The Role of Social Determinants in a Community's Access to Quality Health Coverage
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The document discusses the role of social determinants in communities' access to quality health coverage. It provides an overview of a conference presentation on this topic, including definitions of health disparity and equity. It then summarizes various efforts by the Administration for Children and Families to promote enrollment in the Affordable Care Act and other health programs. These include webinars, social media outreach, and partnerships with organizations. The presentation concludes by discussing next steps like leveraging intake processes and strengthening connections between organizations.
The Role of Social Determinants in a Community's Access to Quality Health Coverage
- 1. © 2016 Enroll America | StateOfEnrollment.org The Role of Social Determinants in Community’s Access to Quality Health Coverage
- 2. State of Enrollment – 2016 National Conference The Role of Social Determinants in Community's Access to Quality Health Coverage May 12, 2016
- 3. 3 A Closer Look at Distributions • “Who gets what, when and how?” • A Cake Example* *Source - Policy Paradox and Political Reason. Deborah Stone, 1988.
- 4. 4 Concepts of Equality Dimension Issue Dilemma Recipients Membership Unequal Invitations Equal Slices Items Need for item Equal Meal Unequal Slices Process Competition Unequal Forks Unequal Slices Adapted from Policy Paradox and Political Reason. Deborah Stone, 1988
- 6. Health Disparity “A health disparity is a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial and/or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.” National Stakeholder Strategy, Healthy People 2020 and Health and Human Services (HHS) Plan The Issue
- 7. Health Equity “Health equity is attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities.” The Vision 7 -National Stakeholder Strategy, Healthy People 2020 and Health and Human Services (HHS) Plan
- 8. ACF’s Mission To foster health and well-being by providing federal leadership, partnership and resources for the compassionate and effective delivery of human services 8
- 9. Budget ACF administers more than 60 programs with a $51 billion budget, making it the second largest agency in the U.S. Department of Health and Human Services 9
- 11. OPPORTUNITY IS NOW HERE!
- 12. ACF’s Approach to Support ACA Implementation ACF Regions LiaisonPartnershipOutreach Dissemination Tailored MaterialsPrograms Rules TA Contracts Grants/FOAIntake 12
- 13. Administration for Native Americans – Sent over 180 tweets, informational news items to grantees and other interested parties on ANA listserv (500+). – Posted ANA Blog - The Affordable Care Act: What’s in it for American Indians and Alaska Natives? – (66 hits). – Conducted ACA webinars for tribal communities. – Program Integration: Issued renewals for Eastern, Western, and Alaska with a requirement to include ACA and CHIP information in all training materials.
- 14. Family and Youth Services Bureau • Conducted a series of webinars for Runaway and Homeless Youth, Domestic Violence, Adolescent Pregnancy and Prevention grantees and stakeholders: – Open Enrollment: How the Affordable Care Act Can Help Patients Experiencing Domestic and Interpersonal Violence. – Connecting Youth to Clinical Services. • Program Integration: FYSB grantees and the Health Resource Center on Domestic Violence promote ACA and respond to training and TA requests.
- 15. OCS: Community Services Block Grant Program • Includes: 50 state grantees, DC, Puerto Rico, the U.S. Territories and 1,000+ CSBG-funded eligible entities and national partners. – Published an Information Memorandum titled “Use of CSBG Resources to Support Information and Referral for Affordable Care Act (ACA) Benefits and Services.” through the CSBG list serve (236 recipients who share with 1000+ CACs). • Program Integration: Develop CSBG/Community Action National Performance Indicators, including measures related to health and well-being
- 16. Office of Head Start, Office of Child Care (OCC) – Provided information to the regional offices for distribution to CCDF grantees and child care resource and referral organizations. – Distributed on OCC listserv, “Are You a Head Start or Child Care Provider in Need of Health Insurance” (4,200 subscribers). – Sent e-blast for the webinar on “Tax implications for ACF constituents.”
- 17. OCS: Low Income Home Energy Assistance Program (LIHEAP) • Includes: 50 state grantees, District of Columbia, 154 tribal grantees, American Samoa, Guam, Northern Mariana Islands, Puerto Rico, Virgin Islands, national partners. – Issued a Dear Colleague Notice on Extension to the A-87 Cost Allocation Exception to all LIHEAP grantees and discussed system integration concepts during quarterly conference calls. – Promoted and participated in the CMS webinar on tax implications and encouraged LIHEAP network to promote the webinar to grantees and partners.
