Affordable Care Act: Opportunities to Reduce Medicare ... · • Increases funds for National Health Services Corps. • Provides funding for School-based health centers, Nurse- managed

CoP/Training Call Affordable Care Act: Opportunities to Reduce Medicare Disparities

:

Presenters: Regina Davis Moss, PhD, MPH, MCHES Associate Executive Director, Public Health Policy and Practice, American Public Health Association (APHA) Rick Potter, CPA, MBA, CHCA CEO, Health Services Advisory Group-California Margie Banse Health Information Supervisor, Healthcare Excel-Kentucky December 10, 2013

2:00 PM Eastern Time

Presenter

Presentation Notes

Speakers: Regina Davis Moss, PhD, MPH, MCHES Associate Executive Director, Public Health Policy and Practice, American Public Health Association (APHA) Rick Potter, CPA, MBA, CHCA CEO, Health Services Advisory Group-California Margie Banse Health Information Supervisor, Healthcare Excel-Kentucky

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Housekeeping

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• Please submit questions via the WebEx chat box or press 14 and the monitor will call on you.

• We are recording this call, and will post slides, recording, and transcript on www.healthcarecommunities.org and www.cmspulse.org

• Evaluation: Please fill out our evaluation at the end of today’s call.

http://www.healthcarecommunities.org/

http://www.cmspulse.org/

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Agenda

Speaker Topic

Barbara Levin, M.D. Introduction Regina Davis Moss, Ph.D., MPH, MCHES Affordable Care Act -Overview

Rick Potter, CPA, MBA, CHCA Health Services Advisory Group of (CA)

Margie Banse Health Care Excel (KY) Participants Questions and Answers

Ava Richardson Announcements

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Webinar Goals

Provide an overview of the Affordable Care Act, providing examples of: • The major provisions that address health equity and

health disparity. • Progress in terms of funding. • Opportunities for health equity

Understand the impact of ACA at the state level from the perspective of two QIOs - the “on the ground story” • ACA Roll-out in California • ACA Roll-out in Kentucky

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Regina Davis Moss, Ph.D., MPH, MCHES Associate Executive Director of Public Health Policy and Practice

The American Public Health Association

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=QCkikiVop4_hXM&tbnid=wHAuUcWvdWZf6M:&ved=0CAUQjRw&url=http://www.apha.org/about/board/aphastaff/biomoss.htm&ei=4mWfUpzvCcbdkQew6IGgAw&bvm=bv.57155469,d.eW0&psig=AFQjCNEnuu8leJQxiJyi6a2KfgTwX3tNlA&ust=1386263336805486

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Affordable Care Act:

Disparities National Coordinating Committee Community of Practice

December 10, 2013

Progress Towards Advancing Health Equity

Regina Davis Moss, PhD, MPH, MCHES Associate Executive Director, Public Health Policy and Practice

Affordable Care Act (ACA)

ACA Provisions Specific to Race, Ethnicity and Language Improved Data Collection and Reporting by Race, Ethnicity and Language

• Requires that population surveys collect and report data on race, ethnicity and primary language.

• Monitors health disparities trends in federally-funded programs.

• Collects/reports disparities data in Medicaid and CHIP.

Workforce Diversity

• Increase diversity among primary care providers, long-term care providers, dentists, mental health providers, and the nursing professions.

• Health professions training for diversity.

• Grants for Community Health Workers, providing culturally and linguistically appropriate services (CLAS).

• Community-based training for AHECs targeting underserved pops.

• Grants to train providers on pain care, including CLAS.

• Support for health professions/home care aid training for individuals from disadvantaged backgrounds.

• Investment in HBCUs and minority-serving institutions.

Source: Joint Center for Political and Economic Studies, Patient Protection and Affordable Care Act of 2010: Advancing Health Equity

Cultural Competence Education and Organizational Support

• Develop, evaluate, and disseminate model cultural competence training and education curricula, via a web-based clearing house.

• Cultural competence training for primary care providers and home care aides.

• Curricula for cultural competence training in working with individuals with disabilities.

• Transfers Office of Minority Health to the Office of the Secretary of HHS.

