The Affordable Care Act (ACA) provides opportunities for states to make lasting
and comprehensive systems change in their approaches to achieving health equity
for their most vulnerable populations. Through provisions in areas such as coverage
and access, prevention, care coordination, population health, and quality and efficiency,
the Act offers state policymakers a broad range of policy levers for improving health care
and the health status of their racial and ethnic minority populations.
With support from the Aetna Foundation, the National Academy for State Heath Policy is hosting a
webinar to highlight the opportunities presented by health care reform to advance state health equity
agendas. In addition to featuring national health equity experts and information on how states are
using the ACA to achieve health equity, this webinar will announce the NASHP State Health Equity
Learning Collaborative, an initiative to help state policymakers maintain momentum towards achieving
health equity while implementing federal health care reform.
AUTONOMIC NERVOUS SYSTEM organization and functions
Advancing Health Equity through State Implementation of Health Reform
1. Advancing Health Equity through
Health Reform Implementation
Thursday, July 21, 2011
This webcast will begin at 2:00 P.M. EDT
Please hold until we start the conference.
The audio portion of this webcast can be accessed by dialing:
800.757.7641
2. Agenda
n Welcome and Introductions
¡ Diane Justice, MA, Senior Program Director, National Academy for State
Health Policy (NASHP)
¡ Dr. Anne C. Beal, MD, MPH, President, Aetna Foundation
n National Healthcare Quality and Disparities Reports and State
Disparities
¡ Dr. Ernest Moy, MD, MPH, Medical Officer, Center for Quality
Improvement and Patient Safety, Agency for Healthcare Research and
Quality (AHRQ)
n State Obligation and Opportunity in Health Care Reform:
Implementing the Affordable Care Act to Advance Health Equity
for Racially and Ethnically Diverse Populations
¡ Dr. Dennis P. Andrulis, Ph.D., MPH, Senior Research Scientist, Texas
Health Institute; Associate Professor, University of Texas School of Public
Health
3. Agenda (cont.)
n ACA Implementation and Health Equity: Experiences from
Maryland
¡ Dr. Carlessia A. Hussein, Dr.PH, RN, Director, Office of
Minority Health and Health Disparities, Maryland Department of
Health and Mental Hygiene
n State Health Equity Learning Collaborative:
Request for Applications for Technical Assistance
¡ Diane Justice, MA, Senior Program Director, NASHP
n Questions and Answers
4. About NASHP
n 22 year old non-profit, non-partisan organization
n Academy members
¡ Peer-selected group of state health policy leaders
¡ Commitment to identifying state needs and guiding our
work
n Working together across states, branches, and
agencies to advance, accelerate, and implement
workable policy solutions that address major health
issues
5. Advancing Equity through State
Implementation of Health Reform
n Supported by the Aetna Foundation
n Project goals include:
¡ Supporting state leadership for eliminating disparities and
advancing health equity through health care reform
implementation
¡ Establishing a State Health Equity Learning Collaborative
¡ Facilitating a National Invitational Health Equity Summit
¡ Publishing a State Policymakers Action Agenda for
Achieving Health Equity through Health Reform
6. National Healthcare Quality and Disparities
Reports and State Disparities
Ernest Moy
Ernest.moy@ahrq.hhs.gov
301-427-1329
www.ahrq.gov/qual/qrdr10.htm
http://statesnapshots.ahrq.gov
7. National Healthcare Reports
Annual reports to Congress from Secretary since 2003
mandated by 1999 Healthcare Research and Quality Act
Unified team, Interagency Work Group, framework, data,
methods, quality measures
Quality Report Disparities Report
Snapshot & trends in quality of Snapshot & trends in
health care in America disparities in health care
Effectiveness, safety, timeliness,
Differences across race,
patient centeredness, care
ethnicity, & socioeconomic
coordination, efficiency, health
status
system infrastructure, access
Variation across states Variation across populations
11. Hispanic-White Disparity in Colorectal
Cancer Screening across States
30 Worst States
25 All State
Average
20
15
Best States
10
5
0 B e st
S ta te s
Wo rst
S ta te s
-5
-10
-15
12. Black-White Disparity in Colorectal
Cancer Screening across States
30 Worst States
25
20
15 All State
Average
10
5
0 B e st
S ta te s
A ll
S ta te
A v e ra g e
Wo rst
S ta te s
-5
-10
Best States
-15
13. Weak Relationship between Overall Receipt of Colorectal
Cancer Screening and Hispanic-White Differences
14. Weak Negative Relationship between Overall Receipt of
Colorectal Cancer Screening and Black-White Differences
15. Mountain West North Central New
England
East North
Poorer Overall Quality
Central
of Preventive Care
Middle
Atlantic
DC
PR
VI
Pacific
South
Atlantic
East
South
West Central
South
Central
Mountain West North Central New
England
East North
Central
Middle
Atlantic
DC
PR
VI
Pacific
Larger Racial or Ethnic East
South
Atlantic
Disparities in West
South
Central
South
Central
Preventive Care
17. Conclusions
n State need to address
disparities
– Different populations
– Different disparities
n Disparities can help States
– Identify strategies
– Target populations and
services
n States are succeeding at
reducing disparities
18. Click to edit Master title style
Dennis
P.
