National Latino Health Leadership 2011

Key Trends Latinos are the majority ethnic group in America  By 2042, one out of four Americans will be Hispanic/Latino  Immigrants and mixed families with strong cultural values Our nation is undergoing a major transformation :  Cultural Competence & language requirements in hospitals, medical education, & CME  Health care reform expands health care coverage to Hispanic populations and increasing the need for education and outreach efforts  Quality and value payments for care that is patient centered in medical homes  Health IT links providers, payers and patients  New demand for community health prevention and research NHMA/NHHF seeks to cultivate public and private partnerships to make a positive impact promoting prevention awareness & good will in new and growing Latino communities and markets around the nation

Hispanics and Health Policy Access: High rates of uninsured & problems with disparities in health care according to US DHHS Disparities Reports Systems: Cultural competence, language services in services, community, media & communications – outreach, socialmedia, IT Research: Hispanic community-based prevention research & clinical trials Workforce: Hispanic researchers, providers and leaders in public health/private agencies Training: Need for cultural competence training about Latinos – disciplines, settings (home care)

Health Insurance Exchange and Medicaid State Exchange is a marketplace for those individuals and small businesses above Medicaid, seamless, essential benefits, QI, pt satisfaction States can have more than one, leverage Federal and other states resources Patient Navigator grants to educate about the health plans and benefits (language) Plans, network design, marketing

National Quality Strategy To focus on quality outcomes: Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe. Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care. Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

Value Based Purchasing In 2013, for the first time, the Hospital Value-Based Purchasing program authorized by the Affordable Care Act will pay hospitals’ inpatient acute care services based partially on care quality, not just the quantity of the services they provide. Following, will be physician reimbursement – on outcomes of your patients, not on services provided. Physician reimbursement – NHMA involved with now to demand Congress focus and not hold hostage the Prevention Fund plus health care reform

Allignment Initiative An effort to more effectively integrate benefits under Medicare and Medicaid for 9 million Dual Eligibles. Federal Coordinated Health Care Office – at CMS to coordinate care, decrease costs Care coordination, fee-for-service benefits, prescription drugs, cost sharing, enrollment, and appeals.

Prevention Strategy 2011 Healthy and Safe Community Environments: Create, sustain, and recognize communities that promote health and wellness through prevention. Clinical and Community Preventive Services: Ensure that prevention-focused health care and community prevention efforts are available, integrated, and mutually reinforcing. Empowered People: Support people in making healthy choices. Elimination of Health Disparities: Eliminate disparities, improving the quality of life for all Americans.

Community Transformation and Prevention Priorities 2011 Community Grants that address Prevention National Prevention Council – across Fed agencies tobacco-free living; active living and healthy eating; evidence-based quality clinical and other preventive services, HTN and high cholesterol; social and emotional wellness; healthy and safe physical environments. $100M for 75 grants - announced May 13 th

Minority Health 2011 ACA: OMH, NIMHD, HHS Agencies National Partnership for Action: Awareness of health disparities Leadership to address health disparities at all levels Health System and Experience Cultural Competence & Diversity of Workforce Data, Research and Evaluation Federal Interagency Team - NEW Regional Advisory Councils – NHMA nominees. HHS Strategic Action Plan to Reduce Racial and Ethnic Disparities in Health; Tricaucus New Bill coming Sept.

Workforce 2011 Major changes: primary care extension ctrs, teams, advanced nurses, dental careers, integrated care and community clinic GME training with residency programs CDC = HHS lead agency for new public health pipeline HRSA supports NHMA Leadership Fellowship for midcareer physician leaders, NHMA Resident Leadership Program in CA and NY Health IT and NHMA partners – increasing adoption. CMS Innovation $1B to physicians, hospitals – pt safety, quality, community transition to home care and decrease readmissions OMH Promotores de Salud Initiative

“There are many questions, questions that need answering…” Clinician – What can I learn about & how can I better communicate with my patients? Administrator – How can I use information management techniques to help us become an Informatics Leader? IT Leader – How does clinical information relate within the organization? Researcher – How do I advance my research and increase publications/grants through a standards - based process?