• Establishes Offices of Minority Health divisions within key federal HHS agencies—CDC, AHRQ, FDA, CMS, HRSA, SAMHSA.

Health Disparity Research

• Elevates NCMHHD to Institute status.

• Increases funding to Centers for Excellence.

• Supports research in pain treatment/management, post-partum depression, and cultural competence.

• Creates Patient Centered Outcomes Research Institute (PCORI) to examine health disparities through Comparative Effectiveness Research (CER).

Specific Race, Ethnicity & Language Provisions


Health Disparities Initiatives Prevention

• Maternal, infant, and early childhood Home Visitation (MIECHV) Program for at-risk communities.

• 5-year National Oral Health Campaign.

• Standardized drug labeling on risks & benefits.

• Culturally appropriate patient-decision aids and personal responsibility education.

• Establishes the Indian Health Care Improvement Reauthorization and Extension Act of 2009 (S. 1790) as law as well authorizes new programs within the Indian Health Services (HIS).

Addressing Disparities in Health Insurance Reforms

• Enrollment outreach targeting low income populations.

• CLAS/information through health exchanges.

• Nondiscrimination in federal health programs and exchanges.

• Claims appeal process that is culturally/linguistically appropriate.

• Requires plans to provide information in “plain language.”

• Summary of coverage that is culturally/linguistically appropriate.

• Incentive payments for reducing health/healthcare disparities

Specific Race, Ethnicity & Language Provisions


General ACA Provisions with Implications for Racially and Ethnically Diverse Populations

Health Insurance Reforms

• Individual Requirement to have coverage.

• Expands Medicaid income eligibility.

• Employers with >50 employees required to offer coverage or pay penalty.

• Small Businesses (<25 employees) eligible for tax credit to purchase insurance (among workers in small firms, 57% Hispanics, 40% Black, 40% Native American, 36% Asian American are uninsured).

• American Health Benefit Exchanges.

• Multi-state option.

• Temporary High Risk Pools.

• Increases Federal Matching Rate for Medicaid.


Medicaid Eligibility by Race and Ethnicity

54.9 %

19.4 % 18.7 %

7 % 0

10

20

30

40

50

60

White Hispanic or Latino African American Other

Percent of Population with Income below 138% FPL who will be eligible for Medicaid in 2014, by Race and Ethnicity

Source: Kenney, G.M., Zuckerman, S., Dubay, L., Huntress, M., Lynch, V., Haley, J., & Anderson. (2012). Not Opting in to the Medicaid Expansion under the ACA: Who are the Uninsured Adults Who Could Gain Health Insurance Coverage? Timely Analysis of Immediate Health Policy Issues. Robert Wood Johnson Foundation and Urban Institute.

45% of Newly Eligible are Non-White

Improving Access Health Care

• Expands Community Health Center (CHC) funding and operational capacity for medical, oral and behavioral health services.

• Increases funds for National Health Services Corps.

• Provides funding for School-based health centers, Nurse-managed health centers, Community Health teams, and creates a medical home option for Medicaid enrollees.

• Pilot project for emergency & trauma care.

Quality Improvement

• National Strategy for Quality Improvement.

• Quality improvement technical assistance.

• Develop, improve & evaluate quality measures.

• Link Medicare payments to quality outcomes.

• CMS office to improve care coordination for dual eligibles.

General Provisions with Racial & Ethnic Implications


Cost Containment

• Reduces Medicaid and Medicare DSH payments.

• Strengthens Medicaid drug rebate programs.

• Interoperable systems of enrollment.

• Demonstration projects for HIT.

• Enhancing public program fraud screening.

Public Health Initiatives

• Childhood obesity demonstration projects.

• Education campaign for breast cancer.

• National diabetes prevention program.

• Adolescent Personal Responsibility Education program (PREP)

• Prevention and Public Health Fund

• National Prevention, Health Promotion and Public Health Council.

Social Determinants of Health

• CPSTF reviews/recommends interventions that consider social, economic, and physical factors.

• Health Impact Assessments.

• Community Transformation Grants.

