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Promotion, Prevention and the Affordable Care Act

Promotion, Prevention and the Affordable Care Act . Brian Kaskie, PhD Department of Health Management and Policy College of Public Health University of Iowa November 4, 2010. Today’s Presentation. The case for health promotion & prevention The public problem The Affordable Care Act

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Promotion, Prevention and the Affordable Care Act

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  1. Promotion, Prevention and the Affordable Care Act Brian Kaskie, PhD Department of Health Management and Policy College of Public Health University of Iowa November 4, 2010

  2. Today’s Presentation The case for health promotion & prevention The public problem The Affordable Care Act The confluence

  3. THE CASE FOR HEALTH • Definitions - Examples • Pros and Cons • Paradigm

  4. Definition of Terms • Health - Disease • Promotion • Prevention

  5. Examples of Promotion & Prevention • Mammography & Prostate Exams • Secured Perimeters in Nursing Homes • Nutrition & Exercise Programs • Smoking & Drinking Prohibitions

  6. Benefits of P&P… • Individual Level Outcomes • Market Efficiencies • Positive Externalities

  7. Compression of Morbidity

  8. Inefficiencies... • False Positives; Dosaging Difficulties • Profit Maximization • Raided Savings

  9. The math… • A = Incidence of event-disease • B = Cost of care • C = Impact of intervention • D = Cost of intervention • A*B - (C(A)*B + D) = X

  10. DISCUSSION

  11. THE PUBLIC PROBLEM • Access & Use • Costs • Outcomes

  12. DISCUSSION

  13. Intermission The colloquium will resume after this 7 minute break.

  14. THE AFFORDABLE CARE ACT • Oversight • Benefits • Service Delivery Systems • Workforce • Consumer Involvement

  15. Financing

  16. Oversight • National Public Health Council • Sec 4001 • “There’s nothing like it…” • Surgeon General • Healthy People

  17. Oversight • Preventive Service Task Force • Sec 4003 • Agency for Healthcare Research & Quality • Public Health Services Act

  18. Oversight • Research and Data Collection • Sec 4301 - 4302

  19. Benefits • Immunizations • remind me later

  20. Benefits • Medicare Coverage for Wellness Exams • Section 4103 • Baseline Inventory • Schedule Of Exams • On line • January 1, 2011

  21. Benefits • Colorectal Exams!!! • Section 4103 (c)

  22. Benefits • Smoking Cessation Medication • Sec 4107 • coverage of drugs to stop smoking • October 1, 2010 • Hmmmmmm……..

  23. Service Delivery • School Based Health Centers • Sect 4101 • Less than half of the schools • $50m annually til 2013 • 20% copay • Section 10412 • Defibrillation Programs

  24. Service Delivery • Diagnostic Equipment Modification • Sect 4101 NOTE TO SELF • Americans with Disabilities Act

  25. Service Delivery • Depression Excellence Centers • Section 10410 • $1.25 billion over 10 years • History : • Senator Stabenow • Establishing a Network of Centers • Enhanced Act

  26. Service Delivery • Medicaid Quality Measures • Section 2707 • Case management bonuses

  27. Workforce • Area Health Education Centers • Sec 5403 • Fellowship Training in Public Health • Section 5314 • Cultural competency • Sec 5307 (a) (b)

  28. Individuals • Health Education and Outreach • Sec 4004 (c) Rules… (5) “..may include the use of humor…”

  29. Individuals • Caloric and Nutrition Labeling • Sec 403 • College of Public Health Award

  30. Individuals • Personal Responsibility • Abstinence Education

  31. Individuals • Reasonable Break Time for Nursing • Sec 4207 • Fair Labor Standards Act

  32. Individuals • Aging and Disability Resource Centers • Section 2405 • $10 m

  33. Financing • Prevention and Public Health Fund • Sec 4002 • Budget line item • $500m to $2b from now til 2015 • ????

  34. Financing • Waiver of Medicare payment obligation • January 1, 2011

  35. Financing • Payment for Quality

  36. Financing • FROM MORE ON THIS LATER…. • Government Negotiation for Bulk Purchasing for vaccinations

  37. Financing • Demonstration Grants • Medicaid (Sec 4108) • January 2011 • Healthy Aging (Sec 4202)

  38. DISCUSSION…

  39. Intermission The colloquium will resume after this 7 minute break.

  40. “….The passage of health care reform has created an opportunity to move public health into the mainstream of US healthcare…”

  41. “….there is strong support that promotion and prevention are part of the spectrum ranging from well-being to disease, and can shape our physical, mental, and social health…” “….this view sees health and illness as related constructs, and less distinct than ever…”

  42. “…. the goal is to transition from a system focused primarily on treating the sick to one that helps people stay well throughout their lives….”

  43. Rosenbaum & Gruber (2010) • Regulating economic conduct • Regulating individual status

  44. Rights related to obtaining health care • Contracts re: provision and financing • Freedom of Choice • Police Powers – Enforcement • Discrimination • Identified groups

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