W.K. Kellogg Foundation May 25, 2011 Asheville, North Carolina

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W.K. Kellogg FoundationMay 25, 2011Asheville, North Carolina

Dennis P. Andrulis, PhD, MPHSenior Research Scientist, Texas Health InstituteAssociate Professor, University of Texas School of Public Health

Click to edit Master title styleClick to edit Master title styleBackground and PurposeBackground and Purpose• With support from the Joint Center for Political and

Economic Studies, we conducted a comprehensive review of the Patient Protection and Affordable Care Act of 2010:

– To identify and describe provisions specific to race, ethnicity and language; and general provisions likely to have a significant affect on diverse populations.

– To assess status, challenges and opportunities of health care reform provisions for improving the health and health care of racially and ethnically diverse populations.

• We are currently tracking implementation status and progress for provisions with explicit requirements for linguistic and cultural competence.

Click to edit Master title styleClick to edit Master title styleHealth Equity & Cultural CompetenceHealth Equity & Cultural Competence• Health Equity

– Health disparities/inequalities include differences between the most advantaged group in a given category—e.g., the wealthiest, the most powerful racial/ethnic group—and all others, not only between the best- and worst-off groups. Pursuing health equity means pursuing the elimination of such health disparities/inequalities. –Braveman, 2006

• Cultural Competence– “A set of attitudes, skills, behaviors, and policies that enable organizations and

staff to work effectively in cross-cultural situations. It reflects the ability to acquire and use knowledge of the health-related beliefs, attitudes, practices, and communication patterns of clients and their families to improve services, strengthen programs, increase community participation, and close the gaps in health status among diverse population groups.” –Cross et al., 1989.


Click to edit Master title styleClick to edit Master title styleCultural Competence & Workforce DiversityCultural Competence & Workforce Diversity

• Cultural Competence– Model cultural competence curricula.– Cultural competence training for health professionals.– Culturally appropriate patient decision aids.– Culturally appropriate personal responsibility education for teen pregnancy

prevention.– Culturally appropriate national oral health campaign.

• Workforce Diversity– Increase diversity among health professionals.– Health professions training preference for cultural competence.– Investment in HBCUs & minority-serving institutions.– Collect & report workforce diversity data.

Click to edit Master title styleClick to edit Master title styleData Collection & Disparities ResearchData Collection & Disparities Research• Data Collection & Reporting

– Collect racial/ethnic sub group data in population surveys.– Collect/report disparities data in Medicaid & CHIP.– Monitor disparities trends in federally funded programs.

• Health Disparities Research– Examining disparities through comparative effectiveness

research (CER).– Supporting research on topics of cultural competence and

health disparities.

Click to edit Master title styleClick to edit Master title styleCultural Competence in Health Insurance ReformsCultural Competence in Health Insurance Reforms

• Cultural & Linguistic Requirements of Exchanges and Participating Health Plans:– Non-discrimination in health insurance exchanges.– Culturally & linguistically appropriate summary of benefits.– Culturally & linguistically appropriate claims appeal process.– Incentive payments for cultural competence & reducing disparities.


Click to edit Master title styleClick to edit Master title styleHealth Insurance Reforms & Access to CareHealth Insurance Reforms & Access to Care

• Expansion of Medicaid eligibility to 133% FPL• Small business (<25 employees) tax credits• State-based health insurance exchanges• Support for Community Health Centers• Support for nurse-managed health centers, teaching

centers & school-based clinics• Community health teams• Primary care extension programs• Pilots on regional emergency & trauma care

Click to edit Master title styleClick to edit Master title stylePublic Health & Community ProgramsPublic Health & Community Programs

• Childhood obesity demonstration projects• National diabetes prevention program• Education campaign for breast cancer• Community transformation grants• Non-profit hospital community needs

assessment requirement

Click to edit Master title styleClick to edit Master title styleQuality Improvement & Cost ContainmentQuality Improvement & Cost Containment

• National Strategy for Quality Improvement• Developing & evaluating quality measures• Linking Medicare payments to quality outcomes• Pediatric Accountable Care Organizations • Reduction in Medicare & Medicaid

Disproportionate Share Hospital (DSH) Payments


Click to edit Master title styleClick to edit Master title styleHighlightsHighlights• Great breadth of opportunities in ACA to reduce disparities and

improve health equity.

