Advancing Health Equity through State Implementation of Health Reform
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Advancing Health Equity through State Implementation of Health Reform

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The Affordable Care Act (ACA) provides opportunities for states to make lasting ...

The Affordable Care Act (ACA) provides opportunities for states to make lasting
and comprehensive systems change in their approaches to achieving health equity
for their most vulnerable populations. Through provisions in areas such as coverage
and access, prevention, care coordination, population health, and quality and efficiency,
the Act offers state policymakers a broad range of policy levers for improving health care
and the health status of their racial and ethnic minority populations.
With support from the Aetna Foundation, the National Academy for State Heath Policy is hosting a
webinar to highlight the opportunities presented by health care reform to advance state health equity
agendas. In addition to featuring national health equity experts and information on how states are
using the ACA to achieve health equity, this webinar will announce the NASHP State Health Equity
Learning Collaborative, an initiative to help state policymakers maintain momentum towards achieving
health equity while implementing federal health care reform.

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Advancing Health Equity through State Implementation of Health Reform Advancing Health Equity through State Implementation of Health Reform Presentation Transcript

  • Advancing Health Equity through Health Reform Implementation Thursday, July 21, 2011 This webcast will begin at 2:00 P.M. EDT Please hold until we start the conference.The audio portion of this webcast can be accessed by dialing: 800.757.7641
  • Agendan  Welcome and Introductions ¡  Diane Justice, MA, Senior Program Director, National Academy for State Health Policy (NASHP) ¡  Dr. Anne C. Beal, MD, MPH, President, Aetna Foundationn  National Healthcare Quality and Disparities Reports and State Disparities ¡  Dr. Ernest Moy, MD, MPH, Medical Officer, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality (AHRQ)n  State Obligation and Opportunity in Health Care Reform: Implementing the Affordable Care Act to Advance Health Equity for Racially and Ethnically Diverse Populations ¡  Dr. Dennis P. Andrulis, Ph.D., MPH, Senior Research Scientist, Texas Health Institute; Associate Professor, University of Texas School of Public Health
  • Agenda (cont.)n  ACA Implementation and Health Equity: Experiences from Maryland ¡  Dr. Carlessia A. Hussein, Dr.PH, RN, Director, Office of Minority Health and Health Disparities, Maryland Department of Health and Mental Hygienen  State Health Equity Learning Collaborative: Request for Applications for Technical Assistance ¡  Diane Justice, MA, Senior Program Director, NASHPn  Questions and Answers
  • About NASHPn  22 year old non-profit, non-partisan organizationn  Academy members ¡  Peer-selected group of state health policy leaders ¡  Commitment to identifying state needs and guiding our workn  Working together across states, branches, and agencies to advance, accelerate, and implement workable policy solutions that address major health issues
  • Advancing Equity through StateImplementation of Health Reformn  Supported by the Aetna Foundationn  Project goals include: ¡  Supporting state leadership for eliminating disparities and advancing health equity through health care reform implementation ¡  Establishing a State Health Equity Learning Collaborative ¡  Facilitating a National Invitational Health Equity Summit ¡  Publishing a State Policymakers Action Agenda for Achieving Health Equity through Health Reform
  • National Healthcare Quality and Disparities Reports and State Disparities Ernest Moy Ernest.moy@ahrq.hhs.gov 301-427-1329 www.ahrq.gov/qual/qrdr10.htm http://statesnapshots.ahrq.gov
  • National Healthcare Reports Annual reports to Congress from Secretary since 2003 mandated by 1999 Healthcare Research and Quality Act Unified team, Interagency Work Group, framework, data, methods, quality measures Quality Report Disparities ReportSnapshot & trends in quality of Snapshot & trends inhealth care in America disparities in health careEffectiveness, safety, timeliness, Differences across race,patient centeredness, care ethnicity, & socioeconomiccoordination, efficiency, health statussystem infrastructure, accessVariation across states Variation across populations
  • State Snapshots: Overall Health Care Quality for California
  • State Snapshots: CaliforniaDashboard Compared to All States
  • Racial/Ethnic Diversity Across States
  • Hispanic-White Disparity in Colorectal Cancer Screening across States30 Worst States25 All State Average2015 Best States10 5 0 B e st S ta te s Wo rst S ta te s -5-10-15