Andrulis,
PhD,
MPH
Senior
Research
Scien-st,
Texas
Health
Ins-tute
Associate
Professor,
University
of
Texas
School
of
Public
Health
19. Background Master title
Click to edit and Purposestyle
• With
support
from
the
Joint
Center
for
Poli3cal
and
Economic
Studies,
we
conducted
a
comprehensive
review
of
the
Pa3ent
Protec3on
and
Affordable
Care
Act
of
2010:
– To
iden3fy
and
describe
provisions
specific
to
race,
ethnicity
and
language;
and
general
provisions
likely
to
have
a
significant
affect
on
diverse
popula3ons.
– To
assess
status,
challenges
and
opportuni3es
of
health
care
reform
provisions
for
improving
the
health
and
health
care
of
racially
and
ethnically
diverse
popula3ons.
• We
have
also
tracked
implementa3on
status
and
progress
for
provisions
with
explicit
requirements
for
linguis3c
and
cultural
competence.
21. Cultural Competence & Workforce
Diversity
Click to edit Master title style
• Cultural
Competence
– Model
cultural
competence
curricula.
– Cultural
competence
training
for
health
professionals.
– Culturally
appropriate
pa3ent
decision
aids.
– Culturally
appropriate
personal
responsibility
educa3on
for
teen
pregnancy
preven3on.
– Culturally
appropriate
na3onal
oral
health
campaign.
• Workforce
Diversity
– Increase
diversity
among
health
professionals.
– Health
professions
training
preference
for
cultural
competence.
– Investment
in
HBCUs
&
minority-‐serving
ins3tu3ons.
– Collect
&
report
workforce
diversity
data.
22. Data Collection & Disparities
Click to edit Master title style Research
• Data
Collec3on
&
Repor3ng
– Collect
racial/ethnic
sub
group
data
in
popula3on
surveys.
– Collect/report
dispari3es
data
in
Medicaid
&
CHIP.
– Monitor
dispari3es
trends
in
federally
funded
programs.
• Health
Dispari3es
Research
– Examining
dispari3es
through
compara3ve
effec3veness
research.
– Suppor3ng
research
on
topics
of
cultural
competence
and
health
dispari3es.
24. General Provisions
Click to edit Master title style
• Expansion
of
Medicaid
eligibility
to
133%
FPL
• Reauthoriza3on
of
CHIP
• Small
business
(<25
employees)
tax
credits
• State-‐based
Insurance
Exchanges
• Community
Health
Center
support
• Demonstra3on
programs
for
na3onal
priori3es
25. General Provisions
Click to edit Master title style
• Expanding
and
building
a
diverse
workforce
• Requiring
non-‐profit
hospital
community
needs
assessments
• Expanding
the
focus
on
quality
through
linking
Medicare
payments
to
outcomes,
quality
measures
development,
a
na3onal
strategy
for
quality
improvement
and
other
efforts
27. Highlights
Click to edit Master title style
• Great
breadth
of
opportuni3es
in
ACA
to
reduce
dispari3es
and
improve
health
equity.
