Health Care Reform and Hispanics

Elena Rios, MD, MSPH

President & CEO

National Hispanic Medical Association, March 26, 2010

NHMA – Who are We?

Established in 1994 in DC, non-profit 501c6 association representing 45,000 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

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

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

NHMA and Health Reform

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 Leadership Meetings – yesterday w/Spk.Pelosi

Senate Finance Committee 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

Senate Finance CommitteePublic 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

Both – verification, 5 yr wait for immigrants

New Health Insurance

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 – probably in the final Senate bill

Quality & EfficiencySenate HELP Committee 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) Pt outcomes and functional status, H-IT, pt safety, effectiveness,

pt centeredness, appropriateness, efficiency, equity of services and health disparities, patient satisfaction

QualitySenate HELP Committee Center for Health Outcomes Research and Evaluation

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* case management care coordination chronic dz management medication and care

compliance medical home prevention of hospital

readmissions patient safety

Senate HELP Bill

reduction of medical errors

evidence based medicine health IT child health measures culturally and linguistically

appropriate care

Quality and ProvidersSenate Finance Committee 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

Prevention Senate HELP Committee 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)

Prevention Senate HELP Committee 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 WellnessSenate Finance Committee 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

Health Care Reform & WorkforceSenate HELP Committee National Health Care Workforce

Commission – HHS, DEd, DOL Integrated health workforce training, capacityMedicare/Medicaid GME Nursing, oral, mental, allied, and public health

workforceGeographic distribution of providers vs need Increased focus on primary care providers

Health Care Reform & WorkforceSenate HELP Committee 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

Health Care Reform & WorkforceSenate HELP Committee 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 & WorkforceSenate HELP Committee 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 – 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 WorkforceSenate Finance Committee National Workforce Strategy (CMS/HRSA)

and new Advisory CommitteeRecruitingTrainingSupply and demand of workforce, and for

special populations (COE, HCOP)Education training capacity (faculty)Future policy

Health Care WorkforceSenate Finance Committee 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 aides

Certified diabetes educators SGR - .5% increase in 2010

President Obama Proposal

Access – 31 million insured – making bill more affordable, closing the donut hole

Accountability of insurance companies Increased Medicaid to all states Additional GOP issues included

Fraud and wasteMalpractice courts demonstration program Increase Medicaid reimbursement – MDsHealth savings accounts

Hispanics - Health Disparities Priorities in Health Care Reform Mandatory data -racial/ethnicity and language Access: affordable universal insurance, working poor and

Puerto Rico increased access in public programs, cultural competence, language services

Prevention: community education programs Quality: cultural competence in measures Workforce: diversity - COE, HCOP; primary care training Comparative effectiveness research Office of Minority Health reauthorized and Center for Minority

Health and Health Disparities becomes an NIH Institute Center for Cultural Competence and Linguistic Services

NHMA

www.nhmamd.orgSupport health reform - send your letter to

your Senators and CongressmenJoin as a Member NHMA 14th Annual Conference

Washington, DC, Mar. 25-28th 2010Policy meetings prior to Scholarship Dinners

Oct. 9th – San Francisco Dec. 4th – New York