Transcript Changes in our Healthcare System: Thoughts for Complementary and Integrative Health Care (CIHC) American Public Health Association 140th Annual Meeting & Exposition October 30, 2012

Changes in our Healthcare System:
Thoughts for Complementary and
Integrative Health Care (CIHC)
American Public Health Association
140th Annual Meeting & Exposition
October 30, 2012 – San Francisco
Janet R. Kahn, Ph.D., NCTMB
University of Vermont. Dept. of Psychiatry
Member, Advisory Group on Prevention, Health Promotion
and Integrative and Public Health
DONNA M. FEELEY, MPH, RN, CMT, NCTMB
Affordable Care Act 101
• Imperfectly…yet to an unprecedented degree,
this law:
– Offers some opportunities for CIHC
– Reflects the values of CIHC
• Like many laws, the ACA is subject to
interpretation, thus
– the key to our opportunities lies in
rulemaking/implementation and our involvement in
that
Overview
• Public Health reframed through the
National Prevention, Health Promotion and
Public Health Council + Fund + Advisory
Group + Community Transformation Grants
• Other elements of ACA with potential for
CIHC practices
– Current Status
– Opportunities
Thinking Differently About Health
• National Prevention, Health Promotion and
Public Health Council
• Advisory Group on Prevention, Health
Promotion and Integrative and Public Health
• Prevention and Public Health Fund
INTENTIONS
• Shift from sickness care to health &
wellness as primary focus
• Salutogenesis – how is health created? Not by
attacking one disease at a time.
• Search for structural rather than biomedical
solutions to our nation’s health problems
• Coordination between clinical and
community/environmental aspects of health
promotion
National Prevention Council:
Setting a Larger Table -- Policy Matters
Bureau of Indian Affairs
Department of Labor
Corporation for National and Community
Service
Department of Transportation
Department of Agriculture
Department of Veterans Affairs
Department of Defense
Environmental Protection Agency
Department of Education
Federal Trade Commission
Department of Health and Human
Services
Office of Management and Budget
Department of Homeland Security
Office of National Drug Control Policy
Department of Housing and Urban
Development
White House Domestic Policy Council
Department of Justice
National Prevention Strategy
• Vision: Working together to
improve the health and quality
of life for individuals, families,
and communities by moving the
nation from a focus on sickness
and disease to one based on
prevention and wellness.
• Extensive stakeholder and
public input
• Aligns and focuses prevention
and health promotion efforts
with existing evidence base
Empowered People
• People are empowered when
they have the knowledge,
resources, ability, and
motivation to identify and
make healthy choices
• When people are
empowered, they are able to
take an active role in
improving their health,
supporting their families and
friends in making healthy
choices, and leading
community change
Improving Population Health Outcomes Depends on
Transforming the Health System to Coordinate and Integrate
Primary Care, Public Health and Community Prevention Efforts
• Incentives for providers to
achieve pop. health outcomes and improve quality
• Incentives for plans/ACOs to
address population health
outcomes
• Funding mechanisms that
enable braiding of financing
streams
Interventions at the
intersection of primary care,
public health and the social
determinants of health
require:
• Common agendas and goals
• Shared responsibility
• A compelling story
• Partnerships and
collaboration
• Leadership and Integrators
• Data
• Financing systems
• Accountability mechanisms
• Policy leadership on programs
and policies that improve
community health
• Community health assessments
• Educating policymakers,
agencies, and stakeholders
regarding pop. health
• Population health data tracking
and analytic tools
Health Care System/
Primary Care
Payers,
Insurers, and
ACOs
Interventions At The
Intersection
Community
Prevention/
Social
Determinants
of Health
(SDOH)
Public Health
Public policy is a
critical lever to
support all of
these activities
Improved Population Health, Health
Outcomes, and Lower Costs (Triple Aim)
• Primary care & team based
care
• Patient assessments include
personal data and SDOH
regarding patients’ homes
and communities
• Quality improvement
• Leveraging, linkages and
referrals to community
resources
• Data collection & EHRs
contribute to community
health data base
• Coordination with
community health outreach
workers
• Chronic disease mgmt
• Social and support services
• Disease prevention and
management programs
• Outreach and referral to
clinicians
• Education, including health
education
• Coalitions and advocacy to
address SDOH
• Community engagement
Role of Advisory Group
• Advise
• Hold accountable
• Develop a broader constituency
–
–
–
–
Preventive services
Integrative health
Resilience
Outreach
• New focus: education, community development
Affordable Care Act
Other elements with CIHC potential:
Current Status, Opportunities
SEC. 5101. NATIONAL HEALTH CARE
WORKFORCE COMMISSION.
– (i) Definitions- In this section:
– (1) HEALTH CARE WORKFORCE- The term 'health care
workforce' includes all health care providers with direct patient care
and support responsibilities, such as physicians, nurses, nurse
practitioners, primary care providers, preventive medicine
physicians, optometrists, ophthalmologists, physician assistants,
pharmacists, dentists, dental hygienists, and other oral healthcare
professionals, allied health professionals, doctors of chiropractic,
community health workers, health care paraprofessionals, direct
care workers, psychologists and other behavioral and mental health
professionals (including substance abuse prevention and treatment
providers), social workers, physical and occupational therapists,
certified nurse midwives, podiatrists, the EMS workforce
(including professional and volunteer ambulance personnel and
firefighters who perform emergency medical services), licensed
complementary and alternative medicine providers, integrative
health practitioners, public health professionals, and any other
health professional that the Comptroller General of the United
States determines appropriate.