• Federal
agencies,
generally
assigned
leading
responsibility
for
advancing
and
implemen3ng
disparity
and
cultural
competence
provisions.
• Many
provisions
with
requirements
related
to
equity,
cultural
competence
and
language
assistance
have
received
appropria3ons
and
offer
opportuni3es
for
states
and
state
agencies
to
pursue
funding.
• Other
important
race/culture/language
provisions,
however,
have
not
received
appropria3ons
as
yet.
28. Funded Opportunities:
Health edit Master title
Click toInsurance Programs style
• State
Health
Insurance
Exchanges
– State
planning
and
establishment
grants,
with
requirements
for
cultural
&
linguis3c
competence
in
benefit
summaries,
appeals
processes,
and
other
provisions
related
to
health
plans.
• Non-‐discrimina3on
in
health
insurance
exchanges.
• Culturally
&
linguis3cally
appropriate
summary
of
benefits.
• Culturally
&
linguis3cally
appropriate
claims
appeal
process.
• Navigator
to
provide
culturally
&
linguis3cally
appropriate
informa3on.
• Incen3ve
payments
for
cultural
competence
&
reducing
dispari3es.
• State
Office
of
Consumer
Health
Assistance
– Federal
grants
to
states
to
establish
an
Office
of
Health
Insurance
Consumer
Assistance
or
an
Ombudsman
Program.
29. Funded Opportunities:
Community Health and Prevention
Click to edit Master title style
• Community
TransformaBon
Grants
– Over
$100
million
for
75
grants
to
help
communi3es
implement
projects
proven
to
reduce
chronic
diseases
as
well
as
health
dispari3es.
• Personal
Responsibility
EducaBon
– $75
million
for
states
in
2011
to
educate
youth
in
culturally/linguis3cally
appropriate
ways
to
prevent
teen
pregnancy
and
sexually
transmifed
infec3ons.
• CHIP
Childhood
Obesity
DemonstraBon
– $25
million
in
FY
2011
to
develop
a
model
for
reducing
childhood
obesity.
• Medicaid
PrevenBon
and
Wellness
IniBaBves
– State
grants
to
provide
incen3ves
for
Medicaid
beneficiaries
to
par3cipate
in
evidence-‐based
programs
to
prevent/manage
chronic
disease.
$100
million
for
5-‐year
period
from
FY
2011-‐2016.
30. Funded Opportunities:
Improving Quality and Efficiency
Click to edit Master title style
• Medicaid
Integrated
Care
HospitalizaBon
DemonstraBon
– Up
to
8
states
to
use
bundled
payments
to
promote
integrated
care.
• Pediatric
Accountable
Care
OrganizaBon
DemonstraBon
– Allow
pediatric
providers
to
organize
as
ACOs
and
share
in
federal
and
state
cost
savings
generated
under
Medicaid.
31. Funded Opportunities:
Access to Health Care & Support for Safety
Net
Click to edit Master title style
• Grants
for
Trauma
Care
Centers
– Grants
to
states
to
support
universal
access
to
trauma
care
services.
$100
million
per
FY
2010-‐2015.
States
must
award
at
least
40%
to
safety
net
ins3tu3ons.
• Primary
Care
Extension
Program
– $120
million
in
2011
to
establish
program
to
support
and
assist
primary
care
providers
to
improve
community
health.
• State
Health
Care
Workforce
Development
Grants
– Up
to
$150,000
per
state
partnership
for
carrying
out
planning
and
implementa3on
of
health
care
workforce
development.
– 25
states
received
planning
grants
and
1
with
an
implementa3on
grant
in
2010.
• Maternal,
Infant
and
Early
Child
Home
VisiBng
Programs
– $1.5
billion
for
FY
2010-‐2014,
for
home
visi3ng
programs
for
at-‐risk
popula3ons.
