Affordable Caretitleof 2010 and Act style Click to edit Master Opportunities for Advancing Health Equity: Taking Vision and Promise to Reality Dennis P. Andrulis, Ph. D, 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 Session 4286. Implementing Health Equity 2020 at the Frontline APHA 139 th Annual Meeting and Exposition Washington, DC | November 1, 2011
Overview Click to edit Master title style • ACA’s Vision, Promise and Background • Status of Diversity, Cultural Competence & Equity Provisions • State and Local Actions and Initiatives • Continuing and Growing Challenges • Moving Forward
ACA’s Vision and Promise Click to edit Master title style • Working to eliminate health disparities and advance health equity is central to the Affordable Care Act (ACA) of 2010. • Over three dozen provisions that directly address disparities, diversity and cultural/linguistic competence. • Dozens of other provisions with major implications for racial/ethnic disparities and equity.
Track Record of Analyzing Health Care Reform with a Click. Racial/Ethnic. Master title. Health Equity Lens to edit Disparities and style Aug 2008* Comparative Report on Health Reform Proposals of Obama vs. Mc. Cain 2008 2009* Analysis of House & Senate Health Reform Bills Jan 2009 President Obama inaugurated July 2010* Release of Comprehensive Report on ACA & Health Equity May 2011† Report on Progress & Status of ACA’s Cultural Competence Provisions Oct 2011 Health Affairs article on ACA, Safety Net & Diversity 2011 – 2013§ Tracking Implementation Progress, Opportunities & Challenges for Health Equity & Diverse Populations 2013 Mar 2010 ACA Enacted * Supported by Joint Center for Political and Economic Studies. † Supported by SRA International. § Supported by The California Endowment & other foundations. 2012 Presidential Elections & Supreme Court Decision
Click to edit Master title style From Vision to Reality…
Authorized and Appropriated Click towith Cultural/Linguistic (C/L) Requirements Provisions edit Master title style – Health Care Workforce • Loan repayment programs with preference to providers having training or experience in C/L competence or from R/E backgrounds – Data Collection and Reporting • Establishment of standards for collecting and reporting data by race, ethnicity, and primary language in federally supported public health programs, activities or surveys – Health Insurance • Uniform, C/L appropriate explanation of coverage • C/L appropriate claims appeals process • Navigator to provide C/L information on exchanges, enrollment, etc – Public Health Programs • Community Transformation Grants for chronic disease and disparities • Culturally-tailored personal responsibility education on teen pregnancy
Authorized and Appropriated Click to edit with Major Implications for Health Equity General Provisions Master title style • Health Insurance – Expansion of Medicaid eligibility to 133% FPL – Reauthorization of CHIP – State Health Insurance Exchanges • Access to Health Care – $11 billion for Community Health Centers – Grants to expand trauma centers– at least 40% of funds to safety net – Maternal and child home visiting programs for at-risk populations • Quality and Systems Innovation – Medical Home demonstration programs for care coordination – Aligning payment with quality and continuity of care
State Actions to Advance Equity Click to edit Master title style • California’s “Bridge to Reform” 1115 Medicaid Waiver – Expands county-based Health Care Coverage Initiative (HCCI) for adults with incomes between 133 -200% FPL – Support for county hospitals to improve quality of care through infrastructure updates (e. g. , IT) and systems innovation (e. g. , care coordination) – Support to enhance care delivery for high burden diseases at public hospitals • Texas’ 1115 Medicaid Waiver Proposal – Expands Medicaid managed care to other counties across the state – Transitions to quality-based payments for managed care and hospitals – Diverts savings into a pool to cover uncompensated care for hospitals and safety net providers
State Progress on Cultural Competence Click to edit Master title style States with Cultural Competence Legislation 2000 -2011 Dark Blue : legislation requiring (WA, CA, NJ, NM, CT) or strongly recommending (MD) cultural competence training, which was signed into law. Purple : legislation which has been referred to committee and is currently under consideration. Royal Blue : legislation which died in committee or was vetoed. Source: Think Cultural Health, 2011
Local/Community Progress & Click to edit Master title style Programs • Philanthropic Funding Pools – e. g. , 5 health philanthropies in Kansas formed an “Affordable Care Act Opportunity Fund” to assist state/local organizations in implementing ACA • Community Networks for Medical Homes – Community health center collaboration with private practices to extend medical home services to diverse and vulnerable populations • e. g. , Models in Montana, North Carolina, Indiana
Click to edit Master title style National/Academic Progress & Programs • National Initiatives e. g. , National Quality Forum (NQF) – Analyzing and establishing valid measures to evaluate disparities and cultural competence across diverse settings and populations, known as Healthcare Disparities and Cultural Competency Consensus Standards • Academic Initiatives e. g. , Xavier University in New Orleans, LA – Evaluating 12 online cultural competency training programs
