ACHIEVING
HEALTH EQUITY
VIA THE
AFFORDABLE CARE ACT
PROMISES, PROVISIONS, AND MAKING REFORM
A REALITY FOR DIVERSE PATIENTS
Workshop Summary
Karen M. Anderson and Steve Olson, Rapporteurs
Roundtable on the Promotion of Health Equity
and the Elimination of Health Disparities
Board on Population Health and Public Health Practice
Institute of Medicine
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by a contract and grants between the National Academy of Sciences and Aetna Foundation (12-03699); Connecticut Health Foundation; Kaiser Permanente Program Offices Community Benefit II at the East Bay Community Foundation (20121256); The Kresge Foundation (245367); Merck Sharp & Dohme Corp. (2414); Robert Wood Johnson Foundation (70286); and the U.S. Department of Health and Human Services/Health Resources and Services Administration (HHSH25034010T). The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.
International Standard Book Number-13: 978-0-309-29463-8
International Standard Book Number-10: 0-309-29463-0
DOI: 10.17226/18551
Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2015 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2015. Achieving health equity via the Affordable Care Act: Promises, provisions, and making reform a reality for diverse patients: Workshop summary. Washington, DC: The National Academies Press.
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PLANNING COMMITTEE1
PATRICIA BAKER (Chair), Connecticut Health Foundation
GILLIAN BARCLAY, Aetna Foundation
CARA V. JAMES, Centers for Medicare & Medicaid Services
MELENIE MAGNOTTA, Aetna Foundation
PHYLLIS W. MEADOWS, The Kresge Foundation
MILDRED THOMPSON, PolicyLink
ANTONIA M. VILLARRUEL, University of Michigan
WINSTON F. WONG, Kaiser Permanente
__________________
1 The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus.
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ROUNDTABLE ON THE PROMOTION OF HEALTH EQUITY AND THE ELIMINATION OF HEALTH DISPARITIES1
ANTONIA M. VILLARRUEL (Chair), Professor and Margaret Bond Simon Dean of Nursing, University of Pennsylvania School of Nursing
MILDRED THOMPSON (Co-Chair), Senior Director and Director of the PolicyLink Center for Health Equity and Place
PATRICIA BAKER, President and CEO, Connecticut Health Foundation
GILLIAN BARCLAY, Vice President, Aetna Foundation
ANNE C. BEAL, Deputy Executive Director, Patient-Centered Outcomes Research Institute
NED CALONGE, President and CEO, The Colorado Trust
IRENE DANKWA-MULLAN, Director, Office of Innovation and Program Coordination, National Institute on Minority Health and Health Disparities, National Institutes of Health
GEM DAUS, Public Health Analyst, Office of Health Equity, Health Resources and Services Administration
JAMILA DAVISON, ACM Medical Transition Care
FRANCISCO GARCIA, Director and Chief Medical Officer, Pima County Department of Health
ALLAN GOLDBERG, Executive Director, U.S. Academic and Professional Affairs, Merck & Co., Inc.
NADINE GRACIA, Deputy Assistant Secretary for Minority Health and Director of the Office of Minority Health at the U.S. Department of Health and Human Services
JEFFREY A. HENDERSON, President and CEO, Black Hills Center for American Indian Health
EVE J. HIGGINBOTHAM, Vice Dean, Perelman School of Medicine, University of Pennsylvania
CARA V. JAMES, Director, Office of Minority Health, Centers for Medicare & Medicaid Services
OCTAVIO MARTINEZ, Executive Director and Clinical Professor, Hogg Foundation for Mental Health, University of Texas at Austin
NEWELL McELWEE, Executive Director, U.S. Outcomes Research, Merck & Co., Inc.
PHYLLIS W. MEADOWS, Senior Fellow, Health Program, The Kresge Foundation
ELENA O. NIGHTINGALE, Scholar in Residence, Institute of Medicine
__________________
1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
AMELIE G. RAMIREZ, Director and Professor, University of Texas Health Science Center
JOHN RUFFIN, Retired, National Institute on Minority Health and Health Disparities, National Institutes of Health
MELISSA SIMON, Vice Chair, Clinical Research, Associate Professor, Northwestern University Feinberg School of Medicine
PATTIE TUCKER, Associate Director for Health Equity, Centers for Disease Control and Prevention
ROHIT VARMA, Chair of the Department of Ophthalmology and Visual Sciences and Associate Dean for Strategic Planning, University of Illinois–Chicago
WINSTON F. WONG, Medical Director, Community Benefit, Director Disparities Improvement and Quality Initiatives, Kaiser Permanente
TERRI D. WRIGHT, Director, Center for School, Health and Education, American Public Health Association
IOM Staff
KAREN M. ANDERSON, Senior Program Officer
ANDRÉS GAVIRIA, Research Associate (through August 2013)
ANNA MARTIN, Senior Program Assistant (since February 2015)
ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice
Reviewers
This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:
Elizabeth Krause, Connecticut Health Foundation
Menoo Mishra, Association of State and Territorial Health Officials
Jewel Mullen, Connecticut Department of Public Health
Cheri Wilson, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Elena Fuentes-Afflick, University of California, San Francisco. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution.
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4 THE PATIENT-CENTERED MEDICAL HOME
Standards for Patient-Centered Medical Homes
Identify and Manage Patient Populations
Provide Self-Care and Community Support
Measure and Improve Performance
Leveraging Opportunity in a Changing Health Care Landscape
Workforce and Delivery of Care
Aligning Resources and Needs Within the Safety Net
Driving Health Equity Through Public Policy
The PCORI Approach to Patient and Stakeholder Engagement
Assessment of Prevention, Diagnosis, and Treatment Options
Communication and Dissemination Research
Accelerating Patient-Centered Outcomes Research and Methodological Research
The Role for Consumer Engagement
Box and Figures
BOX
1-1 The Connecticut Health Foundation
FIGURES
2-1 Minority groups and uninsured people in the United States
2-2 Southern states and proportions of non-elderly persons of color
2-3 Southern states and proportions of non-elderly uninsured persons
2-5 The exchange enrollment process in Connecticut
3-1 Child health insurance continuity by family income, 1998–2009
3-2 Child and parent full-year health insurance status, 1998–2009, by family
3-3 Electronic health record data
3-4 Symptoms versus hospitalizations
3-5 Information technologies and building patient-centered medical bases
5-1 Community health improvement and contributions to community groups
| ACA | Patient Protection and Affordable Care Act |
| ACO | accountable care organization |
| AHRQ | Agency for Healthcare Research and Quality |
| APRN | advanced practice registered nurse |
| CHCS | Center for Health Care Strategies |
| CMS | Centers for Medicare & Medicaid Services |
| EHR | electronic health record |
| FQHC | federally qualified health center |
| HHS | U.S. Department of Health and Human Services |
| IOM | Institute of Medicine |
| IRS | Internal Revenue Service |
| NCQA | National Committee for Quality Assurance |
| NQF | National Quality Forum |
| PCORI | Patient-Centered Outcomes Research Institute |
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