Core Capabilities of EHR Health information and data. Having immediate access to key information - such as patients' diagnoses, allergies, lab test results, and medications - would improve caregivers' ability to make sound clinical decisions in a timely manner. Result management. The ability for all providers participating in the care of a patient in multiple settings to quickly access new and past test results would increase patient safety and the effectiveness of care. Order management. The ability to enter and store orders for prescriptions, tests, and other services in a computer-based system should enhance legibility, reduce duplication, and improve the speed with which orders are executed. Decision support. Using reminders, prompts, and alerts, computerized decision-support systems would help improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments. Electronic communication and connectivity. Efficient, secure, and readily accessible communication among providers and patients would improve the continuity of care, increase the timeliness of diagnoses and treatments, and reduce the frequency of adverse events. Patient support. Tools that give patients access to their health records, provide interactive patient education, and help them carry out home-monitoring and self-testing can improve control of chronic conditions, such as diabetes. Administrative processes. Computerized administrative tools, such as scheduling systems, would greatly improve hospitals' and clinics' efficiency and provide more timely service to patients. Reporting. Electronic data storage that employs uniform data standards will enable health care organizations to respond more quickly to federal, state, and private reporting requirements, including those that support patient safety and disease surveillance." Source: IOM, Key Capabilities of an Electronic Health Record System, 2003

HITECH ACT Greater efficiencies for providers, as well as patients and payers. Increase of the quality and quantity of the information able to be stored. Improved patient safety and outcomes Less redundancies and medical errors. Decreased health care costs.

Quality and Patient Outcomes Increased adoption of electronic health records and computer-aided clinical decision support (CDS) will open new opportunities to rapidly promote clinical practice guidelines to healthcare providers and patients. To advance this goal, guideline developers should structure the format, vocabulary, and content of clinical practice guidelines to help ease the implementation of computer-aided CDS by end-users. IOM, Clinical Practice Guidelines We Can Trust, Mar. 2011

H-IT Decreases Health Care Disparities National Ambulatory Medical Care Survey: EHR adoption rates are lower for providers serving Hispanic patients who are uninsured or rely upon Medicaid. Changing systems can be huge and employees need to be involved and prepared for the change in procedures and handling of data. Hospital EHR systems expect smaller medical practices to be able to connect and share information electronically with them. Opportunity to raise underserved patients to technology  (HIT tools, trackers, devices and applications)

Meaningful Use and EHR Med Record data: patients' vital signs and demographics, active medications and allergies, up-to- date problem lists of current and active diagnoses, and smoking status (Quality standards: HTN, wt, smoking) Software applications to improve safety, quality, and efficiency of care - enter clinical orders, prescription meds, patient health records Drug-formulary checks, clinical laboratory results, reminders to patients for needed care, patient-specific health education resources, and support the patient's transitions between care settings or personnel The Health Information Technology for Economic and Clinical Health Act (HITECH) 2010 and Medicare ($44K) and Medicaid ($67K) Incentives

NHMA and H-IT NHMA partnered with Dr. First, the largest and most respected independent e-Prescribing and modular EHR company in the U.S. Patient Rx fill, health testing and appointment reminder messaging, Patient coupon and saving incentives, Patient education, resources and tools, Patient Health Coaching, Patient/Provider Surveys USPS Mail, , SMS/Text messages or Print in English or Spanish Dr. First providing 1000 licenses of their e-Prescribing Meaningful Use module to NHMA members

NHMA & NHHF– Who are We? Established in 1994 in DC, NHMA is a non-profit 501c6 association representing 45,000 Hispanic physicians in the U.S. Mission: to empower Hispanic physicians to improve the health of Hispanic populations with Hispanic medical societies, residents, students and public and private partners. Established in 2002, NHMA’s foundation, National Hispanic Health Foundation, a non- profit 501c3 foundation for research & education activities – affiliated with NYU Wagner Graduate School of Public Service

