1. Federal Policies to Eliminate Health Disparities Elena Rios, MD, MSPH President & CEO National Hispanic Medical Association March 1, 2005 CDC Chronic Disease Prevention Conference

2. NHDR & Policy Lifespan approach & State profiles Lifespan approach & State profiles Databases – link to new bill Databases – link to new bill 109 th : NIH, CDC Futures, Disparities/AHRQ/OMH and Health Professions, Pt Navigator – need advocacy 109 th : NIH, CDC Futures, Disparities/AHRQ/OMH and Health Professions, Pt Navigator – need advocacy Develop Interventions and tracking Develop Interventions and tracking Leadership development program Leadership development program – market prevention & target services with efficiency –Advocacy training for Health Disparities

3. Insurance Coverage Hispanics have the highest rates of uninsured of racial/ethnic groups, for all or part of 2000: Hispanics have the highest rates of uninsured of racial/ethnic groups, for all or part of 2000: –50% Hispanics under age 65 –37% 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 7.4 to 12.8 million. In the last decade the number of uninsured Hispanics increased from 7.4 to 12.8 million. Less likely to have insurance, even when offered through employer. Less 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. 2003 Source: The Commonwealth Fund, Nov. 2003

6. Profile of Uninsured Hispanics: Risk Factors 75% of uninsured Hispanics are classified as low- income (200% poverty level). 75% of uninsured Hispanics are classified as low- income (200% poverty level). Foreign-Born Hispanics have the highest uninsured rate, declines with length of time/generations in U.S. Foreign-Born Hispanics have the highest uninsured rate, declines with length of time/generations in U.S. Legal immigrants have a 5 yr wait for public insurance Legal immigrants have a 5 yr wait for public insurance For non-elderly Hispanics, 61% of those who primarily speak Spanish are uninsured, compared to 36% of those who primarily speak English. For non-elderly Hispanics, 61% of those who primarily speak Spanish are uninsured, compared to 36% of those who primarily speak English.

7. Quality of Care Patient Centered Spanish- speaking report greatest problems communicating with doctors and staff. Spanish- speaking report greatest problems communicating with doctors and staff. Access to interpreters limited, only 1% of those used are medically trained. Access to interpreters limited, only 1% of those used are medically trained. Lack of cultural competence training for physicians or in medical education. Lack of cultural competence training for physicians 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 5% of U.S. physicians). Low representation of Hispanics as physicians (only 5% of U.S. physicians).

8. NHMA and CHC 2002 National Hispanic Health Leadership Summit, San Antonio, TX Purpose: to build consensus recommendations to improve Hispanic health programs and policies at the Federal, State, private, and community levels for the next 5 years. Purpose: to build consensus recommendations to improve Hispanic health programs and policies at the Federal, State, private, and community levels for the next 5 years. Partners: Congress, DHHS, CDC, AHRQ, HRSA, NIH, RWJF, Ca Endowment, Amgen, Aventis, GSK, PhRMA, EPA, NHTSA, natl groups; 170 participants Partners: Congress, DHHS, CDC, AHRQ, HRSA, NIH, RWJF, Ca Endowment, Amgen, Aventis, GSK, PhRMA, EPA, NHTSA, natl groups; 170 participants

9. Summit Workgroups and Recommendations Health Access Health Access Cultural Competence and Language Cultural Competence and Language Health Professions Development Health Professions Development Community-Based Research Community-Based Research Chronic Disease Prevention & Management Chronic Disease Prevention & Management Public Health Emerging Issues – asthma, injury, immunizations, behavioral health Public Health Emerging Issues – asthma, injury, immunizations, behavioral health Women’s and Children’s Health Women’s and Children’s Health Bio-terrorism, US-Mexico Border Health, and Puerto Rico, environmental health Bio-terrorism, US-Mexico Border Health, and Puerto Rico, environmental health

10. Health Access Ensure that outreach, education, and enrollment efforts are community-based and target LEP. Ensure that outreach, education, and enrollment efforts are community-based and target LEP. Develop automatic re-enrollment in highly uninsured populations. Develop automatic re-enrollment in highly uninsured populations. Develop uniform financial screening tools for public programs and migrant insurance program. Develop uniform financial screening tools for public programs and migrant insurance program. Establish a web-based clearinghouse to promote research on underutilization and disenrollment of underinsured populations. Establish a web-based clearinghouse to promote research on underutilization and disenrollment of underinsured populations. Expand Medicaid/SCHIP -eligibility, parents and pregnant women, waivers, tax breaks for employers. Expand Medicaid/SCHIP -eligibility, parents and pregnant women, waivers, tax breaks for employers. Adopt universal healthcare policy. Adopt universal healthcare policy.