- 18. ACF External Affairs: ACA Utilities Partnership • Rationale: – Medical debt is the single largest cause of personal bankruptcy. – Costly utility service terminations are on the rise. – Health insurance eliminates one major cause of financial instability for utility customers. • Strategies: – Leverage the saturated reach of utilities to find the uninsured and connect them to navigators for help finding free or low-cost health insurance. – Use Zip Code data to identify high uninsured in service area. • Outcome: • ACF, CMS, and Enroll America collaborated successfully with 3 major utility companies to reach the uninsured in their service areas.
- 19. What worked especially well this open enrollment period? • The Process – Direct contact with enrollers, navigators, and assisters. – Playing to everyone’s strengths, not over-reaching resources. – Relationships & collaborations (CMS, Head Start grantees, partners). – Strategies, target areas, and data-driven plans. • Communication – Messages/dissemination on listservs. – Relevant information. – Customized materials (flyers).
- 20. How to Incorporate? • Strategic planning for the entire year—infusing ACA messages into program activities and priorities • Grants offices taking an active part in facilitating ACA and CHIP enrollment for all new grantee awards • Strong leadership conveying that ACA outreach is a priority • Share success stories • Include in Commissioners’ performance plans • Implement strategies in enrollment, contracts, and technical assistance that result in more parents getting insurance • Include in TA contracts, intake forms, rules, etc.
- 21. Next Steps • Leveraging intake process for ACF means-tested programs. • Taking a deeper dive on how to reach Head Start parents. • Forging stronger connections between utility companies and navigators. • Sharpening the region’s strategic focus to provide more direct one-on-one assistance to the uninsured.
- 22. “Make no little plans, they have no magic to stir men’s blood and probably themselves will not be realized. Make big plans; aim high in hope and work, remembering that a noble, logical diagram once recorded will never die, but long after we are gone will be a living thing, asserting itself with ever growing insistency.” David Burnham (Chicago architect, 1925)
- 23. Contact Information Rochelle Rollins HHS/ACF Office on Trafficking in Persons Rochelle.Rollins@acf.hhs.gov Website www.acf.hhs.gov 23
- 24. © 2016 Enroll America | StateOfEnrollment.org The Role of Social Determinants in Community’s Access to Quality Health Coverage Ronald Ashford, Director Public Housing Supportive Services, U.S. Department of Housing and Urban Development
- 25. Proyecto Salud Clinic Safety Net Clinic in Montgomery County May 12, 2016
- 26. Everyone should have access to healthcare
- 27. One million + population One in two minority One in three immigrant One in seven senior (America’s longevity capital – AARP blog) MC CountyStat – community dashboards Montgomery County
- 28. Montgomery County ‘majority minority county’’ (MC CountyStats community dashboards)
- 29. Montgomery County (MC CountyStats community dashboards)
- 30. El Salvador China (MC #1 in DC Metro) India Ethiopia (MC #1 in US) Korea Montgomery County Top countries of origin
- 31. Montgomery County Uninsured Populations: 112, 992 –11.5% uninsured rate (American Comm. Survey 2009-2013 estimate) 6% 49%25% 20% Non-Hispanic White Hispanic or Latino Black or African American Asian or Pacific Islander
- 32. The Montgomery Cares Program is a Public Private Partnership, its purpose is to facilitate access to primary health care to low income, uninsured adults living in Montgomery County.
- 33. Serves annually close to 5,000 patients in two clinic sites Proyecto Salud Clinic Our Mission is to serve as a community health center that provides comprehensive, coordinated, and patient centered compassionate care.
- 37. Primary Adult Healthcare Behavioral/Mental Health (collaborative model) Diabetes Education and Management Care coordination – PCMH project Referral coordination to specialist Services and programs
- 38. Medicaid program expansion Diversification of services to include children Growth in new location Strengthening of partnerships going forward….