  • Black-White Disparity in Colorectal Cancer Screening across States30 Worst States252015 All State Average10 5 0 B e st S ta te s A ll   S ta te A v e ra g e Wo rst S ta te s -5-10 Best States-15
  • Weak Relationship between Overall Receipt of Colorectal Cancer Screening and Hispanic-White Differences
  • Weak Negative Relationship between Overall Receipt ofColorectal Cancer Screening and Black-White Differences
  • Mountain West North Central New England East North Poorer Overall Quality Central of Preventive Care Middle Atlantic DC PR VIPacific South Atlantic East South West Central South Central Mountain West North Central New England East North Central Middle Atlantic DC PR VI PacificLarger Racial or Ethnic East South Atlantic Disparities in West South Central South Central Preventive Care
  • State Snapshots:California Focus on Disparities
  • Conclusionsn  State need to address disparities –  Different populations –  Different disparitiesn  Disparities can help States –  Identify strategies –  Target populations and servicesn  States are succeeding at reducing disparities
  • Click to edit Master title style Dennis  P.  Andrulis,  PhD,  MPH   Senior  Research  Scien-st,  Texas  Health  Ins-tute   Associate  Professor,  University  of  Texas  School  of  Public  Health      
  • Background Master titleClick to edit and Purposestyle•  With  support  from  the  Joint  Center  for  Poli3cal  and   Economic  Studies,  we  conducted  a  comprehensive  review   of  the  Pa3ent  Protec3on  and  Affordable  Care  Act  of  2010:   –  To  iden3fy  and  describe  provisions  specific  to  race,  ethnicity  and   language;  and  general  provisions  likely  to  have  a  significant  affect  on   diverse  popula3ons.   –  To  assess  status,  challenges  and  opportuni3es  of  health  care  reform   provisions  for  improving  the  health  and  health  care  of  racially  and   ethnically  diverse  popula3ons.  •  We  have  also  tracked  implementa3on  status  and  progress   for  provisions  with  explicit  requirements  for  linguis3c  and   cultural  competence.    
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  • Cultural Competence & WorkforceDiversityClick to edit Master title style•  Cultural  Competence   –  Model  cultural  competence  curricula.   –  Cultural  competence  training  for  health  professionals.   –  Culturally  appropriate  pa3ent  decision  aids.   –  Culturally  appropriate  personal  responsibility  educa3on  for  teen   pregnancy  preven3on.   –  Culturally  appropriate  na3onal  oral  health  campaign.    •  Workforce  Diversity   –  Increase  diversity  among  health  professionals.   –  Health  professions  training  preference  for  cultural  competence.   –  Investment  in  HBCUs  &  minority-­‐serving  ins3tu3ons.   –  Collect  &  report  workforce  diversity  data.  
  • Data Collection & DisparitiesClick to edit Master title style Research•  Data  Collec3on  &  Repor3ng   –  Collect  racial/ethnic  sub  group  data  in  popula3on  surveys.   –  Collect/report  dispari3es  data  in  Medicaid  &  CHIP.   –  Monitor  dispari3es  trends  in  federally  funded  programs.  •  Health  Dispari3es  Research   –  Examining  dispari3es  through  compara3ve  effec3veness   research.   –  Suppor3ng  research  on  topics  of  cultural  competence  and   health  dispari3es.  
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  • General ProvisionsClick to edit Master title style•  Expansion  of  Medicaid  eligibility  to  133%  FPL  •  Reauthoriza3on  of  CHIP  •  Small  business  (<25  employees)  tax  credits  •  State-­‐based  Insurance  Exchanges  •  Community  Health  Center  support  •  Demonstra3on  programs  for  na3onal   priori3es    
  • General ProvisionsClick to edit Master title style•  Expanding  and  building  a  diverse  workforce  •  Requiring  non-­‐profit  hospital  community   needs  assessments  •  Expanding  the  focus  on  quality  through  linking   Medicare  payments  to  outcomes,  quality   measures  development,  a  na3onal  strategy   for  quality  improvement  and  other  efforts  
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  • HighlightsClick to edit Master title style•  Great  breadth  of  opportuni3es  in  ACA  to  reduce  dispari3es  and   improve  health  equity.  •  Federal  agencies,  generally  assigned  leading  responsibility  for   advancing  and  implemen3ng    disparity  and  cultural  competence   provisions.  •  Many  provisions  with  requirements  related  to  equity,  cultural   competence  and  language  assistance  have  received  appropria3ons   and  offer  opportuni3es  for  states  and  state  agencies  to  pursue   funding.  •  Other  important  race/culture/language  provisions,  however,  have   not  received  appropria3ons  as  yet.      
