ACA and Future Policy
Elena Rios, MD
National Hispanic Medical Association
October 2013
Demographics
Demographics
Key Trends
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Minorities face health care disparities in America
 By 2042, over half of Americans will be minority populations
 Latinos – immigrants, mixed families with strong cultural values -will be 1 out of 4
Americans
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Our nation is undergoing a major transformation:
 Cultural Competence & language requirements in hospitals/clinics and for future
providers in medical education and public health
 Health care reform expands health care coverage to Hispanics and African
Americans and increases the need for education and outreach efforts
 Quality value payments for coordinated patient centered care
 Disparities in obesity and chronic disease for minority populations remain high
 New demand for community-based health prevention and research
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NHMA/NHHF seeks to cultivate public and private partnerships to make a positive
impact promoting prevention awareness & good will in new and growing Latino
communities and markets around the nation
Social Determinants of Health
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SES
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Education
Income
Residential segregation
gradient of health outcomes and risk behaviors
occupation, culture, social network and cohesion,
correctional systems, legal policies, mental health
and psychosocial factors, and forms of
discrimination
Residential Segregation
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The fundamental cause of racial/ethnic health
disparities in the U.S.
Environmental hazards, reduced access and
quality of health care, increased violence and
crime, and poorly built environments in which
there is less access to supermarkets
providing fresh fruits and vegetables, greater
access to fast foods, and less recreational
facilities than non-segregated neighborhoods,
substandard housing.
Societal Costs
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Safety net providers (clinics, ED) more costly
treatment than preventive and primary care
Poor have more severe disease with
complications and comorbidities
Potentially preventable hospitalizations
Premature deaths, loss in productivity
Individuals, families, communities, employers,
health plans, and governmental agencies, health
insurance companies, businesses
Societal Costs
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To date, estimated societal costs tend to
underestimate the economic impact of health
disparities by excluding costs to employers
due to a larger pool of unhealthy workers and
broader societal impacts such as decreased
tax revenue because of lower productivity
and increased insurance premiums as risk
pools deteriorate.
With increased minority population, global
competition is at stake for the US.
ACA, Disparities & Access
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Increased newly insured patients unfamiliar with
healthcare, behavioral healthcare, oral healthcare and
healthy living concepts
Increased outreach and education especially to young
adults and increase awareness about healthcare
Increased communications – information on websites,
social media, media, appointment systems, grievances,
complaints with billing and subsidies/discounts
Hispanic family-focused health information, coalitions,
organizations, leaders
Health Insurance Marketplace
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States/Federal Facilitated
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Grants to develop outreach with navigators that is culturally and
linguistically appropriate; enrollment counselors; brokers
Qualified healthplans - limited participation
Essential community provider - safetynet
Standards for benefits – presented in a culturally and
linguistically appropriate manner, health literacy
Subsidies 100-400%FPL ($23K -$96K) individuals/families, small
businesses to get tax credits
CBO Estimates by 2022, 25M Americans in the marketplaces
Essential Benefits – transition
policies needed
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Ambulatory care services
Emergency
Hospitalization
Maternity/newborn
Mental Health/Substance abuse disorders
Prescription medications
Rehabilitative and habilitative
Laboratory
Preventive services and chronic care management
Pediatric, including oral, vision care
Health Policy Trends
Health insurance will be more prevalent in
shopping centers, pharmacies, stores
 Home health, adult day care, PCMH –
coordinated care, outpt care will increase
 Community prevention care programs
 Govt Hearings/document best practices
 Medical care use – population health,
health planning needed
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Uninsured Populations Policy
Need health insurance education in govt
programs for mixed families– adult
education programs, job training, CBOs,
mental health, Medicaid, clinics,
nutrition/farmers markets, schools
 Small business programs, faith-based,
media campaigns
 Funding to public hospitals, clinics
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Public-Private Partnerships are
the Future (social enterprise)
Government procurement needs to link to
public sector markets and solution
economy or social innovation
 Example: Sec Clinton announced the
USAID impact investment approach to
development assistance, matching private
sector funding
 Health insurance, pharmacies
 Corporations need healthy employees
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ACA, Disparities & Quality
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National Strategy for Quality Improvement in
Health Care
 Priorities
that have the greatest potential for
improving health outcomes, efficiency, and patientcenteredness of health care, for all, including
vulnerable populations
 Quality measures – Medicare/Medicaid hospitals,
physicians
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experience, quality, use of info for pts and caregivers
Equity of health services/disparities across health disparity
populations
Patient-centered, pt satisfaction, accessibility, availability
ACA, Disparities & Quality
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Reimbursement – including activities to prevent
hospital readmissions – comprehensive
discharge program with pt centered education
and counseling
Best clinical practices that improve pt safety and
reduce medical errors through evidence based
medicine and Health Information Technology
H-IT : EMR and PMR to include health
disparities information from
provider/patient/community assessments – for
example, language needs
ACA, Disparities & Quality
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Center for Medicare/Medicaid Innovation
 Pt
centered medical home models
 Community health teams, small practice med
homes – chronic care, self management
