Transcript Insert Title Here - National Hispanic Medical Association

Health Disparities
Elena Rios, MD, MSPH
President & CEO
National Hispanic Medical Association
QualityNet Conference | Baltimore, MD
December 13 – 15, 2011
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@QualityNet11
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Demographic Trends
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Demographic Trends
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Demographic Trends
Reprinted from US Census Bureau. Hispanics in the United States. Available at:
http://www.census.gov/population/www/socdemo/hispanic/files/Internet_Hispanic_in_US_2006.pdf. Accessed November 10, 2011.
Key Trends
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Minorities face disparities in risk factors and chronic disease rates in America
– By 2042, over half of Americans will be minority populations
– Latinos – immigrants, mixed families with strong cultural values -will be 1 out of 4
Americans
– Minority communities – poor, air pollution, toxic homes, food deserts, stress
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Our nation is undergoing a major transformation:
– Cultural Competence & language requirements in hospitals/clinics and for future
providers in medical education and public health
– Health care reform expands health care coverage to Hispanics and African
Americans and increases the need for education and outreach efforts
– Quality and value payments for care that is patient centered in medical homes
– Disparities in obesity, CVD, chronic diseases for minority populations remain high
– New demand for community-based health prevention and research
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National Hispanic Medical Association and its Foundation seek to cultivate public and
private partnerships to make a positive impact promoting prevention awareness & good
will in new and growing Latino communities and markets around the nation
HHS 2011 Disparities Plan
• Assess the impact of policies, programs, resources
• Data and use of data
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New : race, ethnicity, language, disability status
Target high disparities areas/resources
Dual eligibles, obesity, oral care, CVD, readmissions
CPBR and Dissemination and adoption
• Quality measures and incentives
– Value based reimbursement
– Patient centered care, need new measures
• Workforce and leadership for future
– CLAS Standards, diversity
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OMH National Partnership for
Action Recommendations
• Awareness
– Regional Councils, Communications, Partnerships
• Leadership
– Minority representation needed to change health delivery
• Health Outcomes of Minority Populations
• Culturally and Linguistically Appropriate Services
Standards adoption
– Increase health workforce diversity and training
• Data and Evaluation
– CBPR
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ACA, Disparities & Access
• Increased insured patients outreach & demand for
all services with critical shortages of safety-net
providers, need for increased nursing
• Health Insurance Exchanges – consumer grants to
develop outreach with community health workers that
is culturally and linguistically appropriate
– Information & Websites
– Standards for benefits – presented in a culturally and
linguistically appropriate manner, health literacy
ACA, Disparities & Quality
• National Strategy for Quality Improvement in
Health Care
– Priorities that have the greatest potential for improving
health outcomes, efficiency, and patient-centeredness
of health care, for all, including vulnerable populations
– Quality measures – Medicare/Medicaid hospitals,
physicians
• experience, quality, use of info for pts and caregivers
• Equity of health services/disparities across health disparity
populations
• Patient-centered
ACA, Disparities & Quality
• HHS lead - strategic plans, incentives w/public and
private payers, mandates racial/ethnicity and
language data
• Office of Minority Health at OS, CDC, FDA, HRSA,
CMS, SAMHSA; Institute for Minority Health and
Health Disparities at NIH
• Key National Indicator System (and Independent
Institute like 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
ACA, Disparities & Quality
• Reimbursement – including activities to prevent
hospital readmissions – comprehensive discharge
program with pt centered education and counseling
• Best clinical practices that improve pt safety and
reduce medical errors through evidence based
medicine and Health Information Technology
• H-IT : EMR and PMR to include health disparities
information from provider/patient/community
assessments – for example, language needs
ACA, Disparities & Quality
• Center for Medicare/Medicaid Innovation
– Pt centered medical home models
– Community health teams, small practice med homes –
chronic care, self management
– Home health chronic care services
– Best practices
– Healthcare innovation zones
– Programs that address health care disparities and show
impact
ACA, Disparities & Prevention
• 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
• Prevention and Health Promotion Investment Fund ($10B)
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Community Transformation Plan
– to promote healthy living and reduce disparities (including
social determinants)
– Schools, restaurants, worksites
– Community Prevention
ACA, Disparities & Workforce
• National Health Care Workforce Commission – HHS,
DEd, DOL
– Integrated health workforce training, capacity of prim care
– Medicare/Medicaid GME
– Nursing, oral, mental, allied, and public health workforce,
diversity
– Geographic distribution of providers vs need
– Increased focus on primary care providers
• HHS Workforce to Reduce Disparities:
– Diversity to increase URM minority health professionals
– Cultural Competence Training for all providers
ACA, Disparities & Research
• Patient Centered Outcomes Research
– Comparative Clinical Effectiveness Research
• Importance of dissemination of research and adoption
by providers
• Community involvement in research
• Impact assessments on health disparities needed
Cultural Competence Training is
Key to Decreasing Health
Disparities
• Cultural competence is a set of congruent behaviors,
attitudes, and policies that come together in a system,
agency, or among professionals that enables effective
work in cross-cultural situations. 'Culture' refers to
integrated patterns of human behavior that include the
language, thoughts, communications, actions, customs,
beliefs, values, and institutions of racial, ethnic, religious,
or social groups. (Adapted from Cross, 1989).
