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STATE Policymakers' GUIDE for ADVANCING HEALTH Equity

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STATE Policymakers' GUIDE for ADVANCING HEALTH Equity State Policymakers’ Guide for Advancing Health Equity Through Health Reform Implementation Carrie Hanlon and Brittany Giles u g u s t A 2012 II State Policymakers’ Guide For Advancing Health Equity Through Health Reform Implementation Copyright © 2012 National Academy for State Health Policy. For reprint permission, please contact NASHP at (207) 874-6524. This publication is available on the web at: www.nashp.org b o u t t h e A t i o na l c A d e m y f o r t A t e e A l t h o l i c y A N A S h P The National Academy for State Health Policy We work across a broad range of health policy (NASHP) is an independent academy of state topics including: health policymakers. We are dedicated to help- • Affordable Care Act and State Health ing states achieve excellence in health policy Care Reform and practice. A non-profit and non-partisan • Coverage and Access organization, NASHP provides a forum for con- • Medicaid structive work across branches and agencies of • Quality, Cost, and Health System Per- state government on critical health issues. Our formance funders include both public and private organi- • Long Term and Chronic Care zations that contract for our services. • Quality and Patient Safety To accomplish our mission we: • Population and Public Health • Insurance Coverage and Cost Contain- • Convene state leaders to solve problems ment and share solutions • Conduct policy analyses and research Our strengths and capabilities include: • Disseminate information on state policies • Active participation by a large number and programs of volunteer state officials • Provide technical assistance to states • Developing consensus reports through The responsibility for health care and health active involvement in discussions among care policy does not reside in a single state people with disparate political views agency or department. At NASHP, we provide a • Planning and executing large and small unique forum for productive interchange across conferences and meetings with substan- all lines of authority, including executive offices tial user input in defining the agenda and the legislative branch. • Distilling the literature in language use- able and useful for practitioners • Identifying and describing emerging and promising practices • Developing leadership capacity within states by enabling communication within and across states For more information about NASHP and its work, visit www.nashp.org Portland, Maine Office: Washington, DC Office: 10 Free Street, 2nd Floor 1233 20th Street, NW, Suite 303 Portland, ME 04101 Washington, DC 20036 Phone: [207] 874-6524 Phone: [202] 903-0101 FollowNational us Academy @nashphealth for State Health on Twitter Policy III Table of Contents Acknowledgements 1 Executive Summary 2 Introduction 4 Common Definitions 4 State Opportunities to Advance Health Equity through Health Reform Implementation 5 Table 1: Select ACA Provisions that Can Advance Health Equity* 5 Insurance Coverage 6 Health Care Delivery Reform 7 Data 8 Population Health 9 The NASHP State Health Equity Learning Collaborative 9 State Selection Process 10 Table 2: Health Equity Learning Collaborative States’ Workplan Priority Areas 11 State Action to Advance Health Equity using Select ACA and State Policy Levers 13 State Action Related to Coverage and Access 13 Exchange planning and leadership 13 Connecticut 13 Minnesota 13 Table 3: State Action through the Health Equity Learning Collaborative to Advance Health Equity using Select ACA and State Policy Levers 14 Consumer assistance and outreach in navigator programs 15 Arkansas 15 Data agreements and analysis to inform Medicaid enrollment and service provision 15 Virginia 16 Recommendations based on state actions to advance health equity through coverage and access strategies 16 State Action Related to Quality and Delivery Reform 16 Health and medical homes 17 Ohio 17 Minnesota 17 Hawaii 17 REL data collection guidelines and recommendations 18 Minnesota 18 Connecticut 19 Cultural competency training for Medicaid providers 19 Virginia 19 Medicaid managed care contracting and education 19 Ohio 20 Virginia 20 Using Data to Engage Communities in Policy Development in New Mexico 20 