Health Care Reform and ACA: Worcester Perspectives

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Health Care Reform and ACA Worcester
Perspectives

• Andrea Mathias, MD, MPH
• Deputy Health Officer
• Worcester County Health Department

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HCR and ACA in MD

• Maryland focused on three areas of HCR this year
• Insurance reforms.
• Health Insurance Exchange.
• Establishment of Quality and Cost Council.

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Overview

• Worcester Stats
• Health Provider Workforce
• Preventative Services
• Oral Health
• Mental Health Parity
• Health Service Delivery

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Worcester Workforce Status

• Federal and State Health Provider Shortage Area
  (HPSA).
• Primary Care, Dental and Mental Health.
• Based on geography, provider ratios, Medicaid
  eligible population.

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HPSA Primary Care
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HPSA Dental
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HPSA Mental Health
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MUA/P and FQHC
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Shortage Designations Mean What?

• Workforce Recruitment Retention funds
• Federal NHSC
• Federal and State LARP
• Established Community Health Center/ FQHC- Three
  Lower Counties.
• J-1 Visa placements.

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ACA Healthcare Workforce

• Invest in training health care professionals.
• Invest in scholarship, loan repayment, and
  training grant programs.

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ACA Primary Care Workforce Development Benefits

• Provide 10 Medicare bonus for primary care
  services provided by primary care physicians
  through 2016.
• Increase Medicaid reimbursement.
• 1.5 billion - mandatory spending for the
  National Health Service Corps.
• 11 billion - building new and expanding existing
  community health centers.

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National Health Services Corps

• Worcester has approved sites for National Health
  Services Corps service.
• Loan repayment for clinicians for years of
  service.
• WCHD has a physician placement.

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• PCPs
• Worcester 10931
• Maryland 7131
• U.S. 90th percentile 6311

http//www.countyhealthrankings.org/maryland
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PCP National Comparison
HSC Research Brief No. 19 March 2011
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ACA Shortage Designation Impact

• Negotiated rulemaking committee to develop NEW
  methodology for designating MUA/MUP and HPSA.
• Expected date for publication of the new rule is
  end of 2011.

 
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ACA Medicaid Expansion

• Will enable more low income individuals to be
  covered.
• Recognizes family diversity to include families
  with children and without children.

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• Medicaid Enrolled vs. Eligibles per month FY2011
  
• Worcester 6,700 of 9,000
• Maryland 710,000 of 865,700

MCO Enrollees by Month in Fiscal Year '11
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• Uninsured Adults
• Worcester 21
• Maryland 17
• National 90th percentile 13

http//www.countyhealthrankings.org/maryland
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ACA Medicaid Expansion

• Medicaid will be expanded in low income
  individuals under age 65.
• Newly eligible adults will be guaranteed at least
  essential health benefits.
• States will receive increased Medicaid funding.
• Medicaid payments in fee-for service and managed
  care for primary care services will be increased.

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Physician quality reporting

• Payment to providers will be reduced if data on
  quality measures is not submitted by 2015 - 2016
  and each year afterward.
• Aggressive timeline for rural physicians and
  employers.
• HITECH law

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ACA Preventative Care

• Refocus nations health care spending
• From clinical medicine and disease treatment.
• To preventative services to help reduce burden
  of chronic disease.

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Program Wor. MD US
Diabetic Screening 84 81 89
Mammogram Screening 74 64 74
Obesity 28 27 25
Smoking 21 18 15
http//www.countyhealthrankings.org/maryland
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ACA Preventative Health Services

• Increased insurance coverage of preventative
  health services
• Immunizations, screenings.
• Evidence based guidelines for services.
• Reduced cost-sharing for proven services.
• Medicare coverage of wellness visits.
• Improved payment for Medicaid recipients
• Employer based wellness programs

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Public Health Prevention Services

• Lifestyle balance program and nutrition
  counseling.
• Diabetes self management education.
• Tobacco cessation program.
• Colorectal, breast and cervical cancer screenings.

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ACA and Oral Health Care

• Children are 2.5 times more likely to be
  uninsured for dental than for other medical
  conditions.
• Tooth decay is the most common disease of
  childhood, more common than asthma or hay fever.

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ACA Oral Health Care

• Establish a 5-year national public health
  education campaign focused on oral healthcare
  prevention and education.
• Require coverage and access for oral care for all
  children beginning 2014.
• Development of expanded workforce and training of
  dental and other health professionals.

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Worcester County Dental Center
Opened March 15, 2011
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• Poor Mental Health Days
• (per month)
• Worcester 3.1
• Maryland 3.3
• National 90th percentile 2.3

http//www.countyhealthrankings.org/maryland
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Mental Health Parity

• An estimated 22.6 of Americans age 19 and older
  suffer from a diagnosable mental disorder in a
  given year.
• Insurance coverage - economic disparity for
  mental health disorders compared to physical
  illnesses.

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Mental Health Parity Act

• Enacted Oct. 3, 2008 benefits equity for
  mental health/substance use disorders.
• Employers may not apply separate cost sharing
  requirements or treatment limitations to mental
  health/substance use disorder benefits.
• For most plans, effective date began Jan. 1, 2010.

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Mental Health and Addictions Service in Worcester

• WCHD individual, family, group counseling,
  psychiatry.
• Partnership with AGH at AHC.
• Telemed with Shepherd Pratt.
• School-based and In-Home services.
• Crisis Response and Suicide Prevention.
• CSA

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Delivery of Public Health Services

• Examine best practices related to prevention.
  Focus on areas identified in National Prevention
  Strategy or Healthy People 2020.
• Identify strategies for organizing, financing or
  delivering public health services.
• Become more cost effective.

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MedPAC Study

• MedPAC will analyze
• Adjustments in payments to providers and
  suppliers.
• Access by Medicare beneficiaries to items and
  services in rural areas.
• Adequacy of payment to providers and suppliers.
• Quality of care furnished in rural areas.
• Institute of Medicine study on appropriateness of
  geographic variation.

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Health Disparities

• Ensure ongoing or federally conducted or
  supported health care or public health program,
  activity or survey collects and reports to the
  extent practicable, data on race, ethnicity,
  gender, geographic location, socioeconomic
  status, language, disability status.

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Questions?

• Andrea Mathias, MD, MPH
• Deputy Health Officer
• Worcester County Health Department