health care reform and hispanics
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Health Care Reform and Hispanics. Affordable Patient Protection and Care Act (ACA), January 2011 Elena Rios, MD, MSPH National Hispanic Medical Association. Hispanics & Health Care . The majority ethnic group in America 2042: one out of four Americans will be Hispanics - PowerPoint PPT PresentationTRANSCRIPT
Health Care Reform and Hispanics
Affordable Patient Protection and Care Act (ACA), January 2011Elena Rios, MD, MSPHNational Hispanic Medical Association
Hispanics & Health Care The majority ethnic group in America
2042: one out of four Americans will be Hispanics Immigrants and mixed families, low education and income
High rates of uninsured & problems with disparities in health care according to US DHHS Disparities Reports
Limited cultural competence, language service System lacks Hispanic researchers, providers and leaders
in public/private agencies Need for new approaches to increase Hispanics in primary
care Need for cultural competence training about Hispanic
populations
NHMA & NHHF– Who are We? Established in 1994 in DC, NHMA is a non-profit
501c6 association representing 45,000 Hispanic physicians in the U.S.
Mission: to empower Hispanic physicians to improve the health of Hispanic populations
Established in 2002, NHMA’s foundation, National Hispanic Health Foundation, is a non-profit 501c3 foundation for research & education activities – affiliated with and located at the NYU Wagner Graduate School of Public Service
NHMA Board of Directors Ciro Sumaya, MD, MPHTM, Chair,
former Dean, Texas A&M Rural Public Health School
Kathy Flores, MD, Secretary, Director, UCSFresno Latino Research Center
Louis Aguilar, MD, Treasurer, Tucson, AZ
Sam Arce, MD, ViceChair/Chair –Council of Medical Societies
Elena Rios, MD, President/CEOWashington, DC
Carol Brosgart, MD, Medical Officer, Oakland Children’s Hospital
Emilio Carrillo, MD, MPH, Professor, Cornell Weill School of Medicine
Onelia Lage, MD, Professor, Pediatrics, Univ of Miami, FL
Rosalio Lopez, MD, Vice President and Medical Officer, Presbyterian Intercommunity Hospital, Whittier, CA
Jorge Puente, MD, Regional President of Asia, Pfizer
Joan Reede, MD, MPH, Associate Dean, Harvard School of Medicine
Jaime Rivera, MD, Consultant, State Corrections, Dover, DE
Reed Tuckson, MD, Vice President, UnitedHealth Group, Minnetoka, MN
Richard Zapanta, MD, Monterey Park, CA
Alvaro Galvis, Coordinator, Latino Medical Students Association
NHHF Board of Directors Mark Diaz, MD Chairman, Principal, Alivio
Medical Group, Sacramento, CA Conchita Paz, MD Secretary -Treasurer,
Principal, Family Care Associates,
Las Cruces, NM Elena Rios, MD, MSPH President, NHHF, NY
Jo Ivey Boufford, MD President, New York Academy of Medicine
Gary Pelletier Director, Pfizer Helpful Answers Miguel Sanchez, MD Professor, Dermatology NYU School of Medicine
I. Access to Health Coverage
Individual mandates, affordable - 2013Subsidies based on incomeMax of 10% income on premiumsDependent to age 26Family can apply as a unitEmployer insurance, ineligible for low income
tax credit thru the Health Insurance Exchange Employer mandates
I. Access to Public Health Care Programs Medicaid –
Nationwide: 133% FPL, childless adultsDual eligibles – new CMS office to monitorMedications – benefit by 2014Territories’ caps increase by 30% & FMAP increases by
5% (new eligibles don’t count)DSH – state trigger as uninsured decreases
CHIP133-250%FPL, cost sharing up to 5% income
Barriers: verification, immigrant 5yr wait
I. Access:New Health Insurance
State Health Insurance ExchangesVoluntary enrollment to qualified individuals to
select qualified health plansWebsites, Ombudsman systems
New grants for community health workers to assist with enrollment, provide information that is culturally and linguistically appropriate
II. Quality & Efficiency
National strategy to improve health care quality AHRQ – standards/ CMS – inform, payments
HHS lead - strategic plans, incentives w/public and private payers, mandates racial/ethnicity and language data
Office of Minority Health at OS, CDC, FDA, HRSA, CMS, SAMHSA; Institute for Minority Health and Health Disparities at NIH
Key National Indicator System (and Independent Institute by the National Academy of Sciences) Pt outcomes and functional status, H-IT, pt safety, effectiveness, pt
centeredness, appropriateness, efficiency, equity of services and health disparities, patient satisfaction
II. Quality & Efficiency
Patient Centered Outcomes Research Institute Public/Private new entity AHRQ and NIH research on health disparities
Advisory Committee, public input, report to Congress Build capacity at the State and community level to lead
quality and safety efforts through education, training and mentoring programs
