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
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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 & 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
Established in 2002, NHMA’s foundation,
National Hispanic Health Foundation, is a nonprofit 501c3 foundation for research & education
activities – affiliated with and located at the NYU
Wagner Graduate School of Public Service
NHMA Board of Directors
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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/CEO
Washington, 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
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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
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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
Miguel Sanchez, MD
Professor, Dermatology
NYU School of Medicine
I. Access to 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
I. Access to Public Health Care
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
Barriers: verification, immigrant 5yr wait
I. Access:New Health Insurance
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State Health Insurance Exchanges
 Voluntary
enrollment to qualified individuals to
select qualified health plans
 Websites, Ombudsman systems
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New grants for community health workers
to assist with enrollment, provide
information that is culturally and
linguistically appropriate
II. Quality & Efficiency
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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, 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)
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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
II. Quality & Efficiency
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Patient Centered Outcomes Research Institute
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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*
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case management
care coordination
chronic dz management
medication and care
compliance
medical home
prevention of hospital
readmissions
patient safety
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reduction of medical
errors
evidence based medicine
health IT
child health measures
culturally and
linguistically appropriate
care
mental health
II. Quality and Providers
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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
III. Prevention
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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, includes cancer
Prevention and Health Promotion Investment Fund
($10B)
III. Prevention – New Programs
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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
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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
IV. Health Care Workforce
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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, diversity
 Geographic distribution of providers vs need
 Increased focus on primary care providers
IV. Health Care Workforce
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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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IV. Health Care Workforce
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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, diversity
IV. Health Care Workforce
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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 – Title VII COE, HCOP expansion
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
IV. Health Care Workforce
Medicare
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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 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
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 Fraud
and waste
 Malpractice courts demonstration program
 Increase Medicaid reimbursement – MDs
 Health savings accounts
How to contact NHMA & NHHF
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NHMA - www.nhmamd.org
NHHF - www.nhmafoundation.org
Hispanic Health Portal
 www.hispanichealth.info
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NHMA 15th Annual Conference – “Health
Care Reform Implementation for the
Hispanic Community” – Washington, DC,
Mar. 17-20, 2011