Click to edit Master title style Continuing and Growing Challenges…
Authorized Provisions, but NOT Appropriated Click to edit Master title style • Cultural Competence Education – Model cultural competency curricula • Health Care Workforce – Community health workers, defined as providing C/L appropriate outreach and health education – Community health teams to support medical homes in providing culturally appropriate, patient-centered care • Public Health Programs – C/L appropriate oral health education campaign – Pain management education addressing C/L barriers
Populations remaining at or beyond Click to edit Master title stylethe margins • 23 million uninsured, of which 11 million undocumented immigrants
Clickfor edit Master title style Risks to the Safety Net • $18 billion reduction in disproportionate share hospital program—which finances 22% of unreimbursed care at public hospitals • State/local safety-net financing possibly in jeopardy due to antipathy toward undocumented and myth that “uninsured problem is solved” • Financial pressures on safety-net in caring for 52 million uninsured between now and 2014, given growth in uncompensated care, low profit margins, and location of many in high-poverty areas • Risks to safety net’s ability to compete for newly insured patients and participate in systems innovation
Timeline and Budget Click to edit Master title style • Timeline – Impending Supreme Court decision on insurance mandate – 27 States with Lawsuits – Change in presidential leadership • Budget – Budget cuts at all levels affecting safety net and disparities-related programs States that have Filed a Federal Lawsuit in Response to the Affordable Care Act, 2011
Click to edit Master title style Moving Forward…
Click to edit Master title style Reform Advancing Equity in the Era of Health Care Creating Healthy Communities • Leveraging support for community initiatives. • Promoting an integrated approach to health and social services. Transitioning Health Care Organizations • Supporting the safety net to update infrastructure and participate in system innovations. • Ensuring diversity and equity are organizational priorities. Promoting Individual Health • Ensuring adequate provider education on cultural competence to enhance patient adherence. • Creating effective care or self-management programs for diverse patients.
What can we do? Click to edit Master title style Monitor Educate • Rollout of appropriations • Progress and status of implementation of funded and unfunded provisions—e. g. , grants, taskforces, advisory issuances, executive orders, etc. • Policymakers, federal, state and local agencies, and foundations & philanthropies on specific language and importance of equity/disparities priorities in ACA • Education on status, progress and challenges in implementation Advocate • For federal appropriations • For private, philanthropic support • For state/local innovation in health equity and reducing disparities
Our to edit Master Click. Future Work title style • With support from The California Endowment and other Foundations, we will: – Track the status of implementation of equity, diversity and cultural competence provisions in ACA as well as general provisions with major implications for diverse populations, given changing health care environment. – Identify emerging opportunities for funding, advisory groups, taskforces, and other issuances, and ways in which to tap them. – Recommend ways to leverage federal funding—or a lack thereof—with state and local resources from public and private sources. • Report will be unveiled at the upcoming National Conference on Quality Health Care for Culturally Diverse Populations in October 2012, in Oakland, California.
Contact Information Click to edit Master title style Dennis P. Andrulis, Ph. D, 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 Our Recent Publications Andrulis DP and Siddiqui NJ. Health Reform Holds Both Risks and Rewards for Safety-Net Providers and Racially and Ethnically Diverse Patients. Health Affairs, 2011, 30(10). Andrulis DP, Siddiqui NJ, Purtle, JP and Duchon L. Patient Protection and Affordable Care Act of 2010: Advancing Health Equity for Racially and Ethnically Diverse Populations. July 2010. Supported and released by the Joint Center for Political and Economic Studies.
Presenter Disclosure Click to edit Master title style Dennis P. Andrulis, Ph. D, MPH The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No Relationships to Disclose.
Cultural Competence Click to edit Master title style A set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations. It reflects the ability to acquire and use knowledge of the health-related beliefs, attitudes, practices, and communication patterns of clients and their families to improve services, strengthen programs, increase community participation, and close the gaps in health status among diverse population groups. (Cross et. al. 1989 and Lavizzo-Mourney and Mackenzie 1996 as cited in Cultural Competence: A Journey, Bureau of Primary Health Care. HRSA, US DHHS, n. d. )
Click to edit Master title style Source: M, Beach. Patient-centeredness and cultural competence: their relationship and role in reducing health disparities. Commonwealth Fund 2006
Скачать презентацию Affordable Caretitleof 2010 and Act style Click to
0ec0edb3fece930886044d37e1f84eec.ppt