Health Policy and Health Equity: Arizona Policy Perspectives Third Annual Latino Health Promotions...

Health Policy and Health Equity:Arizona Policy Perspectives

Third Annual Latino Health Promotions Summit: Achieving Health EquityFebruary 16, 2013

University of Arizona, Arizona Cancer Center, Tucson, AZ

Anita C. Murcko, MD, FACP President & CEO, Cambiare, LLC

Clinical Associate Professor, University of Arizona Health Sciences, College of PharmacyAdjunct Faculty, Arizona State University, Biomedical Informatics

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OBJECTIVES

• Define relevant health equity terms• Focus on health equity-focused areas of

Accountable Care Act (ACA) • Provide overview of the ADHS newly-

released Arizona Health Equity Stakeholder Strategies

• Using ACA to improve health and care in Arizona

OutcomeAccountable

Care

OutcomeAccountable

Care

Coordinated SeamlessHealth Care System 2.0

• Patient/Person Centered• Transparent Cost and Quality Performance

– Results oriented– Assures Access to Care– Improves Patient Experience

• Accountable provider networks designed around the patient including LTC needs

• Shared Financial Risk

• HIT integrated

• Focus on care management and preventive care

– Primary Care Medical Homes– Care management/ prevention

focused– Shared Decision Making and Patient

Self Management

CommunityIntegratedHealthcare

• Patient, Population, and Community Centered— Community Health Resource Linked— Cost , Quality, and Population Health

Outcome Transparency — Community Healthy Living Choices

• Community Health Integrated networks capable of addressing psycho social/economic and LTC needs

• Right care, at the right time in the right setting• Population based reimbursement • Learning Organization: capable of • rapid deployment of best practices

• Community Health Integrated— Community Healthy Living Oriented— Community Health Capacity Builder— Community based support developer— Shared community health responsibility

• E-health and telehealth capable— Wide use of remote monitoring and

telehealth and e-health management— Health E-Learning resources, social

networking, health literacy tools

• Episodic Health Care– Sick care focus– Uncoordinated care– High Use of Emergency Care– Multiple clinical records– Fragmentation of care

• Lack integrated care networks

• Lack of integration between acute and long-term care settings

• Lack quality & cost performance transparency

• Poorly Coordinated Chronic Care Management

Uncoordinated Health Care System 1.0

Health System Transformation Critical Path

Community Integrated Health Care System 3.0

Episodic Non Integrated

Care

Health System Transformation Evolution Critical Path

Health Equity is achieving the highest level of health for all people—identifying and addressing avoidable inequalities, especially for the socioeconomically disadvantaged and those who have sustained historical injustices.

- Source: Healthy People 2020

What is Health Equity?

Health Disparities are differences in health status in distinct segments of population, such as:– Gender, Race or Ethnicity– Education or Income– Disability– Living in various geographic localities

What are Health Disparities?

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• Social determinants of health—examples include gender, socioeconomic status, employment status, educational attainment, food security status, availability of housing and transportation, racism, and health system access and quality

• Behavioral determinants of health—examples include patterns of overweight and obesity; exercise norms; and use of illicit drugs, tobacco, or alcohol

• Environmental determinants of health—examples include lead exposure, asthma triggers, workplace safety factors, unsafe or polluted living conditions

• Biological and genetic determinants of health—examples include family history of heart disease and inherited conditions such as hemophilia and cystic fibrosis

What are other key Health Equity factors?

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The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadows of life, the sick, the needy and the handicapped.”

-Hubert Humphrey,1977

Legislation and Health Equity

1. ARRA (American Recovery and Reinvestment Act) February 2009

– Health Information Technology for Economic and Clinical Health (HITECH)– Health Information Exchange (HIE) funding each state including Direct

Program (secure messaging)– Regional Extension Center (REC) to accelerate electronic record

adoption– Meaningful Use– Patient Centered Medical Home (PCMH)

2. ACA (Patient Protection and Affordable Care Act) March 2010 and upholding by Supreme Court of United States (SCOTUS)

– Health Insurance Market Reform (coverage expansion, community rating, administrative cost controls (80-85%), essential health benefits, dependents to age 26; health insurance exchanges)

– Healthcare delivery system reforms (ACO, PCMH, innovations)– Healthcare payment reforms (ACO, incentives for prevention and primary

care, state flexibility in new model financing)

Strategic Aims of ACA

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Assuring all Americans have better care, better health, and lower costs through continuous coverage, improved health

system performance, self responsibility, and patient/provider mutual accountability.

ACA’s Three Pillars of Reform

Health Insurance

and Coverage Reform

Healthcare Delivery System

Transformation

Value Based Purchasing

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Affordable Care Act

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ACA’s Health Equity TOP TEN

1. Access2. Prevention3. Non-discrimination4. Data5. HRSA expansion6. Health Professional Opportunity

Grants7. Maternal / Infant Home Visitation8. National Health Services Corps9. Community Transformation Grants10. Community Health Workers

Expanding coverage and access to care give millions of people and small businesses access to affordable coverage. – From 50 million now to 16 million by 2019

• Mechanisms include: – Medicaid expansion (2014) and – Health Insurance Exchanges (2014)

ACA Provisions that Address Health Disparities-1

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Emphasis on prevention by encouraging coverage for: – Any clinical preventive service recommended

with a grade A or B by the U.S. Preventive Services Task Force (USPTF);

– Immunizations recommended by the Advisory Committee on Immunization Practices (ACIP).


