Federal Policies toFederal Policies to Eliminate Health Disparities Eliminate Health Disparities

Elena Rios, MD, MSPHElena Rios, MD, MSPHPresident & CEOPresident & CEO

National Hispanic Medical AssociationNational Hispanic Medical AssociationMarch 1, 2005March 1, 2005

CDC Chronic Disease Prevention ConferenceCDC Chronic Disease Prevention Conference

NHDR & PolicyNHDR & Policy

Lifespan approach & State profiles Lifespan approach & State profiles Databases – link to new billDatabases – link to new bill 109109thth: NIH, CDC Futures, : NIH, CDC Futures,

Disparities/AHRQ/OMH and Health Professions, Disparities/AHRQ/OMH and Health Professions, Pt Navigator – need advocacyPt Navigator – need advocacy

Develop Interventions and trackingDevelop Interventions and tracking Leadership development program Leadership development program

– market prevention & target services with efficiencymarket prevention & target services with efficiency

– Advocacy training for Health DisparitiesAdvocacy training for Health Disparities

Insurance Coverage Insurance Coverage Hispanics have the highest rates of uninsured of racial/ethnic groups, Hispanics have the highest rates of uninsured of racial/ethnic groups,

for all or part of 2000: for all or part of 2000: – 50% Hispanics under age 65 50% Hispanics under age 65 – 37% Hispanic children37% Hispanic children

In 2002, comprised 14% of U.S. population, but 29% of the uninsured.In 2002, comprised 14% of U.S. population, but 29% of the uninsured. In the last decade the number of uninsured Hispanics increased from In the last decade the number of uninsured Hispanics increased from

7.4 to 12.8 million.7.4 to 12.8 million. Less likely to have insurance, even when offered through employerLess likely to have insurance, even when offered through employer .. Puerto Rico public insurance lower coverage.Puerto Rico public insurance lower coverage. By 2050, Hispanics will be 25% of all Americans. By 2050, Hispanics will be 25% of all Americans.

Source: The Commonwealth Fund, Nov. 2003Source: The Commonwealth Fund, Nov. 2003

Profile of Uninsured Hispanics:Profile of Uninsured Hispanics:Risk FactorsRisk Factors

75% of uninsured Hispanics are classified as low-75% of uninsured Hispanics are classified as low-income (200% poverty level).income (200% poverty level).

Foreign-Born Hispanics have the highest Foreign-Born Hispanics have the highest uninsured rate, declines with length of uninsured rate, declines with length of time/generations in U.S.time/generations in U.S.

Legal immigrants have a 5 yr wait for public Legal immigrants have a 5 yr wait for public insuranceinsurance

For non-elderly Hispanics, 61% of those who For non-elderly Hispanics, 61% of those who primarily speak Spanish are uninsured, compared primarily speak Spanish are uninsured, compared to 36% of those who primarily speak English.to 36% of those who primarily speak English.

Quality of CareQuality of CarePatient CenteredPatient Centered

Spanish- speaking report greatest problems Spanish- speaking report greatest problems communicating with doctors and staff.communicating with doctors and staff.

Access to interpreters limited, only 1% of those Access to interpreters limited, only 1% of those used are medically trained.used are medically trained.

Lack of cultural competence training for physicians Lack of cultural competence training for physicians or in medical education.or in medical education.

Less likely to report confidence in their doctor.Less likely to report confidence in their doctor. Difficulty in understanding prescription instructions.Difficulty in understanding prescription instructions. Low representation of Hispanics as physicians (only Low representation of Hispanics as physicians (only

5% of U.S. physicians).5% of U.S. physicians).

NHMA and CHC 2002 NHMA and CHC 2002 National Hispanic Health Leadership National Hispanic Health Leadership

Summit, San Antonio, TXSummit, San Antonio, TX Purpose: to build consensus Purpose: to build consensus

recommendations to improve Hispanic recommendations to improve Hispanic health programs and policies at the Federal, health programs and policies at the Federal, State, private, and community levels for the State, private, and community levels for the next 5 years.next 5 years.

