The Role of Social Determinants in a Community's Access to Quality Health Coverage
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© 2016 Enroll America | StateOfEnrollment.org The Role of Social Determinants in Community’s Access to Quality Health Coverage
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Transcript of The Role of Social Determinants in a Community's Access to Quality Health Coverage
© 2016 Enroll America | StateOfEnrollment.org
The Role of Social Determinants in Community’s Access to QualityHealth Coverage
State of Enrollment – 2016 National Conference
The Role of Social Determinants in Community's Access to Quality Health Coverage
May 12, 2016
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A Closer Look at Distributions
• “Who gets what, when and how?”
• A Cake Example*
*Source - Policy Paradox and Political Reason. Deborah Stone,
1988.
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Concepts of EqualityDimension Issue
Dilemma
Recipients MembershipUnequal Invitations
Equal Slices
Items Need for item Equal Meal
Unequal Slices
Process CompetitionUnequal Forks
Unequal SlicesAdapted from Policy Paradox and Political Reason.
Deborah Stone, 1988
Health Disparity
“A health disparity is a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial and/or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”
National Stakeholder Strategy, Healthy People 2020 and Health and Human Services (HHS) Plan
The Issue
Health Equity
“Health equity is attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities.”
TheVision
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-National Stakeholder Strategy, Healthy People 2020 and Health and Human Services (HHS) Plan
ACF’s Mission
To foster health and well-being by providing federal leadership, partnership and resources for the compassionate and effective delivery of human services
8
Budget
ACF administers more than 60 programs with a $51 billion budget, making it the second largest agency in the U.S. Department of Health and Human Services
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OPPORTUNITYISNOWHERE!
OPPORTUNITY IS NOW HERE!
ACF’s Approach to Support ACA Implementation
ACF
Regions
LiaisonPartnershipOutreach
DisseminationTailored MaterialsPrograms
RulesTA ContractsGrants/FOAIntake
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Administration for Native Americans
– Sent over 180 tweets, informational news items to grantees and other interested parties on ANA listserv (500+).
– Posted ANA Blog - The Affordable Care Act: What’s in it for American Indians and Alaska Natives? – (66 hits).
– Conducted ACA webinars for tribal communities.
– Program Integration: Issued renewals for Eastern, Western, and Alaska with a requirement to include ACA and CHIP information in all training materials.
Family and Youth Services Bureau
• Conducted a series of webinars for Runaway and Homeless Youth, Domestic Violence, Adolescent Pregnancy and Prevention grantees and stakeholders:– Open Enrollment: How the Affordable Care Act Can Help
Patients Experiencing Domestic and Interpersonal Violence.
– Connecting Youth to Clinical Services.
• Program Integration: FYSB grantees and the Health Resource Center on Domestic Violence promote ACA and respond to training and TA requests.
OCS: Community Services Block Grant Program
• Includes: 50 state grantees, DC, Puerto Rico, the U.S. Territories and 1,000+ CSBG-funded eligible entities and national partners.
– Published an Information Memorandum titled “Use of CSBG Resources to Support Information and Referral for Affordable Care Act (ACA) Benefits and Services.” through the CSBG list serve (236 recipients who share with 1000+ CACs).
• Program Integration: Develop CSBG/Community Action National Performance Indicators, including measures related to health and well-being
Office of Head Start, Office of Child Care (OCC)
– Provided information to the regional offices for distribution to CCDF grantees and child care resource and referral organizations.
– Distributed on OCC listserv, “Are You a Head Start or Child Care Provider in Need of Health Insurance” (4,200 subscribers).
– Sent e-blast for the webinar on “Tax implications for ACF constituents.”
OCS: Low Income Home Energy Assistance Program (LIHEAP)• Includes: 50 state grantees, District of Columbia, 154 tribal
grantees, American Samoa, Guam, Northern Mariana Islands, Puerto Rico, Virgin Islands, national partners.
– Issued a Dear Colleague Notice on Extension to the A-87 Cost Allocation Exception to all LIHEAP grantees and discussed system integration concepts during quarterly conference calls.
– Promoted and participated in the CMS webinar on tax implications and encouraged LIHEAP network to promote the webinar to grantees and partners.
ACF External Affairs: ACA Utilities Partnership• Rationale:
– Medical debt is the single largest cause of personal bankruptcy. – Costly utility service terminations are on the rise. – Health insurance eliminates one major cause of financial instability for utility
customers.• Strategies:
– Leverage the saturated reach of utilities to find the uninsured and connect them to navigators for help finding free or low-cost health insurance.