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• Medicare beneficiaries can now receive – personalized prevention plans, – initial preventive physical examination, and– any Medicare-covered preventive service

recommended (grade A or B) by the USPTF

Continued

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Nondiscrimination: – Extends existing federal civil rights laws

prohibiting discrimination on the basis of race, color or national origin, gender, disability, or age to any health program or activity receiving federal financial assistance AND

– Must provide information in a culturally and linguistically appropriate manner


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Data • Provisions to strengthen federal data

collection efforts• Requires all federally funded programs to

collect race, ethnicity, primary language, disability status, and gender.


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HRSA Community Health Center Program: Expands access to primary health care– $11 billion for HRSA Community Health

Center CHC program over next five years-- doubling number of patients

– 19 million patients now served• 63 percent are racial and ethnic minorities • 92 percent are below the federal poverty level


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New Access Points (NAPs) grant program. – 350 NAPs – Increase preventive and primary healthcare

services for eligible public and nonprofit entities

– Including tribal, faith-based and community-based organizations.

Continued

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Health Professional Opportunity Grants (HPOG): human service program grants assist organizations that serve Native American, Hispanic, and African American people. – Comprehensive healthcare-related training to

low-income workers and TANF participants – Supportive services to improve success (such as

transportation, dependent care, and temporary housing)


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Maternal, Infant, and Early Childhood Home Visitation Program: – Home visiting is an effective and relatively

low-cost strategy – Targeted communities have more premature

births, low birth-weight infants, infant mortality, poverty, crime and domestic violence, high rates of high school dropouts, substance abuse, and unemployment.


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National Health Service Corps (NHSC): • $1.5 billion over five years to expand the

NHSC. – Since 1970s, NHSC funds and places health

professionals in Health Professional Shortage Areas to provide healthcare services to underserved in exchange for loan repayment or scholarships, half of them in health centers.

– One-third of these clinicians are minorities.


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Prevention and Public Health Funds: Community Transformation Grants – State and local governmental agencies, tribes and

territories, and national and community-based organizations

– Implementation, evaluation, and dissemination of evidence-based community preventive health activities to reduce chronic disease rates, prevent the development of secondary conditions, and address health disparities.


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ACA authorizes promotion of community health workers– Promotoras, peer leaders, community

ambassadors, patient navigators or health advocates

– Uniquely skilled in providing culturally and linguistically appropriate services, particularly in diverse, underserved areas.

– Critical role in providing enrollment assistance to racial and ethnic minorities.


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Key Disparity Measures-1

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Key Disparity Measures-2

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Resources

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• Vision: Health equity for all. We envision a state where each person has equal opportunity to prevent

and overcome disease and live a longer, healthier life.

• Mission: to promote and protect the health and well-being of the minority and vulnerable populations of Arizona by enhancing the capacity of public health system to effectively serve minority populations and reduce health disparities.

http://azdhs.gov/phs/healthdisparities/

Arizona Health Equity Stakeholder Strategies January 2013



Key Drivers of Health Equity

Transformation

Drivers

Widespread,

Meaningful Use of HIT

Payment Reform

Performance

Accountability &

Transparency

Delivery Redesign

Innovation

Accountable Care Health Systems & Medical (Health)

Homes

Shared Reward and Risk Value Based Payment

Methods

“My concerns about the Affordable Care Act are well-known, but it is the law of the land. With this expansion, Arizona can leverage nearly $8 billion in federal funds over four years, save or protect thousands of quality jobs and protect our critical rural and safety-net hospitals.” -Governor Brewer, 2013 State of the State

Health Equity Starts with Access

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• $7.9 billion in federal funds over four years• $1.6 billion in the first year• Expand AHCCCS to 133 percent of the

federal poverty level ($14,856 for an individual)

• Add coverage for 240,000 and continue insuring 50,000 childless adults (coverage via Federal waiver expires at year’s end)

• Funded by local provider fee (on hospitals)

Covering Low Income Arizonans

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We all have a Role

• Send a clear, consistent, and powerful message to Arizona’s lawmakers that Medicaid Coverage proposal makes sense for Arizona. http://www.azahcccs.gov/publicnotices/MedicaidExpansion.aspx

• Coverage expansion requires providers– Healthcare workforce including Graduate Medical Education crisis– Telemedicine and eHealth expansion– Set the stage for 2014 with your organization

Your help is needed now

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http://www.azahcccs.gov/publicnotices/MedicaidExpansion.aspx

It is time to refocus, reinforce, and repeat the message that health disparities exist and that health equity benefits everyone.

--Kathleen G. Sebelius

Secretary, Health & Human Services

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Thank you!Anita C. Murcko, MD, FACP

[email protected]

mailto:[email protected]

http://www.cambiare.us/

Health Policy and Health Equity: Arizona Policy Perspectives Third Annual Latino Health Promotions...

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