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
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