The Impacts of the Affordable Care Act on Preparedness Resources and Programs Workshop Summary (2014) / Chapter Skim
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3 Preparedness Impacts of the Changes to Health Care System Financing and Delivery Infrastructure
3 Preparedness Impacts of the Changes to Health Care System Financing and Delivery Infrastructure
Pages 23-36
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From page 23... ...
expands on the Mental Health Parity and Addiction Equity Act of 2008 by requiring mental health and substance abuse disorder benefits in the individual and small-group markets, increasing access to needed services every day and in a disaster. • Accountable care organizations need to be able to address both the health (including mental health)
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INTEGRATED CARE AND OPPORTUNITIES FOR PREPAREDNESS Integrated care, including ACOs, can contribute much to public health preparedness and response. Delivery system reform also has a tremendous opportunity to impact daily emergency care, said Assistant Secretary for Preparedness and Response Lurie.
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Additionally, the ACA expands this even further, requiring mental health and substance abuse disorder benefits for Americans in the individual and small-group markets (ASPE Issue Brief, 2013)
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Because of this gap, she said the Boston Public Health Commission's Medical Intelligence Center coordinated more than 600 hours of mental health services for thousands affected by the bombings, including more than 200 sessions in the following 10 days. This highlights an important point: Any kind of insurance coverage may not equal good coverage, and gaps that remain could impact preparedness and response activities for state and local authorities (see Figure 3-1)
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Lurie added that a survey by America's Health Insurance Plans, the national trade association representing the health insurance industry, found that insurers want to learn more about their covered patients and want to be prepared for their potential needs in a disaster. From an individual perspective, preparedness plans could be part of discharge instructions for vulnerable patients (e.g., what to do if there is power loss, where to evacuate to, where to obtain medications)
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From page 28... ...
,2 discussed the role of safety net hospitals in emergency preparedness, and the post-ACA outlook for these hospitals. AEH represents more than 200 public and nonprofit safety net hospital systems that provide a disproportionate share of the uncompensated care for low-income, uninsured, and vulnerable U.S.
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Changes from New Infrastructure Development Through a myriad of factors, most notably the ACA, health care infrastructure is shifting to focus more and more on population health management and the nonmedical determinants of health that happen outside hospital walls (ACHI, 2013) , but struggling with the corresponding payment changes that need to happen as well, Rueben stated.
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DISTRIBUTED NETWORKS OF CARE Local public health departments across the country are also transforming as the Public Health Accreditation Board is pushing them away from direct service and toward a focus on population health. These system-level changes are being accelerated by the ACA, with both positive and negative implications, said DeSalvo.
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. In the future, health care organizations could leverage existing cancer, trauma, stroke, joint replacement, acute myocardial infarction, and other registries to develop a new registry of patients who may need attention quickly during a man 3 Provisions include a requirement that qualified health plans reimburse FQHCs no less than the Medicaid Prospective Payment System (PPS)
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In addition to a stronger, more resilient and ready health care system, it became increasingly clear that a strong local health department was also essential. DeSalvo also focused on transforming the New Orleans health department from treatment focused to prevention focused, transitioning out of direct health care service toward promoting and protecting the health of people where they live, learn, work, and play, while maintaining important core functions such as emergency preparedness.
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Medicaid Expansion and Disproportionate Share Hospital Payments In her remarks, Huang noted that while limited funding is available to states and to health care providers to support emergency preparedness activities, these funds are not enough to cover the expense of being ready. Because of the amount of uncompensated care that America's Essential Hospitals (i.e., safety net hospitals)
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State and local support are less and less reliable as many states undergo fiscal pressures, which present a difficult challenge to safety net hospitals in those states that do not expand the Medicaid program. As hospitals face these cuts, coverage expansion under the ACA will increase demand, and the impact of adding covered lives through marketplace plans remains to be seen.
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From page 35... ...
. This could help coordinate routine emergency care services even more, while potentially improving outcomes in an acute disaster requiring robust regional surge response.
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