  • Funded Opportunities:Health edit Master titleClick toInsurance Programs style•  State  Health  Insurance  Exchanges   –  State  planning  and  establishment  grants,  with  requirements  for   cultural  &  linguis3c  competence  in  benefit  summaries,  appeals   processes,  and  other  provisions  related  to  health  plans.   •  Non-­‐discrimina3on  in  health  insurance  exchanges.   •  Culturally  &  linguis3cally  appropriate  summary  of  benefits.   •  Culturally  &  linguis3cally  appropriate  claims  appeal  process.   •  Navigator  to  provide  culturally  &  linguis3cally  appropriate  informa3on.   •  Incen3ve  payments  for  cultural  competence  &  reducing  dispari3es.  •  State  Office  of  Consumer  Health  Assistance   –  Federal  grants  to  states  to  establish  an  Office  of  Health  Insurance   Consumer  Assistance  or  an  Ombudsman  Program.  
  • Funded Opportunities:Community Health and PreventionClick to edit Master title style•  Community  TransformaBon  Grants   –  Over  $100  million  for  75  grants  to  help  communi3es  implement  projects  proven   to  reduce  chronic  diseases  as  well  as  health  dispari3es.    •  Personal  Responsibility  EducaBon     –  $75  million  for  states  in  2011  to  educate  youth  in  culturally/linguis3cally   appropriate  ways  to  prevent  teen  pregnancy  and  sexually  transmifed  infec3ons.      •  CHIP  Childhood  Obesity  DemonstraBon   –  $25  million  in  FY  2011  to  develop  a  model  for  reducing  childhood  obesity.  •  Medicaid  PrevenBon  and  Wellness  IniBaBves   –  State  grants  to  provide  incen3ves  for  Medicaid  beneficiaries  to  par3cipate  in   evidence-­‐based  programs  to  prevent/manage  chronic  disease.  $100  million  for   5-­‐year  period  from  FY  2011-­‐2016.    
  • Funded Opportunities:Improving Quality and EfficiencyClick to edit Master title style•  Medicaid  Integrated  Care  HospitalizaBon  DemonstraBon   –  Up  to  8  states  to  use  bundled  payments  to  promote  integrated  care.  •  Pediatric  Accountable  Care  OrganizaBon  DemonstraBon   –  Allow  pediatric  providers  to  organize  as  ACOs  and  share  in  federal  and  state   cost  savings  generated  under  Medicaid.  
  • Funded Opportunities:Access to Health Care & Support for SafetyNetClick to edit Master title style•  Grants  for  Trauma  Care  Centers   –  Grants  to  states  to  support  universal  access  to  trauma  care  services.  $100   million  per  FY  2010-­‐2015.    States  must  award  at  least  40%  to  safety  net   ins3tu3ons.  •  Primary  Care  Extension  Program   –  $120  million  in  2011  to  establish  program  to  support  and  assist  primary  care   providers  to  improve  community  health.    •  State  Health  Care  Workforce  Development  Grants   –  Up  to  $150,000  per  state  partnership  for  carrying  out  planning  and   implementa3on  of  health  care  workforce  development.   –  25  states  received  planning  grants  and  1  with  an  implementa3on  grant  in  2010.  •  Maternal,  Infant  and  Early  Child  Home  VisiBng  Programs   –  $1.5  billion  for  FY  2010-­‐2014,  for  home  visi3ng  programs  for  at-­‐risk  popula3ons.    
