Achieving Health Equity via the Affordable Care Act Promises, Provisions, and Making Reform a Reality for Diverse Patients: Workshop Summary (2015) / Chapter Skim
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2 The Potential of the ACA to Reduce Health Disparities
2 The Potential of the ACA to Reduce Health Disparities
Pages 7-22
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From page 7... ...
Provisions of the ACA related to health equity are woven throughout the act. Three speakers at the workshop discussed various aspects of these provisions and their potential to reduce differences in health outcomes among racial, ethnic, and primary language groups.
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Health plans qualified to be included in the exchanges will be required to cover a range of essential health benefits, including ambulatory patient services, prescription drugs, emergency services, rehabilitative and facilitative services, hospitalization, laboratory services, maternity and newborn care, preventive and wellness services and chronic disease management, mental health and substance use disorder services (including behavioral health treatment) , and pediatric services (including oral and vision care)
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Existing demonstration projects are already boosting innovation. Such projects include Strong Start, which is a program to reduce early deliveries, particularly among Medicaid populations; nurse-managed care organizations; programs supported by Health Care Innovation Awards and the Community-Based Care Transitions Program; accountable care organizations (ACOs)
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, who have post-graduate education in health care, will provide primary care and wellness care to underserved populations. Other provisions include improved access to nurse-midwife services, establishment of Community Health Teams, an independence-at-home demonstration program, a nursing student and faculty loan program, and retention grants and a demonstration project for the education of APRNs.
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SOURCE: Kaiser Family Foundation.
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Food and Drug Administration, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration. James cited several programs addressing disparities that have received Health Care Innovation Awards: • The Delta Dental Plan of South Dakota has focused on oral health improvements for women and children in American Indian and Alaska Native populations.
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• Makes it easier for facilities run by tribes to recover costs from third parties. • Establishes a Community Health Representative program for urban Indian organizations to train and employ American Indians to pro vide health care services.
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As James said, quoting Lao-tzu, "A journey of a thousand miles begins with a single step." Health Equity and the ACA: An Insurer's Perspective Many provisions in the ACA related to health disparities affect insurers, said Wayne Rawlins, national medical director for racial and ethnic equality initiatives at Aetna. Under the ACA, insurers will provide plans and health insurance exchange marketplaces, and all insured patients must
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for major health benefits surrounding prevention and wellness. Many will be either contracting with or collaborating with ACOs and other entities focused on improving population health.
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Poorer control of diabetes can result in more episodes of blindness, kidney failure, heart attacks, and premature deaths. The National Health Plan Collaborative, which was established in 2004 and includes nearly a dozen major health plans, brings together major health insurance companies to identify ways to improve the quality of health care for racially and ethnically diverse patient populations.
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Figure 2-4 options for exchanges are a state-based exchange (as in Connecticut) , a Bitmapped federal partnership program, and a federal "default" exchange.
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"I always caution audiences not to think that the sky is going to fall when [the ACA] comes about, because that certainly was not the experience that we had in the one state pool on which this is clearly patterned." In Connecticut, the exchange enrollment process will be defined by six major steps (see Figure 2-5)
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The Massachusetts program also partnered with the Boston Red Sox to do outreach. "There is a lot to be learned from consumer product marketing techniques in terms of enrollment and advocating for health insurance." Counihan pointed out that the state-based exchanges have strong and detailed privacy and security features, which will be especially important in addressing concerns about federal agencies revealing personal information.
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Jeff Henderson of Black Hills Center for American Indian Health asked about HHS's plans to ensure coverage for American Indians and Alaska Natives under the ACA. Kevin Counihan responded that Connecticut has been "actively engaged" with the tribal leadership and they are working together on a policy.
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Counihan responded that there is "a very strong and detailed privacy and security feature" to which exchanges must conform. With regard to reaching people with low health literacy levels, staff at the call centers and in-person assisters are trained to deal with these issues.
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