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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 Nadia J. Siddiqui, MPH Senior Health Policy Analyst, Texas Health Institute Jonathan P. Purtle, MPH, MSc Program Manager, Drexel University School of Public Health 138th APHA Annual Meeting Denver, Colorado November 8, 2010 Click to edit and Background Master Purpose title style • With support from the Joint Center for Political and Economic Studies, we conducted a comprehensive review of the Patient Protection and Affordable Care Act of 2010: – To identify and describe provisions specific to race, ethnicity and language; and general provisions likely to have a significant affect on diverse populations. – To assess status, challenges and opportunities of health care reform provisions for improving the health and health care of racially and ethnically diverse populations. – To offer a template and user-friendly framework for documenting and tracking implementation timeline, appropriations and federal agency oversight responsibility. Click to editfor Framework Master Review title style General Priorities A. Health Insurance Reform Review of provisions addressing 12 key public health, health care system and health disparities priorities. B. Access to Health Care C. Quality Improvement D. Cost Containment E. Public Health Initiatives F. Social Determinants of Health Race, Ethnicity and Language-Specific Priorities A. Data Collection and Reporting by Race, Ethnicity & Language B. Workforce Diversity C. Cultural Competence Education and Organizational Support D. Health Disparities Research E. Health Disparities Initiatives in Prevention F. Addressing Health Disparities in Health Insurance Reforms Click to edit Master title style Click to edit General Provisions Master title style Health Insurance Reforms Sec. Improving Access to Care Require individual coverage 1501 Support for community health centers 10503 Expand Medicaid income eligibility to 133% FPL 2001 Nurse-managed health centers 5208 Community health teams 3502 Employer coverage requirement 1513 Redistribute Graduate Medical Education slots 5503 Extends authorization of National Health Services Corps 5207 Teaching community health centers 5508 Innovative models in Medicare/Medicaid 3021 1322 School-based health centers 4101 1311 Pilot projects for emergency & trauma care 3504 Increase federal matching rates for Medicaid Small business (<25 employees) tax credits Multi-state plan option Temporary high risk pools Consumer Operated and Oriented Plans (CO-OPs) State-based American Health Benefit Exchanges 2005 1421 10104 1101 Sec. Click to edit General Provisions Master(continued) title style Quality Improvement Sec. Cost Containment Sec. National Strategy for Quality Improvement 3011 Interoperable systems of enrollment 1561 Quality improvement technical assistance 3501 Reduce Medicaid DSH Payments 1203 Interagency Group on Healthcare Quality 3012 Reduce Medicare DSH Payments 2551 Develop, improve & evaluate quality measures 3013 Demonstration projects for HIT 6114 Link Medicare payments to quality outcomes 3001 Strengthening Medicaid drug rebate programs 2501 Pediatric Accountable Care Organizations 2706 Enhancing public program fraud screening 6401 Click to edit General Provisions Master(continued) title style Public Health & Prevention Sec. Social Determinants Sec. National Prevention & Public Health Council 4001 Health Impact Assessments 4003 4003 Prevention & Public Health Fund 4002 Childhood obesity demonstration projects Community Preventative Services Task Force to review/recommend interventions in social context 4306 National diabetes prevention program Community Transformation Grants 4201 10501 9007 5405 New methods for scoring prevention/wellness programs 4401 Non-profit hospital community needsassessment Education campaign for breast cancer 10413 Primary Care Extension Program Examples of Public Health Opportunities for Advancing Click to edit Master title style Health Equity through General Provisions • 4001. National Prevention and Public Health Council will provide coordination and leadership at the federal level for public health and other services to consider evidence-based models, policies and innovative approaches for transformative models of public health and prevention. • 4003. The CDC will convene an independent Community Preventive Services Task Force to review scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of community preventive interventions for the purpose of developing recommendations. Recommendations must address specific populations and social, economic and physical environments that can have broad effects on health disparities. • 4201. The CDC is authorized to award competitive Community Transformation Grants to State and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidencebased community preventive health activities to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities and develop a stronger evidence-base of effective prevention programming. Click to edit Master title style Click to Data Collection edit Master & Reporting title style Provisions Section No. Require population surveys to collect racial/ethnic sub-group data 4302 Collect/report disparities data in Medicaid and CHIP 4302 Monitor health disparities trends in federally-funded programs 4302 Example of Potential Public Health Obligation and Opportunity: 4302. No later than 2 years after the date of enactment of this title, any federally conducted or supported public health program, activity or survey must collect and report data on race, ethnicity, and primary language for applicants, recipients or participants. Data must be sufficient to generate statistically reliable estimates by racial, ethnic, or primary language subgroups. In collecting these data, the OMB standards for measurement of race, ethnicity and language must be used at a minimum. Click to editDiversity Workforce Master title style Provision Description Section No. Increase diversity among health care providers 5301, 5302, 5303, 5306, 5309 Health professions training on diversity and/or CLAS 5402, 5403, 4305, 5313, 5507 Investment in HBCU and minority-serving institutions 2104 Collect and publicly report data on workforce diversity 5001 Example of Potential Public Health Obligation and Opportunity: 5303. Grants to promote public health dentistry shall give priority to applicants with experience in minority training with emphasis on cultural competence and health literacy; and who have placements in