- 39. THANK YOU! Dr. Cesar Palacios Executive Director cpalacios@proyectosalud.org
- 40. Meeting the Need and Stabilizing Lives TOGETHER WE CAN SOLVE HUNGER TOGETHER WE CAN SOLVE HUNGER
- 41. Feeding America Nation’s leading domestic hunger-relief organization MISSION To feed America's hungry through a nationwide network of member food banks and engage our country in the fight to end hunger. VISION A hunger-free America
- 42. 1NATIONAL OFFICE Together we provide 3.7 billion meals each year 46M200MEMBER FOOD BANKS 60K FOOD PANTRIES AND MEAL PROGRAMS AMERICANS SERVED ANNUALLY
- 43. We increasingly prioritize variety and good nutrition 68% of the food we distribute closely aligns with the USDA Dietary Guidelines for Americans. FRUITS VEGETABLES PROTEIN GRAINS DAIRY
- 44. 48 Million PEOPLE ARE FOOD INSECURE IN AMERICA 48Mx
- 45. IN THE UNITED STATES, FOOD INSECURITY IS HOLDING STEADY AT THE HIGHEST RATES EVER RECORDED
- 46. providing meals alone won’t solve food insecurity
- 47. Needs do not exist in isolation Food Housing Health Employment & Income
- 48. Food insecurity and health are interconnected Across the lifespan, food insecurity is associated with: Poorer dietary intake Poorer physical, psychological, and behavioral health Poorer disease management
- 49. Feeding America’s clients report that their household income is inadequate to cover their basic household expenses. 69% HAVE HAD TO CHOOSE BETWEEN PAYING FOR UTILITIES AND FOOD 57% HAVE HAD TO CHOOSE BETWEEN PAYING FOR HOUSING AND FOOD 67% HAVE HAD TO CHOOSE BETWEEN PAYING FOR TRANSPORTATION AND FOOD 66% HAVE HAD TO CHOOSE BETWEEN PAYING FOR MEDICINE AND FOOD Source: Hunger in America 2014 Households are making difficult tradeoffs that have short and long-term implications for health
- 50. Source: Hunger in America 2014 55%of households reported using 3 or more coping strategies in the past year. 79% Purchase Inexpensive, Unhealthy Food 53% Receive Help From Friends 40% Water Down Foods or Drinks 35% Sell or Pawn Personal Property 23% Grow Food in a Garden
- 51. 47% of clients responded they are in fair or poor health In 29% of households all members have no health insurance* 55% of households report some medical debt *The Affordable Care Act went into effect after the fielding period of this survey. Health-related concerns are present for households served by the Feeding America network
- 52. What can we do together?
- 53. There’s health care and there’s health promotion Health Care Providing direct medical services Health Promotion Activities that support health education, access to care, and healthy behaviors
- 54. A Conceptual Framework: Cycle of Food Insecurity & Chronic Disease CHRONIC DISEASE HEALTH CARE EXPENDITURES EMPLOYABILITY HOUSEHOLD INCOME SPENDING TRADEOFFS HEALTH CARE HEALTH PROMOTION FOOD INSECURITY COPING STRATEGIES: Dietary Quality Eating Behaviors Bandwidth *
- 55. Feeding America’s Newest National Program In July 2015, Feeding America launched the SNAP Application Assistance Program which will expand and maintain SNAP access for eligible individuals and families.
- 56. We explored opportunities with Google SNAP “Google SNAP” uses internet search terms to connect individuals to local food banks for SNAP application assistance Referral Email Sent immediately to the local food bank for direct follow-up
- 57. >20,000 non-required comments have provided considerable insight into opportunities for additional assistance. More than 50% of users report health issue or disability
- 58. Google SNAP now connects to Get Covered Connector tool Cleveland, OH Cincinnati, OH Chicago, IL Geneva, IL Based on area coverage and expanded Medicaid, we are currently working with eight markets to address health care outreach as part of Google SNAP. Wichita, KS Springfield, MO Glouster, OH Harrisburg, PA Additional markets will be included using varying outreach strategies based on state- specific circumstances (e.g., State-Based Marketplace, non-expanded Medicaid).
