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

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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 Presentation

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Page 1: Health Care Reform and Hispanics

Health Care Reform and Hispanics

Affordable Patient Protection and Care Act (ACA), January 2011

Elena Rios, MD, MSPH

National Hispanic Medical Association

Page 2: Health Care Reform and Hispanics

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

Page 3: Health Care Reform and Hispanics

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

Page 4: Health Care Reform and Hispanics

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

Page 5: Health Care Reform and Hispanics

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

Page 6: Health Care Reform and Hispanics

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

Page 7: Health Care Reform and Hispanics

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

Page 8: Health Care Reform and Hispanics

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

Page 9: Health Care Reform and Hispanics

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

Page 10: Health Care Reform and Hispanics

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

Page 11: Health Care Reform and Hispanics

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

Page 12: Health Care Reform and Hispanics

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

Page 13: Health Care Reform and Hispanics

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)

Page 14: Health Care Reform and Hispanics

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

Page 15: Health Care Reform and Hispanics

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

Page 16: Health Care Reform and Hispanics

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

Page 17: Health Care Reform and Hispanics

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

Page 18: Health Care Reform and Hispanics

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

Page 19: Health Care Reform and Hispanics

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

Page 20: Health Care Reform and Hispanics

IV. Primary Care Extension State(s) Hub and Local Agencies

AHRQ -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

Page 21: Health Care Reform and Hispanics

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

Page 22: Health Care Reform and Hispanics

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

Page 23: Health Care Reform and Hispanics
Page 24: Health Care Reform and Hispanics

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