“ Advancing Health Equity through State Implementation of Health Reform ”

1. “Advancing Health Equity through State Implementation of Health Reform” Creshelle R. Nash, MD, MPH Assistant Professor, Department of Health Policy and Management Assistant Professor, Division of General Internal Medicine University of Arkansas for Medical Sciences National Academy for State Health Policy October 3-5Kansas City, Missouri Nash

2. Overview • The State of Arkansas and the Affordable Care Act • Health Equity and Health Disparities • The Opportunity of Health Care Reform • Levers for addressing health equity • Arkansas Health Equity Learning Collaborative • Partners • Planned Activities • Conclusion Nash

3. Arkansas-”The Natural State” • 2.8 million people • 40% living in rural areas • Demographics: • 80% Caucasian • 15% African American • 5% Hispanic/Latino • Poor Health Rankings • Great health disparities • Latest Gallop Poll 21% of Arkansans uninsured • Minorities 28-30% * • 8th highest in the nation Source: http://www.gallup.com/poll/125066/State-States.aspx, BRFSS, 2010 Nash

4. Health Disparity and Health Equity • Our History of Addressing Racial and Ethnic Health Disparities • What is Health Equity??? “Health equity is the absence of systematic disparities in health between social groups who have different levels of underlying social advantage/disadvantage. Inequities put groups of people who are already disadvantaged at further disadvantage with respect to their health. Health is essential to wellbeing and to overcoming other effects of social disadvantage” • Health Care Reform and the Affordable Care Act Source: P Braveman and S Gruskin. Defining Equity in Health, Journal of Epidemiology and Community Health 2003;57;254-258 Nash

5. The Opportunity of Health Care Reform • Access to Health Insurance • Health Insurance Exchanges • Expansion of Medicaid • Health Care Quality • Data and payment reform • Medical homes • Workforce • Diversity and Cultural Competency • Prevention Activities • National Prevention Strategy • Community Transformation Grants Nash

6. Affordable Care Act in Arkansas • Health information exchange – Arkansas Office of Health Information Technology (OHIT) • Health insurance exchange – Arkansas Insurance Department (AID) • Health care workforce – University of Arkansas for Medical Science (UAMS) and Arkansas Department of Health (ADH) • Health Care Payment Initiative – Arkansas Department of Human Services Nash

7. The Arkansas Health Equity Learning Collaborative • Many individuals working within HCR silos that have a commitment to health equity • The NASHP Technical Assistance Program • Goal of advancing health equity through ACA • Vehicle to bring together multiple stakeholders with interest in Health Equity • Engage Local leadership • Engage those charged with implementing policy • Engage broader stakeholders in the community Nash

8. The Arkansas Health Equity Learning Collaborative • Early in the Development of ACA in Arkansas • Core Team and Additional Members • Defining the Health Care Reform Priorities • 3 focus areas: • Engage the Public in Policy Development and Implementation • Simplify and Integrate Eligibility Systems • Use Your Data Nash

9. Engage the Public in Policy Development and Implementation • Building on Prior Advocacy Work • Partners: • Arkansas Minority Health Commission • Arkansas Coalition for Obesity Prevention • Arkansas Hometown Health Improvement • Objectives: • Increase public knowledge about health care reform in Arkansas. • Increase grass roots participation in health care reform implementation. • Increase community-based organization capacity for health care reform advocacy. Nash

10. Engage the Public in Policy Development and Implementation • Activities: • Inform the community about health reform planning • Identify champions from minority communities and underserved communities. • Develop train-the-trainer advocacy training around health care reform. • Establish a system of communication to facilitate between advocates Nash

11. Simplify and Integrate Eligibility Systems • Building on Prior Efforts • Partners: • Arkansas Advocates for Children and Families • Arkansas State Legislature • Objectives: • Define challenges and successes from other expansion efforts in Arkansas (i.e. SCHIP). • Increase knowledge about eligibility and enrollment requirements among providers, consumers and small businesses in Arkansas • Ensure minority representation in outreach strategies for minority and underserved communities. Nash

12. Simplify and Integrate Eligibility Systems • Activities: • Review outreach plans developed by health care reform groups. • Utilize innovative technology for outreach • Promote cultural competency training for providers, case workers, brokers, navigators and others engaged in outreach and eligibility determination • Advocate for the creation of a 24 hour eligibility hotline. • Plan for utilization of data for monitoring insurance coverage and feedback. Nash

13. Use Your Data • Prior Data Initiatives • Partners: • Arkansas Center for Health Improvement • Arkansas Center for Health Disparities and Arkansas Prevention Research Center • Objectives: • Identify current data sources and elements. • Develop strategy to analyze and define inequities in access to care and workforce shortage areas. • Use mapping to target and inform health care reform outreach and activities. Nash

14. Use Your Data • Activities: • Examine inequities by multiple variables including but not limited to: race/ethnicity; primary language, sex, SES, education, urban rural status. • Develop process for dissemination and use of data for policy change and health reform implementation. • Review materials that communicate outcomes and progress to the public. Nash

15. The Arkansas Health Equity Learning Collaborative • The Framework • Development of state plan to ensure ACA addresses those most in need in Arkansas • Seeking funding for implementation and evaluation specific to Racial and Ethnic Health Disparities Nash

16. Conclusion • Even though ACA focuses on health insurance reform, it is important step in improving health care in underserved communities • It can foster system-wide change to address racial and ethnic health disparities • Arkansas Health Equity Collaborative is making concerted effort to engage partners across several sectors including public, private, nonprofit and minority communities to improve the health of all Arkansans Nash