Health Care Reform
and Hispanics
Elena Rios, MD, MSPH
President & CEO
National Hispanic Medical
Association, November 4, 2009
NHMA – Who are We?
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Established in 1994 in DC, non-profit 501c6
association representing 36,000 Hispanic
physicians in the U.S.
Mission: to improve the health of Hispanics and
other underserved
NHMA Board of Directors
Established its foundation, National Hispanic
Health Foundation, 501c3, for research and
education activities – affiliated with NYU Wagner
Graduate School of Public Service
NHMA Networks
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NHMA Council of Medical Societies
NHMA Council of Residents
Latino Medical Student Association
Hispanic Health Professional Leadership
Network – all national Hispanic health
professional associations
Board of Directors – NHMA, NHHF
NHMA Leadership Fellows & Residents (2010)
Hispanics & Health Care
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The majority ethnic group in America
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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 and Health Reform
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Summit Series w/US DHHS 2007-08
Presented to Presidential Campaigns, National
Democrat & Republican Conventions
Presented to Senator Kennedy Hearing w/ AMA,
AAFP, ACP, AAP, NMA – 8/08
Presented to White House, Congressional
Hispanic Caucus 11/08 and in 2009 meetings
Health Disparity Congressional Briefings – June
and October with Tricaucus and advocates
Senate Finance Committee
Health Coverage
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Individual mandates, affordable - 2013
 Subsidies
based on income
 Max of 10% income on premiums
 Dependent to age 26
 Family can apply as a unit
 Employer insurance, ineligible for low income
tax credit thru the Health Insurance Exchange
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Employer mandates
Senate Finance Committee
Public Programs
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Medicaid –
 Nationwide:
133% FPL, childless adults
 Dual eligibles – new CMS office to monitor
 Medications – benefit by 2014
 Territories’ caps increase by 30% & FMAP
increases by 5% (new eligibles don’t count)
 DSH – state trigger as uninsured decreases
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CHIP
 133-250%FPL,
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cost sharing up to 5% income
Both – verification, 5 yr wait for immigrants
New Health Insurance
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Health Insurance Exchange (Gateway)
 Voluntary
enrollment to qualified individuals to
select qualified health plans
Navigators to receive grants to assist with
enrollment, provide information that is
culturally and linguistically appropriate
 Puerto Rico included House side
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Quality & Efficiency
Senate HELP Committee
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National strategy to improve health care quality
 AHRQ – standards/ CMS – inform, payments
HHS lead - strategic plans, incentives w/public
and private payers, Racial/ethnicity and
language data
Key National Indicator System (and Independent
Institute by the National Academy of Sciences)
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Pt outcomes and functional status, H-IT, pt safety, effectiveness,
pt centeredness, appropriateness, efficiency, equity of services
and health disparities, patient satisfaction
Quality
Senate HELP Committee
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Center for Health Outcomes Research and Evaluation
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AHRQ; Research on health disparities mentioned
Finance Committee: private Pt Centered Outcomes Institute
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
Reimbursement for Quality under
the Plan or Coverage*
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case management
care coordination
chronic dz management
medication and care
compliance
medical home
prevention of hospital
readmissions
patient safety
Senate HELP Bill
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reduction of medical
errors
evidence based medicine
health IT
child health measures
culturally and
linguistically appropriate
care
Quality and Providers
Senate Finance Committee
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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
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Physician Value Based Purchasing
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Goal - Attaining a standard or making performance
improvements
Physician Quality Registration Identifier
Maintenance of Certification (new)
Feedback & Appeals process (new)
Quality monitoring to start for nursing homes, rehab,
hospices, cancer hospitals
Prevention
Senate HELP Committee
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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
Prevention and Health Promotion Investment Fund
($10B)
Prevention
Senate HELP Committee
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Right Choices Programs
School clinics
Worksite wellness
Community Transformation Grants
Healthy Aging Grants (55-64)
Food labeling, restaurants, school vending
machines
Health Impact Assessments
Prevention and Wellness
Senate Finance Committee
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Incentives for healthy lifestyles initiatives
 $100M
for Medicare and Medicaid
 Monitor beneficiary participation and health outcomes
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States to improve coverage and access to
preventive services and immunizations with 1%
increase FMAP
Medical Homes
Integrated Care
Health Care Reform & Workforce
Senate HELP Committee
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National Health Care Workforce
Commission – HHS, DEd, DOL
 Integrated
health workforce training, capacity
 Medicare/Medicaid GME
 Nursing, oral, mental, allied, and public health
workforce
 Geographic distribution of providers vs need
 Increased focus on primary care providers
Health Care Reform & Workforce
Senate HELP Committee
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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
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Health Care Reform & Workforce
Senate HELP Committee
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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
Health Care Reform & Workforce
Senate HELP Committee
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Loan Repayment Programs
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Advanced Practice Nurse managed health clinics –
associated with school, university, FQHC or nonprofit
Primary Care Training – GIM, Peds, FP, added: PA
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National Health Service Corps – HPSAs
Nursing, Dental, Allied Health, Pediatric Adolescent, mid-career
Public Health, Faculty
Training in cultural competence and health literacy
Priority for track record of training minorities, rural,
disadvantaged
Innovation in primary care models, integrative care
Diversity – COE, HCOP expansion
Primary Care Extension State(s)
Hub and Local Agencies
Required Activities: learning communities in
primary care, share best practices, community
providers to create new knowledge - hdisparities
 State Hub – State Health Dept, health profession
schools, medical societies
 Coordinate QIO and AHECS – we support
adding Diversity Programs: HCOP/COE
Health Care Workforce
Senate Finance Committee
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National Workforce Strategy (CMS/HRSA)
and new Advisory Committee
 Recruiting
 Training
 Supply
and demand of workforce, and for
special populations (COE, HCOP)
 Education training capacity (faculty)
 Future policy
Health Care Workforce
Senate Finance Committee
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Medicare participation: 10% bonus for:
 PC
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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
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income (TANF); home care aides
Certified diabetes educators
SGR - .5% increase in 2010
Hispanics - Health Disparities
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Mandatory data -racial/ethnicity and language
Access: affordable universal insurance, immigrant ban
lifted, cc -language services
Prevention: community education, CHW
Quality: cultural competence in measures
Workforce: diversity - COE, HCOP expands
Comparative effectiveness research
Office of Minority Health amendment request to provide
coordination of racial/ethnic health
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Center for Cultural Competence and Linguistic Services
NHMA
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www.nhmamd.org
– send your letter to
your Senators and Congressmen
 Join as a Member
 NHMA Foundation Scholarship Dinner –
 Legislative Advocacy
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Marriott Marquis, Dec. 3rd
 NHMA 14th Annual
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Conference
Washington, DC, Mar. 25-28th 2010