– Use Zip Code data to identify high uninsured in service area.• Outcome:
• ACF, CMS, and Enroll America collaborated successfully with 3 major utility companies to reach the uninsured in their service areas.
What worked especially well this open enrollment period?• The Process
– Direct contact with enrollers, navigators, and assisters.– Playing to everyone’s strengths, not over-reaching
resources.– Relationships & collaborations (CMS, Head Start
grantees, partners).– Strategies, target areas, and data-driven plans.
• Communication– Messages/dissemination on listservs.– Relevant information.– Customized materials (flyers).
How to Incorporate?
• Strategic planning for the entire year—infusing ACA messages into program activities and priorities
• Grants offices taking an active part in facilitating ACA and CHIP enrollment for all new grantee awards
• Strong leadership conveying that ACA outreach is a priority
• Share success stories
• Include in Commissioners’ performance plans
• Implement strategies in enrollment, contracts, and technical assistance that result in more parents getting insurance
• Include in TA contracts, intake forms, rules, etc.
Next Steps
• Leveraging intake process for ACF means-tested programs.
• Taking a deeper dive on how to reach Head Start parents.
• Forging stronger connections between utility companies and navigators.
• Sharpening the region’s strategic focus to provide more direct one-on-one assistance to the uninsured.
“Make no little plans, they have no magic to stir men’s blood and probably themselves will not be realized. Make big plans; aim high in hope and
work, remembering that a noble, logical diagram once recorded will never die, but long after we are
gone will be a living thing, asserting itself with ever growing insistency.”
David Burnham (Chicago architect, 1925)
Contact Information
Rochelle RollinsHHS/ACF Office on Trafficking in [email protected]
Website www.acf.hhs.gov
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© 2016 Enroll America | StateOfEnrollment.org
The Role of Social Determinants in Community’s Access to QualityHealth Coverage
Ronald Ashford, Director Public Housing Supportive Services, U.S. Department of Housing and Urban Development
Proyecto Salud ClinicSafety Net Clinic in Montgomery County
May 12, 2016
Everyone should have access to healthcare
One million + population One in two minority
One in three immigrant One in seven senior(America’s longevity capital – AARP blog)
MC CountyStat – community dashboards
Montgomery County
Montgomery County‘majority minority county’’
(MC CountyStats community dashboards)
Montgomery County (MC CountyStats community dashboards)
El Salvador China (MC #1 in DC Metro) India Ethiopia (MC #1 in US) Korea
Montgomery County Top countries of origin
Montgomery County Uninsured Populations: 112, 992 –11.5% uninsured rate
(American Comm. Survey 2009-2013 estimate)
6%
49%25%
20%
Non-Hispanic WhiteHispanic or LatinoBlack or African AmericanAsian or Pacific Islander
The Montgomery Cares Program is a Public Private Partnership, its purpose is to facilitate access to primary health care to low income, uninsured adults living in Montgomery County.
Serves annually close to 5,000 patients in two clinic sites
Proyecto Salud ClinicOur Mission is to serve as a community health center that provides
comprehensive, coordinated, and patient centered compassionate care.
Population Served
Population Served
Uninsured93%
Medicaid7%
Population Served
Primary Adult Healthcare Behavioral/Mental Health (collaborative
model) Diabetes Education and Management Care coordination – PCMH project Referral coordination to specialist
Services and programs
Medicaid program expansion Diversification of services to include
childrenGrowth in new locationStrengthening of partnerships
going forward….
Meeting the Need and Stabilizing Lives
TOGETHERWE CANSOLVEHUNGER
TOGETHERWE CANSOLVEHUNGER
Feeding America
Nation’s leading domestic hunger-relief organization
MISSIONTo feed America's hungry
through a nationwide network of member food banks and engage our
country in the fight to end hunger.
VISIONA hunger-free America
1NATIONALOFFICE
Together we provide 3.7 billion meals each year
46M200 MEMBERFOOD BANKS
60K FOOD PANTRIES AND MEAL PROGRAMS
AMERICANSSERVED ANNUALLY
We increasingly prioritize variety and good nutrition
68% of the food we distribute closely aligns with the USDA Dietary Guidelines for Americans.