 Home health chronic care services
 Best practices
 Healthcare innovation zones
 Programs that address health care disparities
and show impact
ACA, Disparities & Prevention
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National Prevention, Health Promotion and Public Health
Council (Fed agencies under HHS)
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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
Prevention and Health Promotion Investment Fund $10B
Community Transformation Plan
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to promote healthy living and reduce disparities (including social
determinants)
Schools, restaurants, worksites
Community prevention
ACA, Disparities & Workforce
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National Health Care Workforce Plan – HHS, DEd, DOL
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Scope of work laws – need more providers of care
Diversity needs to include Recruitment K-16
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Interprofessional education, focus on primary care
Nursing, oral, mental, allied, and public health workforce
Geographic distribution of providers vs need
Diversity to increase URM minority health professionals
Cultural Competence training for all providers
Community-based participatory research, PCORI (pt
centered outcomes research), evidence based needed
NHMA Vision to increase Latino
Physicians – STEM Diversity
Summit, Nov. 2013
Need for diversity and health professions
in the President’s STEM Initiative
(recruitment counseling still needed)
 OMB White House, Dept of Education,
NSF, NIH, HRSA, Congress, IOM, Josiah
Macy Foundation, RWJF
 Career pathway program – Hispanic
STEM Program from HSIs to medical
school
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Cultural Competence Standards
Federal Law – Title VI
 Medical Education – AAMC, LCME,
ACGME
 Joint Commission
 NCQA
 NQF standards
 Licensing – required in CA, NJ
 Language Services in Medicaid – in 13
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Cultural Competence and
Quality
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There is excellent evidence that tracking/reminder
systems can improve quality of care, and fair evidence
that multifaceted interventions, provider education
interventions, and interventions that bypass the
physician to offer screening services to racial/ethnic
minority patients can improve quality of care. There is,
however, excellent evidence for improvement in provider
knowledge, good evidence for improvement in provider
attitudes and skills, and good evidence for improvement
in patient satisfaction. (AHRQ, Strategies for Improving Minority Healthcare
Quality (Publication No. 04-E008-01, 2004)
National Physician Survey 2011
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Physicians overwhelmingly want the health
care system to cover the costs associated
with connecting patients to services that
address their social needs.
A majority of physicians surveyed say that
the health of up to half their patients would
improve if the health care system did a better
job of addressing social needs.
Source: RWJF Website – 1000 physician survey 2011.
NHMA & NHHF– Who are We?
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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 with
Hispanic medical societies, residents, students
and public and private partners.
Established in 2002, NHMA’s foundation,
National Hispanic Health Foundation, a nonprofit 501c3 foundation for research & education
activities – affiliated with NYU Wagner Graduate
School of Public Service
NHMA Board of Directors
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Kathy Flores, MD, Chairwoman,
Director, UCSFresno Latino
Research Center
Louis Aguilar, MD, Treasurer,
Tucson, AZ
Sam Arce, MD, ViceChair, NYC
Jorge Girotti, PhD, Secretary,
Assoc. Dean, U of Illinois, Chicago
School of Medicine
Elena Rios, MD, President/CEO
Washington, DC
Raymond Arroyo, VP, Aetna
David Carlisle, MD, President,
Charles R. Drew University of
Medicine and Science
Emilio Carrillo, MD, MPH,
Professor, Cornell Weill School of
Medicine
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Judy Flores, MD, Dir, Adol Health,
Woodhull Med Ctr/NYU
Efrain Fuentes, EdD, Walt Disney
Paloma Hernandez, MPH, CEO,
Urban Health Inc.
Norma Parra, MD, med dir,
CentroMed, San Antonio
Jorge Puente, MD, Regional
President of Asia, Pfizer
Nelson Reyneri, VP, Liberty
Power
John Sanchez, MD, Young
Physicians
Gerardo Lopez-Mena, MD,
Chairman, Council of Residents
Alvaro Galvis, Coordinator, Latino
Medical Students Association
NHHF Board of Directors
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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
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Jo Ivey Boufford, MD
President, New York Academy
of Medicine
Gary Pelletier
Director, Pfizer Helpful
Answers
United Healthcare
Walmart
National Hispanic Medical
Association – what do we do?
Serve as a resource for White House,
Congress, and Federal agencies on health
policies and programs
 Support Hispanic physician leadership at
national and state level
 Provide networking opportunities for
advancement of Hispanic health
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National Hispanic Medical
Association Programs
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Resource:
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Federal government
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Private sector
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Provide technical assistance to corporate health programs
Nominate members to corporate boards
Leadership Development:
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Capitol Hill Briefings on Hispanic health Issues to eliminate health disparities
Nominate members to Federal advisory commissions
NHMA Leadership Fellowship
National Hispanic Health Professions Leadership Institute
Health Professional Student Recruitment and Mentoring Programs
Networking:
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NHMA 18th Annual Conference, Mar. 27-30, 2014, Washington, DC
Regional Health Reform Events – NYC, Los Angeles, San Antonio, Chicago,
Atlanta, DC
NHMA Network 2013
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Hispanic State Medical Societies
National Hispanic Health Professional
Leadership Network
 National Association of Hispanic Nurses
 Hispanic Dental Association
 Latino Caucus of APHA
 Latino Forum of Health Executives
 PAs, Mental Health Workers, Dietitians
12,000 Members and 40,000 Prospects
Latino Medical Student Association
Partners, Contacts
NHMA & NHHF Contact Us
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NHMA - www.nhmamd.org
NHHF - www.nhmafoundation.org
Portal - www.hispanichealth.info
National Hispanic Health Professional Student
Scholarship Programs – Nov 21, LA; Dec 5, NYC –
NHMA Annual Conference “ACA and Best Practices that
Improve the Health of Hispanics” – Mar. 2014, DC