPH President, NHHF, NY
Jo Ivey Boufford, MD President, New York Academy of Medicine
Gary Pelletier Director, Pfizer Helpful
Answers United Healthcare Walmart
National Hispanic Medical Association – what do we do? Serve as a resource for White House,
Congress, and Federal agencies on health policies and programs
Support Hispanic physician leadership at national and state level
Provide networking opportunities for advancement of Hispanic health
National Hispanic Medical Association Programs Resource:
Federal government Capitol Hill Briefings on Hispanic health Issues to eliminate health disparities Nominate members to Federal advisory commissions
Private sector Provide technical assistance to corporate health programs Nominate members to corporate boards
Leadership Development: NHMA Leadership Fellowship National Hispanic Health Professions Leadership Institute Health Professional Student Recruitment and Mentoring Programs
Networking: NHMA 18th Annual Conference, Mar. 27-30, 2014, Washington, DC Regional Health Reform Events – NYC, Los Angeles, San Antonio, Chicago,
Atlanta, DC
NHMA Network 2013
Hispanic State Medical Societies National Hispanic Health Professional Leadership
Network National Association of Hispanic NursesHispanic Dental AssociationLatino Caucus of APHA Latino Forum of Health ExecutivesPAs, Mental Health Workers, Dietitians
12,000 Members and 40,000 Prospects Latino Medical Student Association Partners, Contacts
NHMA & NHHF Contact Us
NHMA - www.nhmamd.org NHHF - www.nhmafoundation.org Portal - www.hispanichealth.info National Hispanic Health Professional Student
Scholarship Programs – Nov 21, LA; Dec 5, NYC – NHMA Annual Conference “ACA and Best Practices that
Improve the Health of Hispanics” – Mar. 2014, DC