Demo Program to Integrate QI and Pt Safety training into clinical education of health professionals
II. Reimbursement for Quality under the Plan or Coverage* case management care coordination chronic dz management medication and care
compliance medical home prevention of hospital
readmissions patient safety
reduction of medical errors
evidence based medicine health IT child health measures culturally and linguistically
appropriate care mental health
II. Quality and Providers
Hospital Value Based Purchasing – paying for performance on quality measures, funding from Hospital Trust Fund, Fed Suppl Med Ins Trust Fund, Medicare IPPS payments to CMS Goal - Attaining a standard or making performance
improvements Physician Value Based Purchasing
Physician Quality Registration Identifier Maintenance of Certification (new) Feedback & Appeals process (new)
Quality monitoring to start for nursing homes, rehab, hospices, cancer hospitals
III. Prevention
National Prevention, Health Promotion and Public Health Council (Fed agencies under HHS)
Provide coordination and leadership at the Federal level with respect to prevention , health promotion, public health system and integrative health care in the US
Develop a National Prevention and Health Promotion Strategy – health disparities priority, includes cancer
Prevention and Health Promotion Investment Fund ($10B)
III. Prevention – New Programs
Right Choices Programs School clinics Worksite wellness Community Transformation Grants Healthy Aging Grants (55-64) Food labeling, restaurant menus, school vending
machines – decrease obesity Health Impact Assessments
III. Prevention and Wellness
Incentives for healthy lifestyles initiatives $100M for Medicare and Medicaid Monitor beneficiary participation and health outcomes
States to improve coverage and access to preventive services and immunizations with 1% increase FMAP
Medical Homes Integrated Care
IV. Health Care Workforce
National Health Care Workforce Commission – HHS, DEd, DOL Integrated health workforce training, capacityMedicare/Medicaid GME Nursing, oral, mental, allied, and public health
workforce, diversityGeographic distribution of providers vs need Increased focus on primary care providers
IV. Health Care Workforce
State Health Workforce Planning & Development Grants – HRSA ($158M)State partnerships (25% match)Seed grants to regional partnerships
Career pathway guidance, training Change State and local policies for health care
career pathways and workforce development Performance benchmarks
IV. Health Care Workforce
National Center for Health Care Workforce Analysis ($5M) & Advisory Committees State and Regional Centers ($4.5M) Data from HHS, Bureau of Labor Stats, Census
Bureau, DOD, VA, medical societies and health professions organizations
Grants for longitudinal evaluation of students, faculty, residents who have received training & funding, NHSC – MUA, primary care practice, diversity
IV. Health Care Workforce
Loan Repayment Programs National Health Service Corps – HPSAs Nursing, Dental, Allied Health, Pediatric Adolescent, mid-career
Public Health, Faculty Advanced Practice Nurse managed health clinics –
associated with school, university, FQHC or nonprofit Primary Care Training – GIM, Peds, FP, added: PA
Training in cultural competence and health literacy Priority for track record of training minorities, rural,
disadvantaged Innovation in primary care models, integrative care
Diversity – Title VII COE, HCOP expansion
IV. Primary Care Extension State(s) Hub and Local AgenciesAHRQ -Required Activities: learning communities
in primary care, share best practices, community providers to create new knowledge – health disparities; other: home health.
State Hub – State Health Dept, health profession schools, medical societies
Coordinate QIO and AHECS – we support adding Diversity Programs: HCOP/COE
IV. Health Care WorkforceMedicare Medicare participation: 10% bonus for:
PC doctors, general surgeons, docs in HPSAs Redistribution of residency slots to PC Training in outpatient clinics (funds to hospitals
with agreements with clinics) Training demo grants ($85M/yr x 5 yrs)
Low income (TANF); home care doctor/nurse care SGR – need to revise
Reconciliation Bill
Access – 32 million insured – making bill more affordable, closing the donut hole
Accountability of insurance companies Increased Medicaid/Clinics to all states Additional GOP issues included
Fraud and wasteMalpractice courts demonstration program Increase Medicaid reimbursement – MDsHealth savings accounts
How to contact NHMA & NHHF
NHMA - www.nhmamd.org NHHF - www.nhmafoundation.org Hispanic Health Portal
www.hispanichealth.info NHMA 15th Annual Conference – “Health
Care Reform Implementation for the Hispanic Community” – Washington, DC, Mar. 17-20, 2011