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Affordable Care Act: Implications for Public Health and Physicians
The document discusses the implications of the Affordable Care Act (ACA) on public health and physicians, outlining its goals of improving healthcare access, quality, and cost-effectiveness. It highlights the changes brought about by health reform, including Medicaid expansion and an increased focus on preventive care, alongside the Healthy Chicago agenda. Furthermore, it emphasizes the importance of technology and data in enhancing healthcare delivery and community health outcomes.
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Affordable Care Act: Implications for Public Health and Physicians
- 1. Affordable Care Act: ChicagoDepartment of Public Health Implications for Public Health and Physicians Empowering Future Physicians Conference October 27, 2012 Bechara Choucair, MD Commissioner Chicago Department of Public Health @choucair on Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
- 2. Presentation Outline • AffordableCare Act Overview • Connection with Public Health and Medical Practice Foundations • Effects of Health Reform on Public Health and Physicians • Healthy Chicago Agenda
- 3. Patient Protection and Affordable Care Act (ACA) • Signed into law on March 23, 2010 • Main Goals: – Ensure more Americans have access to health care – Improve quality of healthcare – Reduce costs of health care and budget deficit – Increase preventive efforts
- 4. Patient Protection and Affordable Care Act (ACA) • Implemented through: – Mandates – Tax credits – Required health insurance company policy changes – Increased funding for prevention – Other increased funding
- 5. Presentation Outline • AffordableCare Act Overview • Connection with Public Health and Medical Practice Foundations • Effects of Health Reform on Public Health and Physicians • Healthy Chicago Agenda
- 6.
- 7. Physician Competency Framework Adoptedby the Royal College of Physicians and Surgeons in Canada in 1996
- 8. Presentation Outline • AffordableCare Act Overview • Connection with Public Health and Medical Practice Foundations • Effects of Health Reform on Public Health and Physicians • Healthy Chicago Agenda
- 9. Effects of HealthReform on Public Health and Physicians • Changes in Health Insurance Coverage • Technology and Data • Focus on Prevention and Public Health • Innovation
- 10. Increased Access toInsurance • State Health Insurance Exchange: – U.S. citizens and legal residents can purchase – Small employers can purchase insurance for their workers • Enrollment begins October 2013; Coverage in January 2014 • Administered at the State level and operated either: – By the state – In partnership with US Department of Health and Human Services, or – By the US Department of Health and Human Services
- 11. Increased Access toInsurance • Navigators will be funded to inform consumers and help them enroll • Other provisions: – Young adults up to age 26 can continue on parent’s insurance – No life-time or annual limits on coverage – No exclusion due to pre-existing conditions – No gender rating
- 12. Essential Health Benefits •Ambulatory care • Preventive and wellness • Emergency care services and chronic • Hospitalization disease management • Pediatric services, • Maternity and newborn care including oral & vision • Mental health & substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services
- 13. Medicaid Expansion • Statescan expand Medicaid to U.S. residents living at or below 138% of federal poverty level • Expansion will cover adults without dependent children • States reimbursed at 100% of costs for first 2 years • Pregnant women and children are usually covered at higher levels
- 14. Consumer Cost Savings •Women can now obtain preventive screenings with no cost-sharing • Medicare recipients can receive annual physical with no cost-sharing • The Medicare prescription coverage gap (i.e., “donut hole”) will be eliminated, saving seniors from paying all costs out-of-pocket between their yearly coverage limit and the catastrophic cap.