NHMA Board of Directors Kathy Flores, MD, Chairwoman, Director, UCSFresno Latino Research Center Ciro Sumaya, MD, MPHTM, Past Chairman, founding Dean, Texas A&M Rural public Health School Louis Aguilar, MD, Treasurer, Tucson, AZ Sam Arce, MD, ViceChair, NYC Onelia Lage, MD, Secretary, Professor, Pediatrics, U of Miami Elena Rios, MD, President/CEO Washington, DC Carol Brosgart, MD, San Francisco, CA Emilio Carrillo, MD, MPH, Professor, Cornell Weill School of Medicine Jorge Girotti, PhD, Assoc. Dean, U of Illinois, Chicago Medical School Paloma Hernandez, MPA, CEO, Urban Health Inc. Leonora Lopez, MD, Chairwoman, Council of Medical Societies, Alb, NM Jorge Puente, MD, Regional President of Asia, Pfizer Joan Reede, MD, MPH, Associate Dean, Harvard School of Medicine Jaime Rivera, MD, Consultant, DE Richard Zapanta, MD, Monterey Park, CA Vanessa Salcedo, MD, Chairwoman, Council of Residents Ray Morales, Coordinator, Latino Medical Students Association

NHHF Board of Directors Mark Diaz, MD Chairman, Principal, Alivio Medical Group, Sacramento, CA Conchita Paz, MD Secretary -Treasurer, Principal, Family Care Associates, Las Cruces, NM Elena Rios, MD, MSPH President, NHHF, NY Jo Ivey Boufford, MD President, New York Academy of Medicine Gary Pelletier Director, Pfizer Helpful Answers Miguel Sanchez, MD Professor, Dermatology NYU School of Medicine Yasmine Winkler, United Healthcare

National Hispanic Medical Association – what do we do? Serve as a resource for White House, Congress, and Federal agencies on health policies and programs Support Hispanic physician leadership at national and state level Provide networking opportunities for advancement of Hispanic health

National Hispanic Medical Association Programs Resource:  Federal government Capitol Hill Briefings on Hispanic health Issues to eliminate health disparities (10/12) Develop cooperative agreements with Federal agencies Nominate members to Federal advisory commissions  Private sector Provide technical assistance to corporate health programs Nominate members to corporate boards Leadership Development:  NHMA Leadership Fellowship  NHMA Resident Leadership Program  National Hispanic Health Professions and Medical Societies Leadership Institutes Networking:  NHMA 16 th Annual Conference, Apr , 2012  Regional Health Reform Events – NYC, Los Angeles, Miami, DC, El Paso.

NHMA Network 2011 Hispanic State and Regional Medical Societies National Hispanic Health Professional Leadership Network  National Association of Hispanic Nurses  Hispanic Dental Association  Latino Caucus of APHA  Latino Forum of Health Executives  Assoc of Hispanic Health Execs of NY  Regional Mental Health Associations Latino Medical Student Association

National Hispanic Health Foundation – what we do? Education Research Support Hispanic health professionals and health professional students

NHHF Selected Programs Education  Kellogg Foundation Child Obesity in CA and NY  White Papers Research  Policy research, eg. Increasing Diversity for Title VII at HRSA, Summit Report supported by the Josiah Macy, Jr. Foundation  National Center for Hispanic Community Health Research (in progress) Training and Recruitment of Hispanic researchers Clinical Trials training and recruitment CA Hispanic Health Professional Student Scholarship  Casa Del Mar Hotel, Nov. 10 th Gala

How to contact NHMA & NHHF NHMA NHHF Portal Hispanic Health Professional Student Scholarship Galas  Santa Monica-Nov.10 th /NYC-Dec.1 st NHMA 16 th Annual Conference – “Innovations that Improve Hispanic Health” Washington, DC, Apr , 2012