2. Minority Fellowship Program: Challenges and Opportunities Under Healthcare Reform Miriam E. Delphin-Rittmon, Ph.D MFP 40 th Anniversary Celebration and Grantees Meeting April 23-24, 2013

3. Healthcare landscape quickly changing as a result of ACA MFP aligns well with key provisions of ACA and priorities of HHS Disparities Action Plan Alignment opens program to challenges and opportunities for remaining current and in step with HHS policies MFP-Youth Expansion creates additional opportunities MFP and Healthcare Reform

4. Overview Disparities Related Provisions of the Affordable Care Act HHS Secretary’s Action Plan to Eliminate Disparities Challenges and Opportunities for MFP Discussion

5. 5 Federal Efforts: Health Reform and Disparity Populations The Affordable Care Act (ACA) brings reforms to the insurance industry; increases affordability; increases access; strengthens Medicare; promotes health equity.

6. 6 Selected Health Reform Provisions Expanded Coverage Eliminates Discrimination Increase in Workforce Diversity, Use of CHW Improvement in Data Collection Supports Healthcare Integration Benefits of ACA

7. 77 Expanded Coverage Medicaid coverage will be expanded to cover more legally present, non-elderly children and adults: Almost 1.3 million Asian Americans 90,800 Native Hawaiians and other Pacific Islanders 4 million African Americans 7 million Latinos 277,800 American Indians FamiliesUSA, 2010

8. 8 Health Reform and Disparity Populations Eliminates discrimination related to pre-existing conditions Without ACA, nonelderly that have a condition that can be denied coverage: 23.4% African Americans 25.9% American Indian/Alaska Natives 11.7% Asian Americans; 14.5% NHOPI (14.5%) 16.9% Latinos Increase in Workforce Diversity ACA funds scholarships, grants and loan repayment programs for: HC professionals who serve minority and underserved populations Continuing education support for those HC professionals Grants for minority faculty members and health professionals FamiliesUSA, 2010

9. 9 Health Reform and Disparity Populations Support to Community Health Workers Grants provide support for community health workers through funding for the training, supervision, and support of community health workers People of color: high users of community health centers that employ CHWs Increased focus on promotoras Capacity building in primary care including funding for training in cultural competence and health literacy FamiliesUSA, 2010

10. 10 Health Reform and Disparity Populations Improvement in Data Collection Need for coordination, documentation, and analysis of data to identify the health disparities by race and ethnicity ACA Section 4302, requires data to be collected and reported by race, ethnicity, sex, disability and primary language for participants. To be used in national population health surveys. The law also requires any data standards published by HHS comply with standards created by the Office of Management and Budget (OMB). HHS on Oct. 31, 2011, published final standards for data collection on race, ethnicity, sex, primary language and disability status, as required by Section 4302 of the Affordable Care Act Section 4302 of the Affordable Care Act http://www.minorityhealth.hhs.gov/templates/content.aspx?ID=9227&lv l=2&lvlID=208http://www.minorityhealth.hhs.gov/templates/content.aspx?ID=9227&lv l=2&lvlID=208 FamiliesUSA, 2010

11. ACA Provision 4302: Final Standards Published by HHS Ethnicity Data Standard Categories Are you Hispanic, Latino/a, or Spanish origin? (One or more categories may be selected) ____No, not of Hispanic, Latino/a, or Spanish origin ____Yes, Mexican, Mexican American, Chicano/a ____Yes, Puerto Rican ____Yes, Cuban ____Yes, another Hispanic, Latino, or Spanish origin 11

12. What is your race? (One or more categories may be selected) ____ White ____Black or African American ____American Indian or Alaska Native ____ Asian Indian ____Chinese ____Filipino ____Japanese ____Korean ____Vietnamese ____Other Asian ____Native Hawaiian ____Guamanian or Chamorro ____Samoan ____Other Pacific Islander These categories are part of the current OMB standa rd These categories roll-up to the Asian category of the OMB standard These categories roll-up to the Native Hawaiian or Other Pacific Islander category of the OMB standard 12

13. 13 Health Reform and Disparity Populations Support for Healthcare Integration Integrated and collaborative care  optimize recovery outcomes, improve cost effectiveness Bi-directional Primary and Behavioral Health Care Integration: multiple models Cross-training for both behavioral health and primary health care workers Health Home Provision: people of color less likely to have consistent health provider; receive care via child welfare, emergency departments; provision targets chronic disease conditions, including mental illnesses FamiliesUSA, 2010

14. 14 Call To Action: A Federal Policy Driver As a provision of the ACA Offices of Minority Health established in six HHS Agencies HHS agencies are required to assess the impact of policies and programs on disparities Improve language access in Medicaid, promote healthcare interpreting profession Increase diversity and cultural competence of healthcare workforce

15. Challenges and Opportunities Impact assessment - accountability – Consistent with HHS priority of assessing impact and outcomes, will be important to track specific outcomes as they relate to goals of the program – What percentage of fellows are working with in underserved communities post fellowship? – What percentage are engaged in research? What do the career trajectories of fellows look like over time? – How is outcome information used to inform implementation of MFP? **

16. Challenges and Opportunities Language Access – Given the HHS Priority of addressing language access, how can MFP continue to address language access? – What recruitment strategies can be put in place, or expanded, to attract bilingual and bicultural applicants? – What data is collected regarding the language competencies of fellows? – Findings can inform recruitment

17. Challenges and Opportunities Diversity and Cultural Competence – What strategies can MFP implement to continue to prepare fellows to work with the changing healthcare populations? – Newly insured individuals released from prison? Individuals who have experienced trauma? Refugee populations? – How can fellows be assisted in their preparation for working in primary care settings?

18. Challenges and Opportunities Cross-disciplinary Grantee Planning – Six disciplines could partner to develop recommendations for the optimizing behavioral health service delivery for underserved populations in primary care settings – Develop and test models for involving service users in trainee and provider cultural competence education and training programs – Develop strategies and recommendations for addressing language access in integrated care settings

19. Challenges and Opportunities Workforce Expansion - FY 2014 MFP-Youth – Aims to increase the number of culturally competent behavioral health providers who provide clinical services to underserved minority children, adolescents and transition-age youth (16-25) – Working through existing MFP structure will expand the focus to Master’s level trainees in psychology, social work, professional counseling, MFT and nursing. – Creates opportunities for mentoring of master’s level trainees

20. Challenges and Opportunities What challenges or opportunities do you anticipate as a function of the ACA or other Secretarial priorities? What challenges or opportunities might arise with the MFP-Y Expansion? Questions and Discussion