• Federal agencies, generally assigned leading responsibility for advancing and implementing these provisions.

• Many provisions related to equity, cultural competence and language assistance have received appropriations and offer opportunities for community based organizations, county agencies and states to pursue funding.

• However, important provisions, with a strong evidence base for need have not received appropriations as yet and may require state, county and community organizations to take innovative approaches to achieve their objectives.

Click to edit Master title styleClick to edit Master title stylePrimary Care OpportunitiesPrimary Care Opportunities• Community Health Centers

– HRSA providing $10 million for new & expanded services for up to 125 FQHCs, a maximum of $80,000 for 1 year per award in 2011.

• School-based Health Clinics– $50 million for each FY 2010-2013 for capital grants for facility construction,

expansion and equipment.

• Primary Care Extension Program– $120 million in 20011 to establish program to support and assist primary care

providers to improve community health.

• Health Professions Training Opportunities– HRSA grant programs for training in dentistry, primary care, & personal and home

care aides, with preference given for experience in cultural & linguistic competence.

Click to edit Master title styleClick to edit Master title stylePrevention OpportunitiesPrevention Opportunities• Community Transformation Grants

– Over $100 million for 75 grants to help communities implement projects proven to reduce chronic diseases as well as health disparities.

• Investment in Prevention– $750 million to reduce tobacco use, obesity and heart disease, and build

healthier communities ($298 mil for community prevention, $182 mil for clinical prevention, $137 mil for public health, $133 mil for research).

• Personal Responsibility Education – $75 million for states in 2011 to educate youth in culturally/linguistically

appropriate ways to prevent teen pregnancy and sexually transmitted infections.

Click to edit Master title styleClick to edit Master title styleOpportunities in Health Insurance ProgramsOpportunities in Health Insurance Programs• Community Based Care Transition Program

– Funding in 2011 for eligible hospitals and community-based organizations that provide evidence-based transition services to Medicare beneficiaries with multiple chronic conditions to prevent hospital readmission.

• CHIP Childhood Obesity Demonstration– $25 million in 2011 for a demonstration program to develop a model for reducing

childhood obesity.

• Medicaid Prevention and Wellness Initiatives– State grants in 2011 to provide incentives for Medicaid beneficiaries to participate in

evidence-based programs to prevent/manage chronic disease.

• State Health Insurance Exchanges– State planning and establishment grants for health insurance exchanges, which can also

be used to set up a navigator program and provide appeals process and benefit summaries in culturally/linguistically appropriate ways.


Community Access & Prevention Opportunities (with no appropriations)

Community Access & Prevention Opportunities (with no appropriations)

• Community Health Teams (CHTs)– As states adopt medical home models, more low income & diverse

individuals with chronic illness will be able to turn to a CHT to help them link with a full range of health and social services they may need.

• Community Health Workers (CHWs)– Use of CHWs in health intervention programs associated with

improved access, prenatal care, pregnancy and birth outcomes, health status, screening behaviors & reduced health care costs.

• Oral Health Prevention Activities– Blacks, Hispanics, & AI/AN have poorest oral health access and

outcomes & could significantly benefit from these programs.


Cultural Competence Opportunities (with no appropriations)

Cultural Competence Opportunities (with no appropriations)• Model Curricula for Cultural Competency

– Opportunity to test impact of a range of cultural competency training programs on health outcomes and to identify efficacy & effectiveness.

• Facilitating Shared Decision Making– Patient decision aids are required to present up-to-date clinical

evidence about risks and benefits of treatment options to meet cultural & health literacy requirements of populations.

Click to edit Master title styleClick to edit Master title styleNext StepsNext Steps• Education around specific ACA language for priority areas.

• Work with representative associations/organizations to educate and discuss strategies for pursuing priority areas.

• Advocate for state, county and community innovation in health equity and reducing disparities.

• Appropriations, appropriations, appropriations—assuring adequate funding for provisions.

• Communicate with agencies likely to oversee identified priority areas about status and progress in adding content to these areas.


Dennis P. Andrulis, PhD, MPHSenior Research Scientist, Texas Health Institute

Associate ProfessorUniversity of Texas School of Public Health

[email protected]

Documents

W.K. Kellogg Foundation May 25, 2011 Asheville, North Carolina