General Provisions with Racial & Ethnic Implications


ACA Equity Progress More Fully funded

or Implemented Partially Funded or

Implemented Not Funded or Implemented

Health Insurance Marketplace 7 0 1 8

Safety Net 3 3 1 7

Workforce Diversity 7 6 6 19

Data, Research, Quality 4 3 4 11

Public Health & Prevention 6 4 1 11

Total 27 (48%)

16 (29%)

13 (23%) 56

Source: Texas Health Institute, 2013

Challenges to Implementation • Insurance Volatility

• Funding and Sustainability Shortfalls in appropriations

State budget restrictions

• Lack of a stronger efficacy evidence base

• Opposition to federal marketplace and Medicaid expansion

• Undocumented immigrants left at margins

• Misinformation and confusion

• Equity is embedded in the law • Enhanced emphasis on partnership development and

community-based prevention • Addressing Gaps in Access • Increasing community-based initiatives • Outreach and Education

Opportunities

Why We Must Continue to Advance Health Equity • Over half of all babies currently born in the U.S. are

non-white.

• 40% of youth under 17 are people of color.

• By 2042, 1 of every 2 people living in the U.S. will be a person of color.

• TX, CA, DC, NM, and HI have minority populations greater than 50%. By 2020, AZ, FL, GA, MD, MS, NV, NJ, and NY are projected to join the list.

• Continued disparities in access, quality and health will exact a human and economic toll on our nation.

Source: U.S. Census Bureau; Joint Center for Political and Economic Studies.

For Science, For Action, For Health!

Regina Davis Moss, PhD, MPH, MCHES Associate Executive Director Public Health Policy and Practice 800 I Street, NW Washington, DC 20001 E-mail: [email protected] Telephone: (202) 777-2515

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Rick Potter, CPA, MBA, CHCA Chief Executive Officer

Healthcare Services Advisory Group, California

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=8YFWSFXFKdPa3M&tbnid=KrO246UD3s3mnM:&ved=0CAUQjRw&url=http://bmirec.asu.edu/edu/node/6&ei=GjSiUtnXK8qtsQS1tYH4CQ&bvm=bv.57752919,d.cWc&psig=AFQjCNGMXcPHG-AjG8Nbu9n92_7E9RhPtw&ust=1386448271847855

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=8YFWSFXFKdPa3M&tbnid=KrO246UD3s3mnM:&ved=0CAUQjRw&url=http://bmirec.asu.edu/edu/node/6&ei=GjSiUtnXK8qtsQS1tYH4CQ&bvm=bv.57752919,d.cWc&psig=AFQjCNGMXcPHG-AjG8Nbu9n92_7E9RhPtw&ust=1386448271847855

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Rick Potter, CEO Health Services Advisory Group of California, Inc.

(HSAG of California)

Affordable Care Act (ACA) Rollout: Success in the Golden State

December 10, 2013

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ACA Enrollment at a Glance

Presenter

Presentation Notes

--79,891 currently enrolled Californians as of Nov. 19, 2013. (>2K per day) Sources: Covered California boots plans that miss Obamacare standards, CNBC, Nov.21, 2013, http://www.cnbc.com/id/101218932 California is Obamacare rollout’s one bright spot, The Reporter, Nov. 24, 2013, http://www.thereporteronline.com/opinion/20131124/california-is-obamacare-rollouts-one-bright-spot Covered California, Executive Director’s Report, Nov. 21, 2013, http://www.healthexchange.ca.gov/BoardMeetings/Documents/November%2021,%202013/PPT%20-%20Executive%20Director's%20Report_November%2021,%202013.pdf

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Enrollment By Age

Presenter

Presentation Notes

--Enrollment by age (as of Nov. 14, 2013). 35-64 years olds are over-represented, but so too are 18-34 year olds as compared to their general numbers in the state’s population. Sources: Covered California boots plans that miss Obamacare standards, CNBC, Nov.21, 2013, http://www.cnbc.com/id/101218932 Covered California, Executive Director’s Report, Nov. 21, 2013, http://www.healthexchange.ca.gov/BoardMeetings/Documents/November%2021,%202013/PPT%20-%20Executive%20Director's%20Report_November%2021,%202013.pdf