- 15. Implications for InsuranceCoverage For Physicians: For Public Health: ˖ Better patient outcomes: ˖ Healthier communities • Patients seeking care sooner • Increased access to • Coverage for preventive preventive and primary care screenings • Improved chronic disease ˖ Improved payor mix management • More insured patients ˗ No health insurance ˗ Insufficient workforce to options for non-US citizens/legal residents treat all newly insured ˗ HIE basic health plans may not cover all needed services
- 16. Effects of HealthReform on Public Health and Physicians • Changes in Health Insurance Coverage • Technology and Data • Focus on Prevention and Public Health • Innovation
- 17. Technology and Data •Improved access to data through innovative technology – Electronic health records – Electronic laboratory reporting • Health Reform using provider incentives (“Meaningful Use”) to obtain public health data — Immunization rates — Reportable diseases — Syndromic surveillance
- 18. Health Information Exchange “Health information exchange (HIE) refers to the sharing of clinical and administrative data across the boundaries of health care institutions, health data repositories, and States.” Agency for Healthcare Research and Quality
- 19. Implications of Technologyand Data For Physicians: For Public Health: • Coordinated and cost- • More efficient and efficient care comprehensive – Duplicative tests surveillance capabilities – Administrative costs • Improved – Improved clinical understanding of public management health conditions
- 20. Effects of HealthReform on Public Health and Physicians • Changes in Health Insurance Coverage • Technology and Data • Focus on Prevention and Public Health • Innovation
- 21. Focus on Prevention •Public health responsible for 80% of increase in US life expectancy • ACA established National Prevention, Health Promotion and Public Health Council – National Prevention Strategy priorities: • Tobacco-free living • Prevention of drug abuse & excessive alcohol use • Healthy Eating • Active Living • Injury and violence-free living • Reproductive and sexual health • Mental and emotional well-being • CDPH Healthy Chicago Agenda
- 22. Prevention and PublicHealth Fund • Goal: To provide stable and increased investment in prevention • First-ever fund dedicated to prevention & public health with total investment of $15 million • Funded at $500 million in 2010; up to $2 billion in 2022 • Funds efforts in: - Community prevention - Clinical Prevention - Public health workforce - Research and Tracking • Chicago: $14.9 million for obesity prevention, HIV prevention, immunization, tobacco, performance management, and surveillance capacity.
- 23. Premature Deaths andRelated Grant 30% Funding, Chicago 25% 20% 15% 10% 5% 0% Heart Disease Cancer Tobacco Use Violence Healthy HIV Prevention Communicable Healthy Homes and Stroke Disparities Prevention Mothers and Disease Babies Control and Prevention Deaths before 75 (2004-2008) 2012 Funding
- 24. Chicago’s Funding Awardsto Date Grant Amount Prevention & Public Health $14,970,000 Community Health Centers $32,860,000 Strengthen Workforce $5,806,000 Innovation Grant $6,078,000
- 25. Community Transformation Grants •Funds community-level interventions to reduce rates of chronic, preventable diseases • State of Illinois received $24M CTG in 2011 • Chicago Public Schools, in collaboration with CDPH, received a $4.4 million grant to fund Healthy CPS – Reduce tobacco use – Increase physical activity – Decrease weight – Improve nutrition – Improve emotional well-being
- 26. Implications of PreventionFunding For Physicians: For Public Health: • Integrative models of care • New and dedicated funding – Primary care into for key public health efforts behavioral heath settings • Substantial investment in • Workforce development chronic disease prevention – Primary care workforce • Funding for epidemiology – National Health Service and lab capacity efforts Corps • Expansion safety net • FQHC Medical Expansion to through FQHC funding serve more patients
- 27. Effects of HealthReform on Public Health and Physicians • Changes in Health Insurance Coverage • Technology and Data • Focus on Prevention and Public Health • Innovation
- 28. Center for Medicareand Medicaid Innovation • Established in 2010 to test innovative payment and delivery models that reduce expenditures for Medicare, Medicaid and the Children’s Health Insurance Program, while improving or maintaining care quality • Provide more cost-effective health care by shifting from “paying for volume” to “paying for value”
- 29. Models of Paymentand Care Delivery • Models that are mandated or have been promoted by policy experts • Models that demonstrate compelling approaches – Innovation Challenge funds grants between $1- $30 million • Models currently being tested include: – Accountable Care Organizations – Initiatives for dual-eligible beneficiaries – Bundled payments