11. Cultural Competence and Limited English Proficiency Increase funding for the enforcement of Title VI of the Civil Rights Act. Increase funding for the enforcement of Title VI of the Civil Rights Act. Adopt CLAS standards devised by DHHS Office of Minority Health. Adopt CLAS standards devised by DHHS Office of Minority Health. Mandate and reimburse CC & LEP services in Medicare, Medicaid, SCHIP, med ed, clinics, etc. Mandate and reimburse CC & LEP services in Medicare, Medicaid, SCHIP, med ed, clinics, etc. Make CC & LEP core value of physicians, delivery systems – for quality care, patient centeredness. Make CC & LEP core value of physicians, delivery systems – for quality care, patient centeredness. Develop measures for CC & LEP performance, outcomes, interpreter training, and link to surveys. Develop measures for CC & LEP performance, outcomes, interpreter training, and link to surveys.

12. Health 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 Excellence programs, NIH career programs. –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 of federal programs. Short Term: Workforce Development Research and reform of federal programs. Long Term: Pipeline Development, eg. School District should establish a Health Professions Academy for Latino Students. Long Term: Pipeline Development, eg. School District should establish a Health Professions Academy for Latino Students. Sullivan Commission Report – Sept. 2004. Sullivan Commission Report – Sept. 2004.

13. Building Hispanic Community- Based Research Increase Hispanic leadership and participation with DHHS, state/private organizations. Increase Hispanic leadership and participation with DHHS, state/private organizations. Build community-based research infrastructure (Empowerment Zone, CAP, Reach, Exceed). Build community-based research infrastructure (Empowerment Zone, CAP, Reach, Exceed). Develop and facilitate pipeline to produce more Hispanic researchers. Develop and facilitate pipeline to produce more Hispanic researchers. Develop culturally appropriate research methods. Develop culturally appropriate research methods. Make partnerships with community organizations mandatory for funding of research on Hispanic populations. Make partnerships with community organizations mandatory for funding of research on Hispanic populations.

14. DHHS – Office of Minority Health Cultural Competence and LEP - CLAS Standards Cultural Competence and LEP - CLAS Standards Disparities in Health Initiative Disparities in Health Initiative Resource Center, Agencies & Regions Resource Center, Agencies & Regions Language Access Initiative - IT Language Access Initiative - IT Community-based Coalitions – Obesity Community-based Coalitions – Obesity Coordination of DHHS efforts – Medicare outreach to providers, community Coordination of DHHS efforts – Medicare outreach to providers, community Links to agencies thru Offices of Minority Health Links to agencies thru Offices of Minority Health

15. Health Disparities Bills Frist and Kennedy/Min.Caucuses Access to health care Access to health care Data Collection Data Collection Research Research Cultural Competence Cultural Competence Language Services Language Services Health Professions Diversity Health Professions Diversity Office of Minority Health Office of Minority Health

16. Health Disparities Kennedy/Min Caucuses Indian Health Indian Health Environmental Justice/Chronic Disease Environmental Justice/Chronic Disease Empowerment Zones Empowerment Zones New Scholarships for Health Students New Scholarships for Health Students CLAS Standards & Ctr for CLHCS CLAS Standards & Ctr for CLHCS COE – public hospitals COE – public hospitals Capacity – clinics Capacity – clinics OMH – FDA, CMS OMH – FDA, CMS

17. Cultural Competence Trends IOM Quality Chasm – CC=Quality with Patient Centeredness IOM Quality Chasm – CC=Quality with Patient Centeredness Standards adopted by LCME and RRCs Standards adopted by LCME and RRCs Evaluation and Tools being developed by NCQA, JACHO, AAMC, ACGME, LCME, NQF, and OMH Evaluation and Tools being developed by NCQA, JACHO, AAMC, ACGME, LCME, NQF, and OMH NHMA and OMH Forum – Sept. 9, 2004 NHMA and OMH Forum – Sept. 9, 2004

