Transcript 11-9-16 Webinar Slides

Meet the Authors
Joel Teitelbaum, JD, LLM
Associate Professor and Director of the Hirsh Health Law and Policy
Program, Department of Health Policy & Management, Milken
Institute School of Public Health, The George Washington University
Sara Wilensky, PhD, JD
Special Services Faculty for Undergraduate Education, Department
of Health Policy & Management, Milken Institute School of Public
Health, The George Washington University
Good Health Requires More Than
Good Medical Care
Spending
In the U.S.
States with higher
ratios of social and
public health spending
to Medicaid and
Medicare spending
have better health
outcomes.
Non-clinical Resources and Services
That Affect Health
According to the U.S. Health Resources and Services
Administration (HRSA), enabling services are defined as “nonclinical services that aim to increase access to healthcare and
improve health outcomes” and include services such as case
management, referrals, translation/interpretation, transportation,
eligibility assistance, health education, environmental health risk
reduction, health literacy, and outreach.
Law is a Social Determinant of Health
1) Law can be used to design/perpetuate social conditions that
can have terrible physical, mental, and emotional effects on
individuals and populations
2) Law can be a mechanism through which behaviors and
prejudices are transformed into distributions of relative wellbeing among populations
(cont.)
Law is a Social Determinant of Health
(cont.)
3) Law can be determinative of health through their underenforcement
4) Law can be used to structure direct responses to healthharming social needs that result from things like
impoverishment, illness, market failure, and individual
behavior that harms others
5) Laws can be interpreted in ways that can help or hinder
health.
Making the Connection:
A Matter of Semantics
Common Civil Legal Problem
Social Determinant of Health
Families wrongfully denied food supports
or housing subsidies
Lack of basic resources
Children living in housing with mold or rodents,
in violation of housing laws
Physical environment
Seniors wrongfully denied long-term care
coverage
Lack of access to insurance
Making the Connection:
A Matter of Civil Legal Aid Practice
Top 3 service areas of Legal Services Corporation (LSC)-funded
legal practice:
1. Family law: 33%
2. Housing: 27%
3. Income maintenance: 12%
Total: 72%
Why Do People Need Civil Legal Aid?
Civil Legal Aid Helps People Solve Legal Problems of Everyday Life
Legal Needs That Impact Health (I-HELP Model)
Income & Insurance
Housing & Energy
Education &
Employment
Legal Status
Personal & Family
Stability
Insurance access &
benefits
Shelter access
Americans with
Disabilities Act
compliance
Immigration asylum,
Violence Against
Women Act
Guardianship, custody,
divorce
Access to housing
Food stamps
Domestic violence
Discrimination
Disability benefits
Sanitary housing
conditions
Social Security benefits
Utilities access
Individuals with
Disabilities in Education
Act compliance
Criminal record issues
Child abuse & neglect
Debt relief
Unlawful termination
Advance directives,
estate planning
Under the Law, Legal Assistance Now
IS Viewed as an “Enabling Service”
In 2014, the Health Resources and Services Administration
(HRSA) — part of the U.S. Department of Health and Human
Services — modified its funding eligibility rules to allow health
centers to use federal “enabling services” funds to pay for on-site
civil legal aid to help meet the primary care needs of the
population and communities they serve.
Who Needs Civil Legal Aid?
Huge Population of Low-income People With Unmet Civil Legal Needs
Legal aid provides otherwise unaffordable legal services
The Need
The Services
• 1 in 6 live people live in poverty
•
Legal aid primarily serves people who
live in households with annual
incomes at or below 125% of the
federal poverty guidelines
•
65M qualified for legal aid in 2014
• Every low income person has 2-3
unmet civil legal needs that negatively
affect their health
• There is no guarantee to legal services
in civil matters
Legal Need
Legal Aid
There Isn’t Enough in the Legal Aid Pharmacy
Without Changing How Legal Care is Provided.
8,000 civil legal aid
attorneys in U.S.
with a $600 million
budget
& help from law
schools & pro bono
partners
try to serve 65 million
low-income people
with 2-3 needs.
They are able to meet less than 20% of the need each year,
and unfair, unhealthy systems go unchanged.
Integrating Civil
Legal Aid as
Part of Quality
Health Care
Medical-legal
partnership embeds
lawyers alongside
health care teams to
improve both
individual and
population health.
The Medical-Legal Partnership Approach
TRAIN &
IDENTIFY
NEED
TREAT
PATIENTS
TRANSFORM
CLINIC
PRACTICE
IMPROVE
POPULATION
HEALTH
Individual patient interventions are pathways to finding
policy interventions for improving population health.
Impact of Treating Legal Problems With MLP
People with chronic illnesses are admitted to the hospital less frequently.
People more commonly take their medications as prescribed.
People report less stress.
Less money is spent on health care services for the people who would otherwise
frequently go to the hospital.
Clinical services are more frequently reimbursed by public and private payers.
Class Exercises – Choose a Purpose
• Set the mood/attention grabbers
• Explain content
• Critical analysis
• Writing skills
Set the Mood/Attention Grabbers
Goal: Get your students present and focused for class
Examples
1. Quick oral or written discussion question
2. Start class with overall themes/question, 5 min to respond in writing
3. Quick small group discussion
4. Ungraded quiz – with or without answers
http://kff.org/quiz/uninsured-quiz/
Explain Content
Goal: Ways to convey or reinforce information beyond lecturing and
class discussion
Examples
1. Budget exercise
• Large group discussion of federal gov’t spending areas
• Small group research/discussion of current spending breakdown
• http://www.nytimes.com/ interactive/2010/11/13/ weekinreview/deficits-graphic.
html?_r=0
2. Student group lectures with professor input
3. Oral or written questions to explain connections across several classes
Critical Analysis
Goal: Practice/improve critical analysis skills
Examples
1. All in-class stakeholder exercise
• Provide fact pattern
• Provide stakeholders
• Give time to research in class
- What tools are available to your stakeholder?