Partners: Congress, DHHS, CDC, AHRQ, Partners: Congress, DHHS, CDC, AHRQ, HRSA, NIH, RWJF, Ca Endowment, HRSA, NIH, RWJF, Ca Endowment, Amgen, Aventis, GSK, PhRMA, EPA, Amgen, Aventis, GSK, PhRMA, EPA, NHTSA, natl groups; 170 participantsNHTSA, natl groups; 170 participants

Summit Workgroups and Summit Workgroups and RecommendationsRecommendations

Health AccessHealth Access Cultural Competence and LanguageCultural Competence and Language Health Professions DevelopmentHealth Professions Development Community-Based ResearchCommunity-Based Research Chronic Disease Prevention & ManagementChronic Disease Prevention & Management Public Health Emerging Issues – asthma, injury, Public Health Emerging Issues – asthma, injury,

immunizations, behavioral healthimmunizations, behavioral health Women’s and Children’s HealthWomen’s and Children’s Health Bio-terrorism, US-Mexico Border Health, and Bio-terrorism, US-Mexico Border Health, and

Puerto Rico, environmental healthPuerto Rico, environmental health

Health AccessHealth Access

Ensure that outreach, education, and enrollment efforts are Ensure that outreach, education, and enrollment efforts are community-based and target LEP.community-based and target LEP.

Develop automatic re-enrollment in highly uninsured Develop automatic re-enrollment in highly uninsured populations.populations.

Develop uniform financial screening tools for public Develop uniform financial screening tools for public programs and migrant insurance program.programs and migrant insurance program.

Establish a web-based clearinghouse to promote research Establish a web-based clearinghouse to promote research on underutilization and disenrollment of underinsured on underutilization and disenrollment of underinsured populations.populations.

Expand Medicaid/SCHIP -eligibility, parents and Expand Medicaid/SCHIP -eligibility, parents and pregnant women, waivers, tax breaks for employers.pregnant women, waivers, tax breaks for employers.

Adopt universal healthcare policy.Adopt universal healthcare policy.

Cultural Competence and Limited Cultural Competence and Limited English ProficiencyEnglish Proficiency

Increase funding for the enforcement of Title VI Increase funding for the enforcement of Title VI of the Civil Rights Act.of the Civil Rights Act.

Adopt CLAS standards devised by DHHS Office Adopt CLAS standards devised by DHHS Office of Minority Health.of Minority Health.

Mandate and reimburse CC & LEP services in Mandate and reimburse CC & LEP services in Medicare, Medicaid, SCHIP, med ed, clinics, etc.Medicare, Medicaid, SCHIP, med ed, clinics, etc.

Make CC & LEP core value of physicians, Make CC & LEP core value of physicians, delivery systems – for quality care, patient delivery systems – for quality care, patient centeredness.centeredness.

Develop measures for CC & LEP performance, Develop measures for CC & LEP performance, outcomes, interpreter training, and link to surveys.outcomes, interpreter training, and link to surveys.

Health Professions TrainingHealth Professions Training Encourage Hispanic students to pursue health careers Encourage Hispanic students to pursue health careers

– Expand the HRSA Health Career Opportunity and Centers of Expand the HRSA Health Career Opportunity and Centers of Excellence programs, NIH career programs. Excellence programs, NIH career programs.

– Establish partnerships with the Department of Education.Establish partnerships with the Department of Education. Short Term: National Database and Tracking.Short Term: National Database and Tracking. Short Term: Workforce Development Research and reform Short Term: Workforce Development Research and reform

of federal programs.of federal programs. Long Term: Pipeline Development, eg. School District Long Term: Pipeline Development, eg. School District

should establish a Health Professions Academy for Latino should establish a Health Professions Academy for Latino Students.Students.

Sullivan Commission Report – Sept. 2004.Sullivan Commission Report – Sept. 2004.

Building Hispanic Community- Building Hispanic Community- Based ResearchBased Research

Increase Hispanic leadership and participation Increase Hispanic leadership and participation with DHHS, state/private organizations.with DHHS, state/private organizations.

Build community-based research infrastructure Build community-based research infrastructure (Empowerment Zone, CAP, Reach, Exceed).(Empowerment Zone, CAP, Reach, Exceed).

Develop and facilitate pipeline to produce more Develop and facilitate pipeline to produce more Hispanic researchers.Hispanic researchers.

Develop culturally appropriate research methods.Develop culturally appropriate research methods. Make partnerships with community organizations Make partnerships with community organizations

mandatory for funding of research on Hispanic mandatory for funding of research on Hispanic populations.populations.