  • Caution!Click to edit Master title styleNotwithstanding  these  access  and  safety  net  ini3a3ves:    •  $18  billion  reduc3on  in  Medicaid  Dispropor3onate   Share  payments  over  7  years  creates  great   uncertainty  for  the  future  of  safety  net  hospitals.    •  State  budget  deficits  may  undermine  efforts  to   sustain  the  safety  net  and  improve  access.        
  • Unfunded Opportunities:Click to edit Master title styleCommunity Health & Prevention•  Community-­‐Based  PrevenBon  and  Wellness  Programs     –  Grants  to  state/local  health  depts.  to  carry  out  5-­‐year  pilot  programs   for  Medicare  beneficiaries.    •  Community  Health  Teams  (CHTs)   –  As  states  adopt  medical  home  models,  more  low  income  &  diverse   individuals  with  chronic  illness  will  be  able  to  turn  to  a  CHT  to  help   them  link  with  a  full  range  of  health  and  social  services  they  may  need.  •  Community  Health  Workers  (CHWs)   –  Use  of  CHWs  in  health  interven3on  programs  associated  with   improved  access,  prenatal  care,  pregnancy  and  birth  outcomes,  health   status,  screening  behaviors  &  reduced  health  care  costs.    •  ImmunizaBon  DemonstraBon  Program   –  Grants  for  immuniza3on  programs  for  at-­‐risk  popula3ons.  
  • Unfunded Opportunities:Cultural CompetenceClick to edit Master title style•  Model  Curricula  for  Cultural  Competency   –  Opportunity  to  test  impact  of  a  range  of  cultural  competency  training   programs    on  health  outcomes  and  to  iden3fy  efficacy  &  effec3veness.  •  FacilitaBng  Shared  Decision  Making   –  Pa3ent  decision  aids  are  required  to  present  up-­‐to-­‐date  clinical   evidence  about  risks  and  benefits  of  treatment  op3ons  to  meet   cultural  &  health  literacy  requirements  of  popula3ons.  
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  • Advancing the Health of CommunitiesClick to edit Master title style 1.  Leveraging  support  for  community-­‐based  strategies   and  engagement  in  reducing  dispariBes.       •  Communi3es  must  be  ac3ve  and  involved  par3cipants  in  sekng   overall  objec3ves,  specific  goals  and  strategies  for  achieving  them.   2.      PromoBng  integrated  strategies  across  health  and   social  services  to  improve  the  health  of  diverse   communiBes.     •  Need  for  direct,  concerted  research,  policy  and  programs  that  seek  to   alter  significantly  the  nega3ve  influence  of  social  determinants  in   diverse  communi3es.  
  • Health Care Organization-BasedInitiativesClick to edit Master title style1.      Developing  and  tesBng  model  programs  that  link  specific   organizaBonal  efforts  to  reducing  dispariBes  and  improving   quality  of  care.   •  Organiza3ons  must  be  commifed  to  support  prac33oners  through  more   comprehensive  and  ac3ve  engagement  in  caring  for  diverse  pa3ents.    2.      DocumenBng  and  linking  non-­‐profit  community  needs   assessment/benefit  requirements  to  health  care  reform   incenBves  to  address  dispariBes.       •  Need  to  reach  beyond  demonstra3ons  and  funding  opportuni3es.   •  Require  provider  organiza3ons  to  show  evidence  of  working  to  reduce   dispari3es—e.g.  through  educa3on  &  community  outreach  3.      Preserving  and  transiBoning  the  health  care  safety  net.   •  Providing  direct  support  for  safety  net  hospitals,  par3cularly  in  regions  with   large  uninsured  and  undocumented  popula3ons.   •  Guidance  for  philanthropic  organiza3ons  on  ways  to  support  safety  net.  
  • Individual Level InitiativesClick to edit Master title style 1.  Developing  effecBve  care/disease  management  and  self   management  intervenBons  and  protocols  for  diverse   paBents.     •  New  programs  will  need  to  address  how  and  to  what  extent   inafen3on  to  race-­‐  and  culture-­‐specific  and  language/literacy   concerns  may  create  impediments  to  care  management  and  self   management.       2.  MiBgaBng  the  effects  of  overweight/obesity  and  negaBve         environmental  factors  that  may  impede  progress  on   reducing  dispariBes.     •  Greater  health  care  provider  awareness  of  culture  and  challenges   faced  by  diverse  popula3ons  will  be  important  for  reducing   dispari3es  in  care  and  adherence  to  treatment.  
