HEALTHCARE REFORM

JILLIAN JACOBELLIS PH.D., MS

COLORADO DEPARTMENT OF PUBLIC HEALTH AND THE ENVIRONMENT

MOVING CHRONIC DISEASE PREVENTION FORWARD IN AN ERA OF REFORM

NATIONAL HEALTH REFORMS OPPORTUNITIES FOR PUBLIC HEALTH

HEALTH REFORM

ACCOUNTABLE CARE ORGANIZATIONS

PREVENTION AND PUBLIC HEALTH FUND (TITLE IV, SEC 4002)

CLINICAL AND PUBLIC HEALTH INTEGRATION

IMPLICATIONS FOR THE PUBLIC’S HEALTH

COMMUNITY TRANSFORMATION GRANTS

A YEAR OF THREATS PREVENTION AND WELLNESS FUND

WHAT ABOUT COLORADO ‘S INSURANCE COVERAGE?

COVERAGE AFTER IMPLEMENTATION OF THE FEDERAL ACT IN COLORADO

800,000

258,000

175,000 153,000 214,000

Source: Colorado Health Institute, “Helping communities prepare for health reform: Coverage estimates of Coloradans after implementation”

Employer-sponsored insurance

62.5%

Medicare 1.4%

Medicaid 9.4%

Other private insurance

9.2%

Currently EBNE (Medicaid/CHP+)

13.7%

Will gain eligibility (Medicaid/CHP+)

30.4%

Will be eligible for federal subsidies

34.1% Ineligible for subsidies*

21.7% Uninsured

17.5%

COLORADANS, AGE 0-64, BY INSURANCE STATUS

Source: CHI analysis of the 2009 American Community Survey

*Ineligible for subsidies includes undocumented non-citizens, documented non-citizens in the US for less than 5 years, and citizens and non-citizens >400% of FPL

POST REFORM INSURANCE STATUS BY FPL

39%

51%

31%

28%

18%

12%

12%

9%

-

100,000

200,000

300,000

400,000

500,000

600,000

Newly insured 543,000 Remaining uninsured 258,000

401% and greater

251 to 400%

134 to 250%

0 to 133%

Source: Colorado Health Institute, “Helping communities prepare for health reform: Coverage estimates of Coloradans after implementation”

RESULT = MORE PEOPLE INSURED

PRIORITIES

AMONG EFFECTIVE CLINICAL

PREVENTIVE SERVICES

1. Aspirin chemoprophylaxis 2. Childhood immunization series

3. Tobacco use screening and brief intervention

4. Colorectal cancer screening 5. Hypertension screening

6. Influenza immunization

7. Pneumococcal immunization

8. Problem drinking screening and brief counseling 9. Vision screening – adults

10. Cervical cancer screening Maciosek MV, et al. Priorities among effective clinical services: results of a systematic review and analysis. Am J prev Med 2006;31:52-61

CDC EXPECTATIONS OF STATES

Chronic Disease Prevention Programs: •Leadership •Surveillance and Epidemiology •Communication and Media •Policy and Environmental Change •Engagement with health systems •Provide TA to communities. •Address multiple CDs and risk factors simultaneously

CDC’ EXPECTATION OF STATES: FOUR FOCUS AREAS

CDC WINNABLE BATTLES AREAS

EXPANDED ROLE FOR PUBLIC HEALTH IN SCREENING PROGRAMS

BREAST CANCER DISPARITIES

IMPLICATIONS FOR SCREENING PROGRAMS

BUILD ON CANCER SCREENING INFRASTRUCTURE AND HISTORY OF

COLLABORATION

WE ARE USING EVIDENCE-BASED INTERVENTIONS

SCREENING PROGRAM COMPONENTS

POLICY IMPLICATIONS

DISCUSSION AND QUESTIONS