DHHS – Office of Minority HealthDHHS – Office of Minority Health

Cultural Competence and LEP - CLAS StandardsCultural Competence and LEP - CLAS Standards Disparities in Health InitiativeDisparities in Health Initiative Resource Center, Agencies & RegionsResource Center, Agencies & Regions Language Access Initiative - ITLanguage Access Initiative - IT Community-based Coalitions – ObesityCommunity-based Coalitions – Obesity Coordination of DHHS efforts – Medicare Coordination of DHHS efforts – Medicare

outreach to providers, communityoutreach to providers, community Links to agencies thru Offices of Minority HealthLinks to agencies thru Offices of Minority Health

Health Disparities BillsHealth Disparities BillsFrist and Kennedy/Min.CaucusesFrist and Kennedy/Min.Caucuses

Access to health care Access to health care Data CollectionData Collection ResearchResearch Cultural CompetenceCultural Competence Language ServicesLanguage Services Health Professions DiversityHealth Professions Diversity Office of Minority HealthOffice of Minority Health

Health DisparitiesHealth DisparitiesKennedy/Min CaucusesKennedy/Min Caucuses

Indian HealthIndian Health Environmental Justice/Chronic DiseaseEnvironmental Justice/Chronic Disease Empowerment ZonesEmpowerment Zones New Scholarships for Health StudentsNew Scholarships for Health Students CLAS Standards & Ctr for CLHCSCLAS Standards & Ctr for CLHCS COE – public hospitalsCOE – public hospitals Capacity – clinicsCapacity – clinics OMH – FDA, CMSOMH – FDA, CMS

Cultural Competence TrendsCultural Competence Trends

IOM Quality Chasm – CC=Quality with IOM Quality Chasm – CC=Quality with Patient CenterednessPatient Centeredness

Standards adopted by LCME and RRCsStandards adopted by LCME and RRCs Evaluation and Tools being developed by Evaluation and Tools being developed by

NCQA, JACHO, AAMC, ACGME, LCME, NCQA, JACHO, AAMC, ACGME, LCME, NQF, and OMHNQF, and OMH

NHMA and OMH Forum – Sept. 9, 2004NHMA and OMH Forum – Sept. 9, 2004

NHMANHMA

The National Hispanic Medical Association and its The National Hispanic Medical Association and its Foundation (the National Hispanic Health Foundation) were Foundation (the National Hispanic Health Foundation) were established in 1994 in Washington D.C. to respond to the established in 1994 in Washington D.C. to respond to the compelling need for a leading voice to educate the public and compelling need for a leading voice to educate the public and private sectors on strategies for improving health care to the private sectors on strategies for improving health care to the U.S. Hispanic population. NHMA, a non-profit association, U.S. Hispanic population. NHMA, a non-profit association, represents licensed Hispanic physicians in the United States represents licensed Hispanic physicians in the United States and is the parent organization for the National Network of and is the parent organization for the National Network of Latin American Medical Students. Latin American Medical Students.

NHMA ProgramsNHMA Programs Support for PhysiciansSupport for Physicians

– Nominations for Boards and CommitteesNominations for Boards and Committees– Resume Bank/Job Search/MembershipResume Bank/Job Search/Membership– Media Breakfasts with the CHC, NHTSAMedia Breakfasts with the CHC, NHTSA

Leadership DevelopmentLeadership Development– NHMA Leadership FellowshipNHMA Leadership Fellowship

Promote Access to Quality CarePromote Access to Quality Care– Policy Development & TestimonyPolicy Development & Testimony– NHMA Press, JournalNHMA Press, Journal– NHMA Annual Conference NHMA Annual Conference

Hispanic Health Policy ForumsHispanic Health Policy Forums– Hispanic Health Congressional Briefing SeriesHispanic Health Congressional Briefing Series

NHMA Strategic AssetsNHMA Strategic Assets

National Hispanic Health Leadership NetworkNational Hispanic Health Leadership Network

» State and Local Medical SocietiesState and Local Medical Societies» NHMA National Advisory CommitteeNHMA National Advisory Committee» NHMA Physician Fellows Leadership NetworkNHMA Physician Fellows Leadership Network» NHMA Resident Leadership NetworkNHMA Resident Leadership Network» National Association of Hispanic Nurses (NAHN)National Association of Hispanic Nurses (NAHN)» Hispanic Dental Association (HAD)Hispanic Dental Association (HAD)» OMH Regional Offices & ContactsOMH Regional Offices & Contacts» Government AgenciesGovernment Agencies» FoundationsFoundations» Health Care Industry Health Care Industry » NHHF Corporate Advisory Council NHHF Corporate Advisory Council » Hispanic-Serving Health Professions SchoolsHispanic-Serving Health Professions Schools

NHMA AccomplishmentsNHMA Accomplishments

8 Annual NHMA Conferences8 Annual NHMA Conferences The NHMA Leadership The NHMA Leadership

Fellowship ProgramFellowship Program The NHMA Resident The NHMA Resident

Leadership ProgramLeadership Program The NHMA Medical Student The NHMA Medical Student