- 30. Implications of InnovationEfforts For Physicians: For Public Health: • Incentive payments • Cost savings could fund more primary care and • Funding to test system prevention redesign • Models that monitor care improve: • Opportunities to expand – Quality and outcomes partnerships – Coordination among providers and systems • Creates culture of innovative thinking
- 31. Presentation Outline • AffordableCare Act Overview • Connection with Public Health and Medical Practice Foundations • Effects of Health Reform on Public Health and Physicians • Healthy Chicago Agenda
- 32. HEALTHY CHICAGO CHICAGO DEPARTMENT OF PUBLIC HEALTH TRANSFORMING THE Chicago Department of Public Health HEALTH OF OUR CITY CHICAGO ANSWERS THE CALL Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
- 33. Healthy Chicago Overview •Released in August 2011 as the first comprehensive city-wide public heath agenda • Provides a blueprint for public health action in Chicago • 12 priorities; 192 strategies • Strategies cover areas of: – Policy – Programs – Education and Awareness
- 34. HEALTHY CHICAGO Chicago Departmentof Public Health Infrastructure
- 35. Alignment of ACAand Healthy Chicago Prevention Efforts Healthy ACA Chicago National Healthy Prevention Chicago Strategy Agenda National Inter-agency Prevention Council Council Guiding Guiding Principles Principles
- 36. Alignment of GuidingPrinciples • Focus on issues and strategies with measurable outcomes • Strategies informed by evidenced-based and promising practices • Commitment to health equity and the elimination of disparities • Diverse partnerships • Focus on policy, systems, and environmental change
- 37. Priority: Access toCare ACA, including Medicaid Expansion will help Healthy Chicago to reach its targets and conduct its strategies Targets: Strategies • Increase the number of • Advocate for FQHC Chicagoans receiving sustainability and Medicaid integration of behavioral • Increase FQHC patients and primary care • Improve mental health • Collect and analyze data collaborations and reflective of heath care service capacity system changes
- 38. Accomplishment: School-based Oral HealthServices CDPH’s School-Based Oral Health Program provided over 113,000 Chicago Public School students with oral health care, and placed over 300,000 dental sealants on 65,000 students.
- 39. Priority: Healthy Mothersand Babies ACA improved insurance coverage for women’s preventive care and breastfeeding support Targets: Strategies • Reduce infant mortality • Pass a City ordinance rate, especially among prohibiting discrimination Black infants of breastfeeding in public • Reduce percentage of • Conducting 16,000 home low birthweight babies visits annually to pregnant • Increase percentage of women and new mothers WIC infants still breast • Implement campaign on fed at 6 months nutrition during pregnancy
- 40. Accomplishment: Baby-Friendly Hospitals 14 Chicago hospitals are participating in the Baby- Friendly Hospital Initiative to support breastfeeding and increase breastfeeding rates
- 41. Priority: Tobacco Use Tobacco-freeliving is one of the National Prevention Strategy’s priorities Targets: Strategies • Reduce smoking • Passed City ordinance to prevalence among adults prohibit tobacco vending • Reduce smoking machines prevalence among youth • Support 750 undercover stings to tobacco vendors to prevent sales to minors • Create smoke-free parks through adoption of Park District’s smoke-free policy
- 42. Accomplishments: Smoke-free & Tobacco-freePolicies Smoke-free • Over 3,250 units of private housing • Over 1,600 units of public housing Tobacco-free • 5 hospital campuses • 3 higher education campuses • 6 substance abuse & mental health service agencies
- 43. Priority: Obesity Prevention TheNational Prevention Strategy identifies healthy eating and active living as prevention priorities Targets: Strategies: • Reduce adult and • Implement healthy vending childhood obesity machine policy for City of • Decrease proportion of Chicago youth and adults • Develop toolkit for faith-based consuming <5 servings of and community groups to fruits and vegetables promote healthy food and • Reduce food desserts physical activity • Develop Integrated Food Space Plan
- 44. Accomplishments: Obesity Prevention • Healthy Produce Carts • Healthy Corner Stores • PlayStreets
- 45. Priority: Public HealthInfrastructure Supported by the focus on Technology and Data and increased funding through the Prevention and Public Health Fund Targets: Strategies • Prepare residents and • Strengthen epidemiology providers for emergencies capacity by growing • Use technology for disease program tracking, data dissemination, • Participate on Health and implementation of Information Exchange interventions advisory committees • Improve effectiveness • Strengthen performance through Performance management Management
- 46. Accomplishments: Public Health Infrastructure • First large city health department to submit documents for Public Health Accreditation • Maintain 18 public health data files on City of Chicago’s open data portal
- 47. Cross-cutting Accomplishments: Engaging Diverse Partners • City of Chicago Departments • LISC-Chicago community leaders • LGBT Partners • Chicago Public Schools: “Healthy CPS”
- 48.