- 59. There is now a report for understanding food banks’ role as partners in health promotion Food Banks as Partners in Health Promotion: Creating Connections for Client & Community Health A collaboration between Feeding America and Center for Health Law & Policy Innovation at Harvard Law School Highlights: • New developments in health care • Incentives for health systems • Partnership opportunities for food banks • Report and Executive Summary available at HealthyFoodBankHub.org
- 60. HealthyFoodBankHub.org educates, connects and engages Public microsite of FeedingAmerica.org Educates, connects and engages around the intersection of food insecurity, nutrition and health Target Audience • Professionals, academics and partners working with food insecure communities Provides • Targeted tools, resource and recipes • Latest research insights • Custom trainings for diverse sectors Continued growth reaching 45K+ users since launch in 2013
- 62. © 2016 Enroll America | StateOfEnrollment.org Thank You! Araceli Gutierrez, Health Manager, Podesta Group Agutierrez@podestagroup.com Jessica Hager, Community Health and Nutrition, Feeding America Jehager@feedingamerica.org Ronald Ashford, Director Public Housing Supportive Services, U.S. Department of Housing and Urban Development Ronald.T.Ashford@hud.gov Cesar Palacios, Executive Director, Clinica Proyecto Salud Cpalacios@proyectosalud.org Rochelle Rollins, PhD, MPH, Senior Advisor, U.S. Department of Health and Human Services Rochelle.Rollins@acf.hhs.gov
Editor's Notes
- #3: National Association of Hispanic Nurses Mission: Committed to advancing the health in Hispanic communities and to lead, promote and advocate the educational, professional, and leadership opportunities for Hispanic nurses. The purpose of the Promoting Increased Coverage in Communities (PICC) Initiative (HHS, OMH) is to identify and assist minority populations, to educate them about the Health Insurance Marketplace.
- #5: Latinos suffer from certain illnesses at higher rates than non-Hispanic white Americans. Studies link poor health to poverty, language barriers, cultural factors (access), and lack of health care coverage all of which are difficult issues in many Hispanic communities 2014 Survey -- 78% did not know that the health care law offered financial assistance or subsidies to help pay for their health plans, underscoring the need for continued education in this community. According to national examination surveys, Hispanics are almost twice as likely as non-Hispanic whites to be diagnosed with diabetes by a physician. They have higher rates of end-stage renal disease, caused by diabetes, and they are 40% more likely to die from diabetes as non-Hispanic whites. Higher rates of CVD risk factors Hispanic American men and women generally have lower cancer rates than the non-Hispanic white population. However, disparities still exist in certain types of cancer. Highest uninsured rates compared to any other racial or ethnic minority group 20% of low-income Latino youth have gone a year without a health care visit Almost 50% of Latinos report not always getting care when needed Compared with 43% black and 41% of white Americans
- #6: Data from our NAHN ACA Educator evaluation form.
- #7: We are excited to report that our organization was competitively selected as a recipient of the iCohere’s “Serving Those Who Serve Others” grants for 2015, a special program that awards high-tech resources, expertise, and platform for hosting a nationwide virtual conference on our PICCI grant. We were selected due to the unique contribution of Hispanic Nurses (NAHN) on this topic, noting that we were informed that we “clearly conveyed both the organization’s high level of commitment to those whom we serve, as well as our eagerness to expand the effectiveness of our community outreach through the benefits of hosting a major online event.
- #8: Lessons learned since 2014 Be inclusive, so that no one is left behind Consider those already with health insurance coverage, those who feel do not qualify for tax credits, etc. – they may be your best marketing strategy Latinos are intergenerational (la familia primero) Include grandparents for education and outreach Strategic Partnerships Nurses can offer health screenings as an entry to discuss health insurance coverage/literacy Annual and ongoing cultural events Focus on various target groups (including health care providers) Testing culturally responsive messaging Do not make assumptions Promote the value of health insurance coverage consistent with the values and priorities of consumers
- #9: Limited awareness remains a critical barrier: Fewer than half of adults had heard some or a lot about the coverage expansions; Application assistance from navigators and others was the strongest predictor of enrollment, while Latino applicants were less likely than others to successfully enroll; Hard to reach populations especially in need of in-person, bilingual assistance Rural, border communities experience shortage of resources, including health care providers Season & Migrant Farmworker Challenges Seasonal employees, those in positions for six months or less per year, are not considered fulltime employees and do not have to be offered health insurance. Advertising was strongly associated with perceptions of the law; State policy choices appeared to have had major impacts on enrollment experiences among low-income adults and their perceptions of the ACA. Culturally responsive messaging impacts perception Do not make assumptions Promote the value of health insurance coverage consistent with the values and priorities of consumers