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Enrollment by Language

Presenter

Presentation Notes

As of November 6th, most enrollees are English speakers (26,349 = 85% of all enrollees). Source: Covered California, Executive Director’s Report, Nov. 21, 2013, http://www.healthexchange.ca.gov/BoardMeetings/Documents/November%2021,%202013/PPT%20-%20Executive%20Director's%20Report_November%2021,%202013.pdf

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Enrollment by Region

Presenter

Presentation Notes

Largest enrollment by region was in Los Angeles, Inland Empire, and San Diego counties (Nov.6). Source: Covered California, Executive Director’s Report, Nov. 21, 2013, http://www.healthexchange.ca.gov/BoardMeetings/Documents/November%2021,%202013/PPT%20-%20Executive%20Director%27s%20Report_November%2021,%202013.pdf For other Covered California materials, go to http://www.healthexchange.ca.gov/Pages/Meeting_Materials_for_November_21,2013.aspx

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Challenges and Impacts on Access

Presenter

Presentation Notes

--Enrollees are over represented by 45-64 year olds. Offset by high enrollment of 18-34 year olds at 22.5% (21% of pop). --With greater volume of older enrollees, the program may increase premiums in 2015. --California’s Health Insurance Exchange (California Covered) rejected the President’s request to allow insurance plans that don’t meet ACA standards (~1.1 M plans). --Gaps in insurance coverage will exist due to plans that are voided that don’t meet ACA standards. --Lower sign ups in rural areas. --Rural communities may still reflect lack of coverage without stronger outreach effort. --ACA doesn’t require Native American Indians to sign up. --Lack of penalties for Native American Indians creates opportunity without fiscal burden. Sources: California Encouraged by Health Plan Enrollment, New York Times, Nov. 21, 2013, http://www.nytimes.com/2013/11/22/business/california-encouraged-by-health-plan-enrollment.html Covered California boots plans that miss Obamacare standards, CNBC, Nov.21, 2013, http://www.cnbc.com/id/101218932

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Challenges and Impacts on Access

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Opportunities

Presenter

Presentation Notes

Reformatted

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Opportunities

Presenter

Presentation Notes

--39% of applicants possibly eligible for Medi-Cal. --30% of applicants deemed eligible for subsidies. --Covered California is certifying outreach educators, using media, and awarding grants to community organizations to enroll minorities. Source: Covered California boots plans that miss Obamacare standards, CNBC, Nov.21, 2013, http://www.cnbc.com/id/101218932 California is one of 26 states that is expanding its Medicaid program to cover many people who were previously ineligible due to their low incomes.

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Expectations for Medi-Cal

Presenter

Presentation Notes

--Enrollment in Medi-Cal is expected to increase by 20% by early 2014. >1.4 million Californians will be newly eligible for Medi-Cal 750K-900K to enroll by 2019 --Experts predict that expanding Medi-Cal will improve health outcomes Medicaid coverage = decreased mortality + increased preventive care Funding more stable for providers that care for uninsured and low-income patients Sources: Public Partner: The California Health Benefit Exchange Aligned with Medi-Cal, California Healthcare Foundation, Oct. 2011, http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20CAExchangePublicPartner.pdf UC Berkeley Labor Center, Medi-Cal Expansion under the Affordable Care Act: Significant Increase in Coverage with Minimal Cost to the State, January 2013, http://laborcenter.berkeley.edu/healthcare/medi-cal_expansion.shtml

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More Opportunities

Presenter

Presentation Notes

--Bronze, Gold, Silver plans call for premiums that are higher, but the out-of-pocket expenses are lower. --No lifetime limits. Source: 7 Ways the Affordable Care Act will impact individual health insurance, http://www.calhealthplans.org/pdfs/ACAImpactInfographicMultiplePages042913.pdf

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Impact on Quality of Care for Minorities