Mentorship Program Mentorship Program Cultural Competence GME Cultural Competence GME

Curriculum ProjectsCurriculum Projects Uninsured & Quality Health Uninsured & Quality Health

Care SeriesCare Series

Capital Hill Briefing Series Capital Hill Briefing Series Congressional EarmarkCongressional Earmark Health Policy Consultant to the Health Policy Consultant to the

Congressional Hispanic CaucusCongressional Hispanic Caucus Health Policy Consultant to the Health Policy Consultant to the

Congressional Black Caucus Congressional Black Caucus Health Policy Consultant to the Health Policy Consultant to the

Senate Majority Leader FristSenate Majority Leader Frist

NHMA AccomplishmentsNHMA Accomplishments Developed the Hispanic-Serving Developed the Hispanic-Serving

Health Professions Schools, Inc.Health Professions Schools, Inc. Foundation PartnershipsFoundation Partnerships

– California Endowment California Endowment – RWJ FoundationRWJ Foundation– Commonwealth FundCommonwealth Fund

Cooperative AgreementsCooperative Agreements– USDHHS USDHHS – US DOT, NHTSAUS DOT, NHTSA

CoalitionsCoalitions– National Hispanic Health Coalition National Hispanic Health Coalition – REDEC, Out of Many OneREDEC, Out of Many One

Media BreakfastsMedia Breakfasts CHC/DHHS Hispanic Health CHC/DHHS Hispanic Health

Leadership SummitLeadership Summit

The National Hispanic Leadership The National Hispanic Leadership AgendaAgenda

Board MembershipBoard Membership– Partnership for PreventionPartnership for Prevention– Women’s Policy Inc. (Women’s Women’s Policy Inc. (Women’s

Congressional Caucus)Congressional Caucus)– AMA – MAC, Commission on Health AMA – MAC, Commission on Health

DisparitiesDisparities– Pharma Adhoc Advisory BoardsPharma Adhoc Advisory Boards

D. Satcher Task ForceD. Satcher Task Force L. Sullivan CommissionL. Sullivan Commission AMA Disparities CommissionAMA Disparities Commission Senate Task Force U.S.-Mexico Senate Task Force U.S.-Mexico

Binational Health Insurance SummitBinational Health Insurance Summit

NHMA Advocacy ProjectsNHMA Advocacy Projects

Media Breakfasts with Congressmen and TV, Newspaper Media Breakfasts with Congressmen and TV, Newspaper (English/Spanish) Management in major Cities (English/Spanish) Management in major Cities

Campaign with Congress, State Govt, Health Leaders in Campaign with Congress, State Govt, Health Leaders in LA, Atlanta, DC on Hispanic Uninsured LA, Atlanta, DC on Hispanic Uninsured

Congressional Hispanic Health Briefing Series Congressional Hispanic Health Briefing Series Sacramento and Albany Leadership Forums and Sacramento and Albany Leadership Forums and

ReceptionsReceptions Leadership Fellowship DC Institute WeekLeadership Fellowship DC Institute Week Media Interviews, Press ConferencesMedia Interviews, Press Conferences National Partnerships and Campaigns – HHS, AMA, ACP, National Partnerships and Campaigns – HHS, AMA, ACP,

AAFP, ADA, ACS, Redes, Partnerships in Prevention AAFP, ADA, ACS, Redes, Partnerships in Prevention Board, Pharma, etc.Board, Pharma, etc.

Legislative Alerts - websiteLegislative Alerts - website

NHHF ProgramsNHHF Programs

Education ProgramsEducation Programs– NHMA Leadership FellowshipNHMA Leadership Fellowship– NHMA Resident Leadership ProgramNHMA Resident Leadership Program– Hispanic Health Portal Hispanic Health Portal www.hispanichealth.infowww.hispanichealth.info

Research and Research Training on Hispanic HealthResearch and Research Training on Hispanic Health– Health Services Research InstitutesHealth Services Research Institutes

Diversity in the Health Professions Diversity in the Health Professions – Hispanic Health Professional Student Scholarship Hispanic Health Professional Student Scholarship

» 1st GALA DINNER – Marriott Marquis, NYC, Dec. 21st GALA DINNER – Marriott Marquis, NYC, Dec. 2ndnd

NHMA ---NHMA ---leading the way to a healthier leading the way to a healthier

AmericaAmerica

For more informationFor more information

WWW.NHMAMD.ORGWWW.NHMAMD.ORG