32. Caution!
Click to edit Master title style
Notwithstanding
these
access
and
safety
net
ini3a3ves:
• $18
billion
reduc3on
in
Medicaid
Dispropor3onate
Share
payments
over
7
years
creates
great
uncertainty
for
the
future
of
safety
net
hospitals.
• State
budget
deficits
may
undermine
efforts
to
sustain
the
safety
net
and
improve
access.
33. Unfunded Opportunities:
Click to edit Master title style
Community Health & Prevention
• Community-‐Based
PrevenBon
and
Wellness
Programs
– Grants
to
state/local
health
depts.
to
carry
out
5-‐year
pilot
programs
for
Medicare
beneficiaries.
• Community
Health
Teams
(CHTs)
– As
states
adopt
medical
home
models,
more
low
income
&
diverse
individuals
with
chronic
illness
will
be
able
to
turn
to
a
CHT
to
help
them
link
with
a
full
range
of
health
and
social
services
they
may
need.
• Community
Health
Workers
(CHWs)
– Use
of
CHWs
in
health
interven3on
programs
associated
with
improved
access,
prenatal
care,
pregnancy
and
birth
outcomes,
health
status,
screening
behaviors
&
reduced
health
care
costs.
• ImmunizaBon
DemonstraBon
Program
– Grants
for
immuniza3on
programs
for
at-‐risk
popula3ons.
34. Unfunded Opportunities:
Cultural Competence
Click to edit Master title style
• Model
Curricula
for
Cultural
Competency
– Opportunity
to
test
impact
of
a
range
of
cultural
competency
training
programs
on
health
outcomes
and
to
iden3fy
efficacy
&
effec3veness.
• FacilitaBng
Shared
Decision
Making
– Pa3ent
decision
aids
are
required
to
present
up-‐to-‐date
clinical
evidence
about
risks
and
benefits
of
treatment
op3ons
to
meet
cultural
&
health
literacy
requirements
of
popula3ons.
36. Advancing the Health of Communities
Click to edit Master title style
1. Leveraging
support
for
community-‐based
strategies
and
engagement
in
reducing
dispariBes.
• Communi3es
must
be
ac3ve
and
involved
par3cipants
in
sekng
overall
objec3ves,
specific
goals
and
strategies
for
achieving
them.
2.
PromoBng
integrated
strategies
across
health
and
social
services
to
improve
the
health
of
diverse
communiBes.
• Need
for
direct,
concerted
research,
policy
and
programs
that
seek
to
alter
significantly
the
nega3ve
influence
of
social
determinants
in
diverse
communi3es.
37. Health Care Organization-Based
Initiatives
Click to edit Master title style
1.
Developing
and
tesBng
model
programs
that
link
specific
organizaBonal
efforts
to
reducing
dispariBes
and
improving
quality
of
care.
• Organiza3ons
must
be
commifed
to
support
prac33oners
through
more
comprehensive
and
ac3ve
engagement
in
caring
for
diverse
pa3ents.
2.
DocumenBng
and
linking
non-‐profit
community
needs
assessment/benefit
requirements
to
health
care
reform
incenBves
to
address
dispariBes.
• Need
to
reach
beyond
demonstra3ons
and
funding
opportuni3es.
• Require
provider
organiza3ons
to
show
evidence
of
working
to
reduce
dispari3es—e.g.
through
educa3on
&
community
outreach
3.
Preserving
and
transiBoning
the
health
care
safety
net.
• Providing
direct
support
for
safety
net
hospitals,
par3cularly
in
regions
with
large
uninsured
and
undocumented
popula3ons.
• Guidance
for
philanthropic
organiza3ons
on
ways
to
support
safety
net.
38. Individual Level Initiatives
Click to edit Master title style
1. Developing
effecBve
care/disease
management
and
self
management
intervenBons
and
protocols
for
diverse
paBents.
• New
programs
will
need
to
address
how
and
to
what
extent
inafen3on
to
race-‐
and
culture-‐specific
and
language/literacy
concerns
may
create
impediments
to
care
management
and
self
management.