- What is the key message your stakeholder wants to convey?
- What has your stakeholder done regarding this issue?
• Students present findings from research
• Class discussion
Critical Analysis: All In-class
Stakeholder Exercise - Mylan
• Mylan, a pharmaceutical company based in Pennsylvania, has been
rushing to counter a firestorm of criticism over its pricing of lifesaving
EpiPens. EpiPen, whose list price has climbed nearly 550% over
eight years, dominates the more than $1 billion market to treat
serious allergic reactions.
• A backlash over Mylan’s pricing tactics is growing. Politicians,
physicians and lawmakers have criticized the price of EpiPen. Since
acquiring the rights to sell EpiPen in late 2007, Mylan has increased
the list price of a pack of two to $608.61.
Critical Analysis: All In-class
Stakeholder Exercise - Mylan
• Mylan, the pharmaceutical company
• Jason Chaffetz (R-Utah) and Rep. Elijah Cummings (D-Md.), Chair and Ranking member
of the House Oversight and Government Reform Committee
• Allergykids Foundation, an organization that has been increasing awareness about the
skyrocketing costs of epipens
• Allergy & Asthma Foundation of America, a patient advocacy group that has taken funding
from Mylan in the past and is listed as an “ally” by Mylan
• Pharma, the trade association representing Pharma companies
• Senator Chuck Grassley (R-Iowa), who chairs the Senate Judiciary Committee
• Hillary Clinton, Presidential candidate
Critical Analysis
Examples
2. Homework/in-class combined stakeholder exercise
• In class: provide background information/lecture, split into stakeholder groups
• Homework: individuals research stakeholder position
• In class: small group discussion to come up with a stakeholder position, small
group develop 2 min “elevator speech” that includes clear policy position/proposal
and key points/evidence, one member of group gives speech
• Class discussion on clarity and persuasion of speech
Critical Analysis: Homework/In-class Combined
Stakeholder Analysis – State Exchange
• Policy issue: how to improve state exchanges in ACA
• Stakeholders
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•
•
•
•
•
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Insurance companies
States
Exchange users
Providers
American public/taxpayer
Hillary Clinton, presidential candidate
Donald Trump, presidential candidate
Writing Skills
Goal: Practice/improve writing skills with a focus on precision and
clarity (often also involves critical analysis skills)
Examples
1. Descriptive Table
•
•
•
•
Discuss purpose/how to create a descriptive table
Provide three pieces of legislation to compare
Homework: individuals create descriptive table
In class: view various descriptive tables, identify similarities and differences,
discuss which tables are most effective and why
Writing Skills
Examples
2. Leave Behind Documents
• Discuss purpose of “leave behind” documents
• Information provided to policymakers to support advocate’s position
• Features of good leave behind documents
•
•
•
•
•
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Identify the advocate
Identify the issue
Provide key information to understand the proposed policy/bill
Provide key policy points, especially why that policymaker should care
Include a specific ask, what do you want the policymaker to do?
Should be easy to follow and visually pleasing
Writing Skills – Leave Behind Documents
• Homework: individuals create a leave behind document for bill
included in or similar to the ones used for descriptive table
• In class: split into small groups, join efforts to create one group
leave behind documents by taking best from each individual
effort
• In class: review group leave behind document, discuss which
ones are more effective and persuasive
Writing Skills
Examples
3. Editorials
• In class: lecture on editorial topic and purpose/how to write an editorial
• http://www.nytimes.com/video/opinion/100000002691088/how-to-write-aneditorial.html
• Topic example: Should states expand Medicaid under ACA?
• In class: split class so half the class writes in support of one view and half writes
in support of the opposite view
• Homework: individuals write editorials
Writing Skills – Editorials
• In class: small group peer review
• Read each other’s editorials and provide feedback based on peer
review questions
• Does the editorial have a catchy title?
• Is point of view in editorial clearly explained at the beginning?
• Does the editorial provide convincing evidence to support its point of view ?(I ask
students to provide cites even though editorials usually do not have citations)
• Does the editorial counter expected arguments from opposing side?
• Is the writing clear, concise, and interesting?
Writing Skills – Editorials
• In class: After peer-review, group discussion on both substance
of the issue and what they learned in the peer review process
about writing persuasive editorials
• Homework: revise editorial and include commentary about
what/why made specific revisions
Live Q&A Session
Voice Your Question:
• Press *1
• Follow the prompt to record your name
• The operator will open your line, in turn
Type Your Question:
• Use the chat or Q&A box feature in the lower right-hand side of your
screen
Essentials of Health Policy
and Law, Third Edition
Visit go.jblearning.com/Teitelbaum3 to:
• Request a complimentary instructor’s copy
• Download sample chapters
• Request access to instructor materials
Includes a comprehensive eBook, chapter
quizzes, and pre-loaded assessments.
Thank you for participating!
Sophie Teague
[email protected]
Recorded webinar will be posted on the
LinkedIn Public Health Faculty Lounge
http://go.jblearning.com/PHLinkedIn