Health Care Reform and Hispanics

1. Health Care Reform and Hispanics Elena Rios, MD, MSPH President & CEO National Hispanic Medical Association, March 26, 2010

2. 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

3. 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)

4. 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

5. 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

6. Senate Finance Committee Health Coverage • Individual mandates, affordable - 2013 • Subsidies based on income • Max of 10% income on premiums • Dependent to age 26 • Family can apply as a unit • Employer insurance, ineligible for low income tax credit thru the Health Insurance Exchange • Employer mandates

7. Senate Finance CommitteePublic Programs • Medicaid – • Nationwide: 133% FPL, childless adults • Dual eligibles – new CMS office to monitor • Medications – benefit by 2014 • Territories’ caps increase by 30% & FMAP increases by 5% (new eligibles don’t count) • DSH – state trigger as uninsured decreases • CHIP • 133-250%FPL, cost sharing up to 5% income • Both – verification, 5 yr wait for immigrants

8. 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

9. 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

10. 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

11. 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 Reimbursement for Quality under the Plan or Coverage*

12. 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

13. 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)

14. 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

15. 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

16. Health Care Reform & WorkforceSenate HELP Committee National Health Care Workforce Commission – HHS, DEd, DOL Integrated health workforce training, capacity Medicare/Medicaid GME Nursing, oral, mental, allied, and public health workforce Geographic distribution of providers vs need Increased focus on primary care providers

17. 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

18. 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

19. 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

20. 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

21. Health Care WorkforceSenate Finance Committee National Workforce Strategy (CMS/HRSA) and new Advisory Committee Recruiting Training Supply and demand of workforce, and for special populations (COE, HCOP) Education training capacity (faculty) Future policy

22. 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

23. 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 waste • Malpractice courts demonstration program • Increase Medicaid reimbursement – MDs • Health savings accounts

24. 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

25. NHMA • www.nhmamd.org • Support health reform - send your letter to your Senators and Congressmen • Join as a Member • NHMA 14th Annual Conference • Washington, DC, Mar. 25-28th 2010 • Policy meetings prior to Scholarship Dinners • Oct. 9th – San Francisco • Dec. 4th – New York