2. MiBgaBng
the
effects
of
overweight/obesity
and
negaBve
environmental
factors
that
may
impede
progress
on
reducing
dispariBes.
• Greater
health
care
provider
awareness
of
culture
and
challenges
faced
by
diverse
popula3ons
will
be
important
for
reducing
dispari3es
in
care
and
adherence
to
treatment.
39. Next Steps
Click to edit Master title style
• Educa3on
around
specific
ACA
language
for
priority
areas.
• Work
with
representa3ve
associa3ons/organiza3ons
to
educate
and
discuss
strategies
for
pursuing
priority
areas.
• Advocate
for
state,
county
and
community
innova3on
in
health
equity
and
reducing
dispari3es.
• Appropria3ons,
appropria3ons,
appropria3ons—assuring
adequate
funding
for
provisions.
• Communicate
with
agencies
likely
to
oversee
iden3fied
priority
areas
about
status
and
progress
in
adding
content
to
these
areas.
40. 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
dpandrulis@gmail.com
Nadia J. Siddiqui, MPH
Senior Health Policy Analyst, Texas Health Institute
nsiddiqui@texashealthinstitute.org
Jonathan P. Purtle, MPH, MSc
Program Manager, Drexel University School of Public Health
jpp46@drexel.edu
Lisa Duchon, PhD, MPA
Health Management Associates
lduchon@healthmanagement.com
*Download publication here*
41. ACA Implementation and Health
Equity: Experiences from Maryland
Dr. Carlessia A. Hussein, Dr.PH, RN, Director
Office of Minority Health and Health Disparities
Maryland Department of Health and Mental Hygiene
42. State Health Equity Learning
Collaborative: Request for Applications
for Technical Assistance
Diane Justice, MA
Senior Program Director
National Academy for State Health Policy (NASHP)
43. What is it?
n Opportunity for states to
advance health equity agendas
while engaging in critical health
care reform implementation
activities
n Structured peer-learning
opportunity to integrate health
equity initiatives across state
agencies – specifically
Medicaid, Public Health and
Minority Health Offices
n Collaborative will consist of
seven competitively selected
states working in key policy
areas:
¡ Health insurance coverage
¡ Delivery system reform
¡ Public health
44. What s in it for States?
n Participating states will:
¡ Receive a customized State Health Equity
Profile developed by NASHP
¡ Work across state teams to develop a state
health equity work plan
¡ Collaborate with peer states through an online
community portal
¡ Receive technical assistance from national
health equity experts
¡ Opportunity to attend and present at a National
Invitational Health Equity Summit
45. State Requirements
n Maintain a core team of at least three
members from state agencies
n Develop a state health equity work plan
n Participate in all TA activities
n Achieve reasonable implementation of state
work plan
n Review NASHP products as requested
n Update work plan at end of 8-month TA
period
46. Process: Request for Applications
July 21, 2011 Issue Requests for Applications
Accessible at www.nashp.org
August 9, 2011 Prospective Applicant Call
3:00 pm EDT Call-in: 866-640-1260, Passcode: 3938541
August 23, 2011 Applications Due to NASHP
September 9, 2011 Selected States are Notified
October 7, 2011 Work Plan Due to NASHP
March 2012 National Summit in Washington, DC
May 2012 Final Report Due: State Work Plan Update
Ongoing Participation in Technical Assistance Activities
47. n Statereforum.org is a space for:
¡ Peer-to-peer learning and discussion
¡ Exchanging reform ideas
¡ Posting, organizing, and sharing useful state
documents
¡ Announcing off-line events and activities
¡ Spotlighting the keys to successful
implementation
¡ Mapping states progress in implementing
health reform
49. Contact Information
n Dr. Ernest Moy
¡ ernest.moy@ahrq.hhs.gov
n Dr. Dennis Andrulis
¡ dpandrulis@gmail.com
n Dr. Carlessia A. Hussein
¡ husseinc@dhmh.state.md.us
n Diane Justice
¡ djustice@nashp.org
50. Thank You!
For more information, please visit:
www.nashp.org
www.aetna-foundation.org
www.statereforum.org