  • Next StepsClick to edit Master title style•  Educa3on  around  specific  ACA  language  for  priority  areas.  •  Work  with  representa3ve  associa3ons/organiza3ons  to   educate  and  discuss  strategies  for  pursuing  priority  areas.  •  Advocate  for  state,  county  and  community  innova3on  in   health  equity  and  reducing  dispari3es.    •  Appropria3ons,  appropria3ons,  appropria3ons—assuring   adequate  funding  for  provisions.    •  Communicate  with  agencies  likely  to  oversee  iden3fied   priority  areas  about  status  and  progress  in  adding  content  to   these  areas.  
  • Click to edit Master title style Dennis P. Andrulis, PhD, MPH Senior Research Scientist, Texas Health Institute Associate Professor, University of Texas School of Public Health dpandrulis@gmail.com Nadia J. Siddiqui, MPH Senior Health Policy Analyst, Texas Health Institute nsiddiqui@texashealthinstitute.org Jonathan P. Purtle, MPH, MSc Program Manager, Drexel University School of Public Health jpp46@drexel.edu Lisa Duchon, PhD, MPA Health Management Associates lduchon@healthmanagement.com *Download publication here*
  • ACA Implementation and HealthEquity: Experiences from Maryland Dr. Carlessia A. Hussein, Dr.PH, RN, Director Office of Minority Health and Health DisparitiesMaryland Department of Health and Mental Hygiene
  • State Health Equity LearningCollaborative: Request for Applicationsfor Technical Assistance Diane Justice, MA Senior Program Director National Academy for State Health Policy (NASHP)
  • What is it?n  Opportunity for states to advance health equity agendas while engaging in critical health care reform implementation activitiesn  Structured peer-learning opportunity to integrate health equity initiatives across state agencies – specifically Medicaid, Public Health and Minority Health Officesn  Collaborative will consist of seven competitively selected states working in key policy areas: ¡  Health insurance coverage ¡  Delivery system reform ¡  Public health
  • What s in it for States?n  Participating states will: ¡  Receive a customized State Health Equity Profile developed by NASHP ¡  Work across state teams to develop a state health equity work plan ¡  Collaborate with peer states through an online community portal ¡  Receive technical assistance from national health equity experts ¡  Opportunity to attend and present at a National Invitational Health Equity Summit
  • State Requirementsn  Maintain a core team of at least three members from state agenciesn  Develop a state health equity work plann  Participate in all TA activitiesn  Achieve reasonable implementation of state work plann  Review NASHP products as requestedn  Update work plan at end of 8-month TA period
  • Process: Request for ApplicationsJuly 21, 2011 Issue Requests for Applications Accessible at www.nashp.orgAugust 9, 2011 Prospective Applicant Call3:00 pm EDT Call-in: 866-640-1260, Passcode: 3938541August 23, 2011 Applications Due to NASHPSeptember 9, 2011 Selected States are NotifiedOctober 7, 2011 Work Plan Due to NASHPMarch 2012 National Summit in Washington, DCMay 2012 Final Report Due: State Work Plan UpdateOngoing Participation in Technical Assistance Activities
  • n  Statereforum.org is a space for: ¡  Peer-to-peer learning and discussion ¡  Exchanging reform ideas ¡  Posting, organizing, and sharing useful state documents ¡  Announcing off-line events and activities ¡  Spotlighting the keys to successful implementation ¡  Mapping states progress in implementing health reform
  • Questions and Answers?
  • Contact Informationn  Dr. Ernest Moy ¡  ernest.moy@ahrq.hhs.govn  Dr. Dennis Andrulis ¡  dpandrulis@gmail.comn  Dr. Carlessia A. Hussein ¡  husseinc@dhmh.state.md.usn  Diane Justice ¡  djustice@nashp.org
  • Thank You!For more information, please visit: www.nashp.org www.aetna-foundation.org www.statereforum.org