Current Status
• The law did not mandate funding for the
National Healthcare Workforce Commission –
commissioners were duly appointed but having no
budget for staff, travel or even phone calls, have
never met.
• Definition was intended for that section of the law,
but with many other mentions of CAM/IHC in the
law, this is being used as a talking point with
policymakers in HRSA, DOL and other agencies.
SEC. 2301: COVERAGE FOR
FREESTANDING BIRTH CENTER SERVICES.
(C) A State shall provide separate payments to providers administering
prenatal labor and delivery or postpartum care in a freestanding birth
center (as defined in subparagraph (B)), such as nurse midwives and
other providers of services such as birth attendants recognized under
State law, as determined appropriate by the Secretary. For purposes of
the preceding sentence, the term `birth attendant' means an individual
who is recognized or registered by the State involved to provide health
care at childbirth and who provides such care within the scope of
practice under which the individual is legally authorized to perform
such care under State law (or the State regulatory mechanism provided
by State law), regardless of whether the individual is under the
supervision of, or associated with, a physician or other health care
provider. Nothing in this subparagraph shall be construed as changing
State law requirements applicable to a birth attendant.'...
Current Status
• Mandates reimbursement for both facility
fees and provider fees for freestanding
birthing centers.
• Pace of implementation varies from state to
state; overseen by regional Medicaid offices
PCORI
Patient-Centered Outcomes Research Institute
Sec 6301 – “(c) PURPOSE…to assist patients, clinicians,
purchasers, and policy-makers in making informed health
decisions by advancing the quality and relevance of evidence
concerning the manner in which diseases, disorders, and other
health conditions can effectively and appropriately be prevented,
diagnosed, treated, monitored, and managed through research and
evidence synthesis that considers variations in patient
subpopulations, and the dissemination of research findings with
respect to the relative health outcomes, clinical effectiveness, and
appropriateness of the medical treatments, services, and items
described in subsection (a)(2)(B).
Patient-Centered Outcomes Research
Trust Fund (PCORTF)
Mandated appropriations of
– For FY 2010, $10 million
– For FY 2011, $50 million
– For FY 2012, $150 million
• For FY 2013, $150 million from the general + an annual $1 fee
per individual assessed on Medicare and private health insurance
and self-insured plans. Combined estimated total is $320 million.
• For FYs 2014-2019, $150 million from the genera + an annual $2
fee per individual assessed on Medicare and private health
insurance and self-insured plans and an adjustment for increase
in healthcare spending. The combined estimated total averages
$650 million per year.
Status
Accomplishments
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•
•
•
Governing board appointed
PCOR defined
Research Priorities set w/selection process described
Methodology Committee issued report
Much potential w/caveat:
• Neither PCORI, nor NCCAM, can fund research for
which they have not received a qualified proposal
Action Alert!
3 key provisions are being determined at the
state level
* Section 2706 Non-Discrimination
* Section 3502 PCMH support teams
* Section 2303 Essential Benefits
SEC. 2706: NON-DISCRIMINATION
IN HEALTH CARE:
(a) PROVIDERS.—A group health plan and a health insurance
issuer offering group or individual health insurance coverage shall
not discriminate with respect to participation under the plan or
coverage against any health care provider who is acting within the
scope of that provider’s license or certification under applicable
State law. This section shall not require that a group health plan or
health insurance issuer contract with any health care provider
willing to abide by the terms and conditions for participation
established by the plan or issuer. Nothing in this section shall be
construed as preventing a group health plan, a health insurance
issuer, or the Secretary from establishing varying reimbursement
rates based on quality or performance measures.
SEC. 3502. ESTABLISHING COMMUNITY
HEALTH TEAMS TO SUPPORT THE
PATIENT-CENTERED MEDICAL HOME
(a) IN GENERAL.—The Secretary of Health and
Human Services (referred to in this section as the
‘‘Secretary’’) shall establish a program to provide
grants to or enter into contracts with eligible
entities to establish community-based
interdisciplinary, inter-professional teams
(referred to in this section as ‘‘health teams’’) to
support primary care practices, including
obstetrics and gynecology practices, within the
hospital service areas served by the eligible entities.
SEC. 1302. ESSENTIAL HEALTH
BENEFITS REQUIREMENTS
(1) IN GENERAL.—Subject to paragraph (2), the Secretary shall define
the essential health benefits, except that such benefits shall include at least
the following general categories and the items and services covered within
the categories:
(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including
behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.
What can you do?
• Get to know and be known by your
insurance commissioner
• Find out where your state is re EHB
• What are the implications for your practice
site of the planned EHBs?
• Are your state’s EHB’s compatible with
– Your patients’ best interests/health?
– Integrative healthcare?
– Non-discrimination section 2706?
Timing?
• Now!
– Section 2706 becomes effective 1/1/2014
– EHB’s being determined now for launch of
Insurance Exchanges in 2014
– PCMH demos underway already