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

19. NHMA Programs Support for Physicians Support for Physicians –Nominations for Boards and Committees –Resume Bank/Job Search/Membership –Media Breakfasts with the CHC, NHTSA Leadership Development Leadership Development –NHMA Leadership Fellowship Promote Access to Quality Care Promote Access to Quality Care –Policy Development & Testimony –NHMA Press, Journal –NHMA Annual Conference Hispanic Health Policy Forums Hispanic Health Policy Forums –Hispanic Health Congressional Briefing Series

20. NHMA Strategic Assets National Hispanic Health Leadership Network »State and Local Medical Societies »NHMA National Advisory Committee »NHMA Physician Fellows Leadership Network »NHMA Resident Leadership Network »National Association of Hispanic Nurses (NAHN) »Hispanic Dental Association (HAD) »OMH Regional Offices & Contacts »Government Agencies »Foundations »Health Care Industry »NHHF Corporate Advisory Council »Hispanic-Serving Health Professions Schools

21. NHMA Accomplishments 8 Annual NHMA Conferences 8 Annual NHMA Conferences The NHMA Leadership Fellowship Program The NHMA Leadership Fellowship Program The NHMA Resident Leadership Program The NHMA Resident Leadership Program The NHMA Medical Student Mentorship Program The NHMA Medical Student Mentorship Program Cultural Competence GME Curriculum Projects Cultural Competence GME Curriculum Projects Uninsured & Quality Health Care Series Uninsured & Quality Health Care Series Capital Hill Briefing Series Congressional Earmark Health Policy Consultant to the Congressional Hispanic Caucus Health Policy Consultant to the Congressional Black Caucus Health Policy Consultant to the Senate Majority Leader Frist

22. NHMA Accomplishments Developed the Hispanic-Serving Health Professions Schools, Inc. Developed the Hispanic-Serving Health Professions Schools, Inc. Foundation Partnerships Foundation Partnerships –California Endowment –RWJ Foundation –Commonwealth Fund Cooperative Agreements Cooperative Agreements –USDHHS –US DOT, NHTSA Coalitions Coalitions –National Hispanic Health Coalition –REDEC, Out of Many One Media Breakfasts Media Breakfasts CHC/DHHS Hispanic Health Leadership Summit CHC/DHHS Hispanic Health Leadership Summit The National Hispanic Leadership Agenda Board Membership –Partnership for Prevention –Women’s Policy Inc. (Women’s Congressional Caucus) –AMA – MAC, Commission on Health Disparities –Pharma Adhoc Advisory Boards D. Satcher Task Force L. Sullivan Commission AMA Disparities Commission Senate Task Force U.S.-Mexico Binational Health Insurance Summit

23. NHMA Advocacy Projects Media Breakfasts with Congressmen and TV, Newspaper (English/Spanish) Management in major Cities Media Breakfasts with Congressmen and TV, Newspaper (English/Spanish) Management in major Cities Campaign with Congress, State Govt, Health Leaders in LA, Atlanta, DC on Hispanic Uninsured Campaign with Congress, State Govt, Health Leaders in LA, Atlanta, DC on Hispanic Uninsured Congressional Hispanic Health Briefing Series Congressional Hispanic Health Briefing Series Sacramento and Albany Leadership Forums and Receptions Sacramento and Albany Leadership Forums and Receptions Leadership Fellowship DC Institute Week Leadership Fellowship DC Institute Week Media Interviews, Press Conferences Media Interviews, Press Conferences National Partnerships and Campaigns – HHS, AMA, ACP, AAFP, ADA, ACS, Redes, Partnerships in Prevention Board, Pharma, etc. National Partnerships and Campaigns – HHS, AMA, ACP, AAFP, ADA, ACS, Redes, Partnerships in Prevention Board, Pharma, etc. Legislative Alerts - website Legislative Alerts - website

24. NHHF Programs Education Programs Education Programs –NHMA Leadership Fellowship –NHMA Resident Leadership Program –Hispanic Health Portal www.hispanichealth.info www.hispanichealth.info Research and Research Training on Hispanic Health Research and Research Training on Hispanic Health –Health Services Research Institutes Diversity in the Health Professions Diversity in the Health Professions –Hispanic Health Professional Student Scholarship »1st GALA DINNER – Marriott Marquis, NYC, Dec. 2 nd

25. NHMA --- leading the way to a healthier America For more information WWW.NHMAMD.ORG