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“Advancing Health Equity through State Implementation of Health

Reform”

Creshelle R. Nash, MD, MPHAssistant Professor, Department of Health Policy and

ManagementAssistant Professor, Division of General Internal

Medicine University of Arkansas for Medical Sciences

National Academy for State Health Policy October 3-5

Kansas City, Missouri

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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

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

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Source: http://www.gallup.com/poll/125066/State-States.aspx, BRFSS, 2010

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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

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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

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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

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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

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

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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.

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

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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.

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.

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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.

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.

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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

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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