Presenter

Presentation Notes

--Improved access to insurance = greater opportunity to receive regular care. --Higher concentration of minorities in rural areas = continued disparities. --California offers special benefits for tribal members. --Lower out-of-pocket costs helps low income patients. --Lack of lifetime limits means continued care. --Strong enrollment among 18-24 yr olds can help keep premiums down. Sources: “Bay Area groups struggle to enroll Filipinos in Covered California,” Nov. 6, 2013, http://peninsulapress.com/2013/11/06/covered-california-enrollment-filipino-community/ https://www.coveredca.com/hbex/tribal-consultation/ No health care expenses if income under $66K for family of four; No cost for medical care from many hospitals and doctors if received through the federal Indian Service, tribal orgs, or urban American Indian orgs; ability to buy insurance anytime. 7 Ways the Affordable Care Act will impact individual health insurance, http://www.calhealthplans.org/pdfs/ACAImpactInfographicMultiplePages042913.pdf

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Impact on Quality of Care for Minorities

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ACA and CA Medicare Beneficiaries

Improved access to preventive services: • Mammograms • Prostate Exams

Donut Hole Coverage – An average of $900.00 in savings for each

Medicare beneficiary in California. – Lower premiums

ACA Improved Access to

healthcare

Healthier Medicare beneficiaries in

the future??

Maybe?

Total Savings for CA $725,920,751

Source: CMS.gov, 2013: http://downloads.cms.gov/files/SummaryChart2010_October_2013.pdf

Presenter

Presentation Notes

Donut hole: A gap in coverage when Medicare beneficiaries have reach their maximum allowance on medications annually. ACA mandates protect seniors from the donut hole and high prescription drug costs. Improved access to healthcare as a result of ACA may lead to healthier Medicaid beneficiaries and the become Medicare beneficiaries. This has yet to be determined. Total Savings for CA $725,920,751 Covered California-Phone: 1-800-300-1506 or go online to www.coveredca.com

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www.hsag.com This material was prepared by Health Services Advisory Group of California, Inc., the Medicare Quality

Improvement Organization for California, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not

necessarily reflect CMS policy. Publication No. CA-10SOW-9.0-120513-01

Thank You!

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Margie Banse Health Information Supervisor,

Health Care Excel The Medicare Quality Improvement Organization for Kentucky

Kentucky’s Successful Rollout of

kynect

Health Care Excel Kentucky Medicare QIO

Approach and Method

July 17, 2012 kynect Created

Oct 2012 – Software vendor selected

Jan 2013 – Mar 2013 Developed the system

Apr 2013 – Jun 2013 Built the system

Jul 2013 – Sep 2013 Tested the site

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• kynect made the conscious choice to stick to the basics. A simple interface.

• Hired 622 ‘kynectors’

• Fully supported by Governor Steve Beshear - “My State Needs Obamacare. Now.”

• For more detail regarding the creation of kynect please view the article by Talking Points Memo, dated

10/28/2013 www.huffingtonpost.com/2013/11/05/kentucky-obamacare-website_n_4214629.html

http://www.huffingtonpost.com/2013/11/05/kentucky-obamacare-website_n_4214629.html

By the Numbers

As of 12/5/2013 approximately 100,000 Kentuckians have enrolled through kynect

• Prior to rollout approximately 625,000 Kentuckians were uninsured

• Launch was Oct. 1, 2013, and by Oct. 28, 2013 … o 26,000 Kentuckians had enrolled o 50,000 Kentuckians had started applications o Site has had more than 300,000 unique visitors

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Impact

• Statewide Workgroup • Sharing of Information, barriers and successes • Participants:

- Health Care Excel (QIO)

- Governor’s Office of Electronic Health Information

- Cabinet for Health and Family Services

- Kentucky Health Information Exchange (KHIE)

- Both Regional Extension Centers

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Impact

“Kimberly Cates has seen firsthand the consequences of not having coverage. For more than a decade, she has worked as a certified medical assistant in a family clinic in Paint Lick, KY., that treats the uninsured and indigent. The irony is lost on no one that the clinic cannot afford to offer Cates health care benefits.”