• Unequal Treatment Report (2001, IOM) showed the
existence of bias among physicians and called for cultural
competency training, language services
• Should be an Essential Benefit for minority patients
Culture and Health Care
 Significant implications for cost, quality of care and most
importantly, health outcomes:
 variations in patient recognition of symptoms;
 thresholds for seeking care;
 the ability to communicate symptoms to a provider who
understands their meaning;
 the ability to understand the prescribed management strategy;
 expectations of care (including preferences for or against diagnostic
and therapeutic procedures); and
 adherence to preventive measures and medications
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CLAS Standards – 2001
• The collective set of culturally and linguistically
appropriate services (CLAS) mandates,
guidelines, and recommendations issued by the
United States Department of Health and Human
Services Office of Minority Health intended to
inform, guide, and facilitate required and
recommended practices related to culturally and
linguistically appropriate health services (National
Standards for Culturally and Linguistically
Appropriate Services in Health Care Final Report,
OMH, 2001).
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Cultural Competence Standards
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Federal Law – Title VI
Medical Education – AAMC, LCME, ACGME
Joint Commission
NCQA
NQF standards
Licensing – required in CA, NJ
Language Services in Medicaid – in 13 states
Cultural Competence and Quality
• There is excellent evidence that tracking/reminder systems
can improve quality of care, and fair evidence that
multifaceted interventions, provider education
interventions, and interventions that bypass the physician
to offer screening services to racial/ethnic minority patients
can improve quality of care. There is, however, excellent
evidence for improvement in provider knowledge, good
evidence for improvement in provider attitudes and skills,
and good evidence for improvement in patient satisfaction.
(AHRQ, Strategies for Improving Minority Healthcare Quality (Publication No. 04-E008-01, 2004)
NHMA & NHHF– Who are We?
• Established in 1994 in DC, NHMA is a non-profit
501c6 association representing 45,000 Hispanic
physicians in the U.S.
• Mission: to empower Hispanic physicians to
improve the health of Hispanic populations with
Hispanic medical societies, residents, students
and public and private partners
• Established in 2002, NHMA’s foundation, National
Hispanic Health Foundation, a 501c3 aimed at
research & education activities – at NY Academy
of Medicine & affiliated with NYU Wagner
Graduate School of Public Service
NHMA Board of Directors
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Kathy Flores, MD, Chairwoman,
Director, UCSFresno Latino Research
Center
Ciro Sumaya, MD, MPHTM, Past
Chairman, founding Dean, Texas A&M
Rural public Health School
Louis Aguilar, MD, Treasurer, Tucson,
AZ
Sam Arce, MD, ViceChair, NYC
Onelia Lage, MD, Secretary, Professor,
Pediatrics, U of Miami
Elena Rios, MD, President/CEO
Washington, DC
Carol Brosgart, MD, San Francisco, CA
Emilio Carrillo, MD, MPH, Professor,
Cornell Weill School of Medicine
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Jorge Girotti, PhD, Assoc. Dean, U of
Illinois, Chicago Medical School
Paloma Hernandez, MPA, CEO, Urban
Health Inc.
Leonora Lopez, MD, Chairwoman,
Council of Medical Societies, Alb, NM
Jorge Puente, MD, Regional President
of Asia, Pfizer
Joan Reede, MD, MPH, Associate
Dean, Harvard School of Medicine
Jaime Rivera, MD, Consultant, DE
Richard Zapanta, MD, Monterey Park,
CA
Vanessa Salcedo, MD, Chairwoman,
Council of Residents
Ray Morales, Coordinator, Latino
Medical Students Association
NHHF Board of Directors
• Mark Diaz, MD
Chairman, Principal, Alivio
Medical Group,
Sacramento, CA
• Conchita Paz, MD
Secretary -Treasurer, Principal,
Family Care Associates,
Las Cruces, NM
• Elena Rios, MD, MSPH
President, NHHF, NY
• Jo Ivey Boufford, MD President,
New York Academy of Medicine
• Dolores Leon, MD
A Woman’s Place, Sacramento,
CA
• Gary Pelletier
Director,
Pfizer Helpful Answers
• Miguel Sanchez, MD
Professor, Dermatology
NYU School of Medicine
• Yasmine Winkler
United Healthcare, Chicago
National Hispanic Medical
Association – what do we do?
• Serve as a resource for White House, Congress, and
Federal agencies on health policies and programs
• Support Hispanic physician leadership at national and
state level
• Provide partnership opportunities for advancement of
Hispanic health
NHMA Network 2011
• Hispanic State and Regional Medical Societies
• National Hispanic Health Professional Leadership
Network
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National Association of Hispanic Nurses
Hispanic Dental Association
Latino Caucus of APHA
Latino Forum of Health Executives
Assoc of Hispanic Health Execs of NY
Regional Mental Health Associations
• Latino Medical Student Association
Contact Information
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Elena Rios, MD, MSPH
[email protected]
www.nhmamd.org
www.nhmafoundation.org
www.hispanichealth.info
NHMA Annual Conference: April 26-29, 2012
Washington, DC – “Innovations that Improve the
Health of Hispanics, Families and Communities”