areas that serve health disparities populations. Click to edit Cultural Competence Master title (CC)style Provision Description Develop, evaluate & disseminate model CC curricula CC training for health care providers Section No. 5307 5301, 5507 Loan repayment preference for experience in CC 5203 Federal agency role and support for CC 10334 Example of Potential Public Health Obligation and Opportunity: 5307. Cultural Competency, Prevention and Public Health Grants will be established to develop, evaluate and disseminate research, demonstration projects, and model curricula for cultural competency proficiency, prevention, public health proficiency and reducing health disparities. Click to4.edit Table Health Master Disparities title style Research Provision Description Section No. Patient-Centered Outcomes Research Institute (PCORI) to examine health disparities through CER 6301 Increase funding to Centers of Excellence 5401 Promote National Center for Minority Health and Health Disparities (NCMHHD) to Institute status 10334 Support research on topics disparities and cultural competence 5307, 2952, 4305 Example of Potential Public Health Obligation and Opportunity: 6301. PCORI will identify national priorities for research, addressing practice variation and health disparities in terms of delivery and outcomes of care and the potential for new evidence to improve patient health and quality of care. Click to5.edit Table Health Master Disparities title style & Prevention Provision Description Section No. National oral health campaign, with emphasis on disparities 4102 Standardized drug labeling on risks & benefits 3507 Maternal & child home visiting programs for at-risk pops. 2951 Culturally appropriate patient-decision aids 3506 CLAS personal responsibility education 2953 Support for preventive programs for AI/ANs 10221 Example of Potential Public Health Obligation and Opportunity: 4102. CDC will create a public education oral health campaign with a priority to address oral health disparities in a culturally and linguistically competent manner. Addressing Disparities in Health Insurance Click to edit Master title style Reforms Provision Description Section No. Remove cost-sharing for AI/ANs at or below 300% FPL 2901 Enrollment outreach targeting low-income populations 3306 CLAS/information through exchanges 1311 Nondiscrimination in federal health programs/Exchanges 1557 Require plans to provide information in "plain language” 1303 Incentive payments for reducing disparities 1303 Summary of coverage that is culturally/linguistically appropriate 1001 Claims appeal process that is culturally/linguistically appropriate 1001 Click to edit Master title style Click to editthe Advancing Master Healthtitle of style Communities 1. Leveraging support for community-based strategies and engagement in reducing disparities. • Communities must be active and involved participants in setting overall objectives, specific goals and strategies for achieving them. 2. Promoting integrated strategies across health and social services to improve the health of diverse communities. • Need for direct, concerted research, policy and programs that seek to alter significantly the negative influence of social determinants in diverse communities. Click toCare editOrganization-Based Master title style Initiatives Health 1. Developing and testing model programs that link specific organizational efforts to reducing disparities and improving quality of care. • Organizations must be committed to support practitioners through more comprehensive and active engagement in caring for diverse patients. 2. Documenting and linking non-profit community needs assessment/benefit requirements to health care reform incentives to address disparities. • Need to reach beyond demonstrations and funding opportunities. • Require provider organizations to show evidence of working to reduce disparities—e.g. through education & community outreach 3. Preserving and transitioning the health care safety net. • Providing direct support for safety net hospitals, particularly in regions with large uninsured and undocumented populations. • Guidance for philanthropic organizations on ways to support safety net. Click to edit Individual Level Master Initiatives title style 1. Developing effective care/disease management and self management interventions and protocols for diverse patients. • New programs will need to address how and to what extent inattention to race- and culture-specific and language/literacy concerns may create impediments to care management and self management. 2. Mitigating the effects of overweight/obesity and negative environmental factors that may impede progress on reducing disparities. • Greater health care provider awareness of culture and challenges faced by diverse populations will be important for reducing disparities in care and adherence to treatment. Click to edit Master title style Conclusions • Great breadth of opportunities in ACA to reduce disparities and improve health equity. • However, for many provisions, depth in terms of detail, strategy for implementation, methods for implementation, and measurement/evaluation to assess progress, is still lacking. • Allocations and federal agency roles, likewise, are unspecified for many provisions. – As of 8/1/2010, nearly two-thirds of the diversity specific provisions lacked specificity around appropriations and timeline – About one in ten includes short term, but no long term funding plan Click to edit Master title style What will a new Congress mean for public health efforts to eliminate racial/ethnic disparities and advance health equity through ACA? Click to Next Steps edit Master title style • Education around specific ACA language for priority areas. • Work with representative associations/organizations to educate and discuss strategies for pursuing priority areas. • Appropriations, appropriations, appropriations—assuring adequate funding for provisions. • Track timing and process for rollout. • Communicate with agencies likely to oversee identified 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 [email protected] Nadia J. Siddiqui, MPH Senior Health Policy Analyst, Texas Health Institute [email protected] Jonathan P. Purtle, MPH, MSc Program Manager, Drexel University School of Public Health [email protected] Lisa Duchon, PhD, MPA Health Management Associates [email protected] Click to edit Presenter Master Disclosures title style Dennis Andrulis, PhD, MPH The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose