Health Care Reform Implementation

1. Health Care Reform Implementation Elena Rios, MD, MSPH National Hispanic Medical Association May 24, 2011

2. Access to Affordable Health Care • The Pre-Existing Condition Insurance Plan provides coverage to Americans who have been uninsured because of a pre-existing condition. • The Early Retiree Reinsurance Program makes it easier for businesses to provide coverage to retirees who are not eligible for Medicare.  • Distribution of important information that will help small businesses claim the law’s small business tax credit (>25 employees, 50% of ave. salaries <$50K) • COMING: State Health Insurance Exchanges

3. Constitutionality May 10, 2011 • In the first case – Liberty University v. Geithner – a district judge previously found that the law was constitutional. In the second case – Commonwealth of Virginia v. Kathleen Sebelius – a different district judge issued a very narrow ruling on the constitutionality of the health reform law’s “individual responsibility” provision but upheld the rest of the law.  Both cases were argued on appeal.  (US Court of Appeals, 4th Circuit) – 45 days till decision.

4. Community Transformation Grants • tobacco-free living; • active living and healthy eating; • evidence-based quality clinical and other preventive services, HTN and high cholesterol; • social and emotional wellness, especially for people with chronic conditions; and • healthy and safe physical environments. • $100M for 75 grants - announced May 13th

5. Community Transformation Grants • adolescent health; • arthritis and osteoporosis; • cancer; • diabetes; • disabilities and secondary conditions; • educational and community-based services; environmental health; • HIV; • injury and violence prevention; • maternal, infant, and child health; • mental health and mental disorders; • health of older adults; oral health; and • sexually transmitted diseases.

6. National Quality Strategy • To focus on quality outcomes rather than services ordered. • Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe. • Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care. • Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

7. National Quality Priorities • Making care safer by reducing harm caused in the delivery of care. • Ensuring that each person and family are engaged as partners in their care. • Promoting effective communication and coordination of care. • Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease. • Working with communities to promote wide use of best practices to enable healthy living. • Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models. • Public Comment requested. NHMA working thru NQF.

8. Partnership for Patients • Brings together hospitals, doctors, nurses, pharmacists, employers, unions, and State and Federal government to keep patients from getting injured or sicker in the health care system and to improve transitions between care settings.  • $1 billion investment planned. • 500 hospital partners have signed-up.

9. Partnership for Patients • Hospital Acquired Conditions and Patient Safety in Hospitals • Care Transitions • Adverse Drug Events (ADE) • Catheter-Associated Urinary Tract Infections (CAUTI) • Injuries from Falls and Immobility • Obstetrical Adverse Events • Pressure Ulcers • Surgical Site Infections (SSI) • Ventilator-Associated Pneumonia (VAP) • Venous Thromboembolism (VTE)

10. Allignment Initiative • An effort to more effectively integrate benefits under Medicare and Medicaid for 9M dual eligibles • Federal Coordinated Health Care Office – at CMS to coordinate care, decrease costs • Public comment for ideas on care coordination, fee-for-service benefits, prescription drugs, cost sharing, enrollment, and appeals – July 11th

11. Medicare ACO • ACO = Providers who will collaborate to increase quality and decrease costs. • Pioneer ACO – advanced organizations ready to participate in Medicare shared savings, private payers – RFA this week • Advance Payment ACO Model – public comment requested till June 17 • Learning Sessions for provider groups

12. Value Based Purchasing • In 2013, for the first time, the Hospital Value-Based Purchasing program authorized by the Affordable Care Act will pay hospitals’ inpatient acute care services based partially on care quality, not just the quantity of the services they provide.

13. CMS Innovation Center • $500 million to test models of safer care delivery and promote implementation of best practices in patient safety. • $500 million for a Community-based Care Transition Program to support hospitals and community based organizations in helping Medicare beneficiaries at high risk for readmission to the hospital safely transition from the hospital to other care settings.

14. New Minority Health Activities • 2010: OMH, NIMHD, Offices – all agencies planned. • 2011: strategic and cross‐cutting planning to drive targeted and collaborative efforts; improving integration of disparity elimination efforts across agencies; expanding partnerships within HHS and with external partners; increased information sharing with community groups; improving data collection; and promoting evidence‐based health equity policies. • HHS Strategic Action Plan to Reduce Racial and Ethnic Disparities in Health • immunizations, tobacco, lupus

15. OMH National Partnership for Action • National Partnership for Action to End Health Disparities mission is to increase the effectiveness of programs that target the elimination of health disparities through the coordination of partners. • Three components: (1) National Stakeholder Strategy; (2) Blueprints for Action; and (3) collaborative initiatives and campaigns. • Leadership ----Cultural Competence ----Hispanic Health and Health Equity

16. NPA Goals • Awareness of health disparities • Leadership to address health disparities at all levels • Health System and Experience • Cultural Competence & Diversity of Workforce • Data, Research and Evaluation • Federal Interagency Team - NEW

17. Workforce • Workforce Commission – Kathy Flores, MD, NHMA Chairwoman of the Board appointed • CDC lead agency for public health pipeline for minority undergraduate students • HRSA – integrative training, primary care • NHMA working with CDC and HRSA to increase public health leaders of the future: see information on registration tables for CDC programs. • NHMA Leadership Fellowship, NHMA Resident Leadership Program supported by HRSA.

18. HHS Promotores de Salud Initiative • Announced May 18th, 2011 • to recognize the work of promotores • develop a database of promotores networks, including training and where they work • to foster cooperation among various networks • English-Spanish web site with information and resources to assist community workers • State Health Exchanges to include community health workers

19. E-health Technology • Need for physicians, clinics, hospitals to be connected for better data collection, coordinated care, information for patients and physicians • RECs will provide training and support services to assist doctors and other providers in adopting EHRs • Provider incentive program now in place. • Health Information Technology Extension Program, please email regional-center-applications@hhs.gov.

20. Contact NHMA & NHHF • www.nhmamd.org • www.nhmafoundation.org • www.hispanichealth.info • National Hispanic Health Foundation Scholarship Dinners: • Nov. 10th, 2011 – Santa Monica, CA • Dec. 4th - NYC