FRUITS
VEGETABLESPROTEIN
GRAINS
DAIRY
48 MillionPEOPLE ARE
FOOD INSECUREIN AMERICA
48Mx
IN THE UNITED STATES, FOOD INSECURITY IS HOLDING STEADY AT THE HIGHEST RATES
EVER RECORDED
providing meals alone won’t solve
food insecurity
Needs do not exist in isolation
Food
Housing
Health
Employment & Income
Food insecurity and health are interconnected
Across the lifespan, food insecurity is associated with:
Poorer dietary intakePoorer physical, psychological, and behavioral health
Poorer disease management
Feeding America’s clients report that their household income is inadequate to cover their basic household expenses.
69%HAVE HAD TO
CHOOSE BETWEEN PAYING
FOR UTILITIES AND FOOD
57%HAVE HAD TO
CHOOSE BETWEEN PAYING
FOR HOUSING AND FOOD
67%HAVE HAD TO
CHOOSE BETWEEN PAYING FOR
TRANSPORTATION AND FOOD
66%HAVE HAD TO
CHOOSE BETWEEN PAYING
FOR MEDICINE AND FOOD
Source: Hunger in America 2014
Households are making difficult tradeoffs that have short and long-term implications for health
Source: Hunger in America 2014
55% of households reported using 3 or more coping strategies in the past year.
79%Purchase Inexpensive,
Unhealthy Food
53%Receive HelpFrom Friends
40%Water Down
Foods or Drinks
35%Sell or Pawn
Personal Property
23%Grow Food in a Garden
47% of clients responded they are in fair or poor health In 29% of households all members have no health insurance*
55% of households report some medical debt
*The Affordable Care Act went into effect after the fielding period of this survey.
Health-related concerns are present for households served by the Feeding America network
What can we do together?
There’s health care and there’s health promotion
Health Care
Providing direct medical services
Health Promotion
Activities that support health education, access to care,
and healthy behaviors
A Conceptual Framework: Cycle of Food Insecurity & Chronic Disease
CHRONIC DISEASE
HEALTH CARE EXPENDITURES
EMPLOYABILITY
HOUSEHOLD INCOME
SPENDINGTRADEOFFS
HEALTH CARE
HEALTH PROMOTION
FOOD INSECURITY
COPING STRATEGIES:
Dietary Quality Eating Behaviors
Bandwidth
*
Feeding America’s Newest National Program
In July 2015, Feeding America launched the SNAP Application Assistance Program which will expand and maintain SNAP access for eligible individuals and families.
We explored opportunities with Google SNAP
“Google SNAP” uses internet search terms to connect individuals to local food banks for SNAP application assistance
Referral Email
Sent immediately to the local food bank for direct
follow-up
>20,000 non-required comments have
provided considerable insight into
opportunities for additional assistance.
More than 50% of users report health issue or disability
Google SNAP now connects to Get Covered Connector tool
Cleveland, OH Cincinnati, OH
Chicago, IL Geneva, IL
Based on area coverage and expanded Medicaid, we are currently working with eight markets to address health care outreach as part of Google SNAP.
Wichita, KS Springfield, MO
Glouster, OH Harrisburg, PA
Additional markets will be included using varying outreach strategies based on state-specific circumstances (e.g., State-Based Marketplace, non-expanded Medicaid).
There is now a report for understanding food banks’ role as partners in health promotion
Food Banks as Partners in Health Promotion: Creating Connections for Client & Community Health
A collaboration between Feeding America and Center for Health Law & Policy Innovation at Harvard Law School
Highlights: • New developments in health care
• Incentives for health systems
• Partnership opportunities for food banks
• Report and Executive Summary available at HealthyFoodBankHub.org
HealthyFoodBankHub.org educates, connects and engages
Public microsite of FeedingAmerica.org
Educates, connects and engages around the intersection of food insecurity, nutrition and health
Target Audience• Professionals, academics and partners working
with food insecure communities
Provides• Targeted tools, resource and recipes• Latest research insights• Custom trainings for diverse sectors
Continued growth reaching 45K+ users since launch in 2013
TOGETHER WE CAN SOLVE HUNGER.TM
© 2016 Enroll America | StateOfEnrollment.org
Thank You!Araceli Gutierrez, Health Manager, Podesta [email protected]
Jessica Hager, Community Health and Nutrition, Feeding [email protected]
Ronald Ashford, Director Public Housing Supportive Services, U.S. Department of Housing and Urban [email protected]
Cesar Palacios, Executive Director, Clinica Proyecto [email protected]
Rochelle Rollins, PhD, MPH, Senior Advisor, U.S. Department of Health and Human Services [email protected]