“I'm glad that I've done it and it's over with and I have it,” Cates says a few hours after signing up. “At the same time, it feels like, wow, $17 a month is nothing hardly. I've got insurance now.” Her experience has also given her insight into what it really takes to enroll in health care -- not just to navigate a website, but to overcome fears and doubts and distrust. Cates sent a text the following evening. “I applied to become a Kynector," she wrote.

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ACA and KY Medicare Beneficiaries

Donut Hole Coverage • An average of $928.00 in savings for

Medicare beneficiaries in Kentucky.

Total saving for KY: $180,902,076

42 Source: CMS.gov, 2013: http://downloads.cms.gov/files/SummaryChart2010_October_2013.pdf

Presenter

Presentation Notes

What could this mean for the future? http://downloads.cms.gov/files/SummaryChart2010_October_2013.pdf

Resources

Links for full articles used for this presentation My State Needs Obamacare. Now. – New York Times OP-ED by Governor Steve Beshear –

9/26/13 http://nyti.ms/1dMV1IU How Kentucky Built The Country's Best Obamacare Website – Talking Points Memo by Dylan Scott – 10/28/13 http://talkingpointsmemo.com/dc/how-kentucky-built-the-country-s-best-obamacare-website Kentucky's Obamacare Website Works, But Word Of Mouth Is What Sells It - Huffington Post by Jason Cherkis – 11/5/13 www.huffingtonpost.com/2013/11/05/kentucky-obamacare-website_n_4214629.html kynect Website https://kyenroll.ky.gov/

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http://nyti.ms/1dMV1IU

http://talkingpointsmemo.com/dc/how-kentucky-built-the-country-s-best-obamacare-website






https://kyenroll.ky.gov/

Contact Information

Margie Banse, BA Health Information Supervisor

1941 Bishop Ln. Suite 400

Louisville, KY. 40218

502.454.5112 ext. 2221 [email protected]

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mailto:[email protected]

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Useful Websites:

Healthcare.gov: The official site for the Healthcare Marketplace: https://www.healthcare.gov/families/ Department of Health and Human Services: http://www.hhs.gov/healthcare/rights/ Affordable Care Act: Action at CMS: http://www.cms.gov/about-cms/aca/affordable-care-act-in-action-at-cms.html AARP Health Care Law Navigation Tool: http://healthlawanswers.aarp.org/ To contact Medicare, call 1-800-MEDICARE, or visit: www.medicare.gov. Enroll America: http://www.enrollamerica.org/ American Public Health Association: http://www.apha.org/advocacy/Health+Reform/ACAbasics/

https://www.healthcare.gov/families/

http://www.hhs.gov/healthcare/rights/

http://www.cms.gov/about-cms/aca/affordable-care-act-in-action-at-cms.html
















http://healthlawanswers.aarp.org/

http://www.medicare.gov/

http://www.enrollamerica.org/

http://www.enrollamerica.org/

http://www.apha.org/advocacy/Health+Reform/ACAbasics/

http://www.apha.org/advocacy/Health+Reform/ACAbasics/

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Q&A

Please type your question into the chat box or press 14 on your telephone.

Data

Shanta Whitaker, PhD, MPH Senior Disparities Analyst

Phone: 410-290-2106 Email: [email protected]

Behavioral Health

Shanta Whitaker, PhD, MPH Senior Disparities Analyst

Phone: 410-290-2106 Email: [email protected]

Rural Health

Barbara Levin, MD, MPH Subject Matter Expert Phone: 423-337-1147

Email: [email protected]

Community Engagement

Izione Silva, PhD Language, Culture & Engagement

Coach Phone: 410-872-9615



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CMS Pulse Website

LEARN HOW TO SHARE YOUR SUCCESS ON THE CMS PULSE WEBSITE!

Contact Ava Richardson Phone: 410-872-9682



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CMS Pulse Website

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Sign up for the disparities listserv to stay current on all DNCC happenings!

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Thank you for participating in today’s webinar.

At the close of the presentation, you will automatically be directed to an evaluation screen.

This material was prepared by the Delmarva Foundation for Medical Care (DFMC), the Disparities National Coordinating Center, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-MD-DNCC-120613-347.