Recommendations based on state actions to advance health equity using quality and delivery system strategies 21 Sustaining State Efforts to Advance Health Equity 22 National Academy for State Health Policy State Policymakers’ Guide For Advancing Health Equity Through Health Reform Implementation IV Table of Contents, continued Federal Data and Tools to Support State Efforts 22 The Role of States in Facilitating Community Engagement 23 Cross-agency Collaboration 23 Equity as a Quality, Cost and Justice Issue 23 Lessons 25 Conclusion 27 Appendix: Health Equity Learning Collaborative In-Person Meeting Participants 29 Endnotes 31 National Academy for State Health Policy State Policymakers’ Guide For Advancing Health Equity Through Health Reform Implementation 1 Acknowledgements T he authors wish to thank the Aetna Foundation for its support of this project, specifically Dr. Gillian Barclay, Vice President of Programs, and Melenie Magnotta, Grants Manager. We also thank the many state officials who gave generously of their time to participate in the project’s learning collab- orative, attend the in-person meeting (see appendix for all meeting attendees), and/or provide substantive comments and guidance for this report, especially: • Arkansas Team Members: Marquita Little, Department of Human Services; Dr. Creshelle Nash, Fay W. Boozman College of Public Health; Dr. Michelle Smith, Department of Health; • Connecticut Team Members: Dr. Margaret Hynes and Leonard Lee, Department of Public Health; Rod- erick Bremby and Sylvia Gafford-Alexander, Department of Social Services; Matt Salner, Office of Health Reform and Innovation; Dr. Raja Staggers-Hakim, Connecticut Commission on Health Equity; • Hawaii Team Members: Dr. Christian (Kimo) Alameda, Karen Krahn, and Dr. David Sakamoto, Depart- ment of Health; Dr. Curtis Toma and Dr. Kenneth Fink, Department of Human Services; • Minnesota Team Members: Jeanne Ayers, José González, and David Stroud, Department of Health; Antonia Apolinário-Wilcoxon, Lauren Gilchrist, and David Godfrey, Department of Human Services; • New Mexico Team Members: Beth Leopold and Jeff Lara, Department of Health; • Ohio Team Members: Johnnie (Chip) Allen, Department of Health; Angela Dawson, Ohio Commission on Minority Health; Carol Ware, Department of Job and Family Services; • Virginia Team Members: Dr. Michael Royster and Dr. Diane Helentjaris, Department of Health; Rebec- ca Mendoza and Ashlee Harrell, Department of Medical Assistance Services; The following project advisory committee members provided helpful guidance and expertise throughout this project: Dr. Dennis Andrulis, Texas Health Institute and University of Texas; John Auerbach, Massachusetts Department of Public Health; Dr. JudyAnn Bigby, Massachusetts Executive Office of Health and Human Services; Carrie Bridges, Rhode Island Department of Health; Dr. Rosanna Coffey, Thomson Reuters; Scott Leitz, Minnesota Department of Human Services; Dr. Dena Ned, University of Utah; Dr. Ernest Moy, Agency for Healthcare Research and Quality; Cheryl Roberts, Virginia Department of Medical Assistance Services; and Dr. George Rust, Morehouse School of Medicine. Finally, this report benefited from the thoughtful input of and/or review by Jill Rosenthal, Alan Weil, Neva Kaye and Diane Justice of NASHP. Any errors or omissions are those of the authors. National Academy for State Health Policy State Policymakers’ Guide For Advancing Health Equity Through Health Reform Implementation 2 Executive Summary C 1 ompared to other populations, racial and ethnic minorities suffer from poorer health status, health 2 outcomes, health care quality, healthy lifestyle options and access to health care. The Patient Protection and Affordable Care Act (ACA) offers states multiple policy levers to improve the health status of and quality of care for racial and ethnic minority populations through broad delivery system reforms, targeted public health and community interventions and expanded health insurance coverage and access, as well as provisions specific to racial and ethnic minorities. This report draws from the experiences of teams of state officials in seven states that participated in the Health Equity Learning Collaborative, sponsored by the Aetna Foundation and administered by the National Academy for State Health Policy. It highlights select policy levers that can advance health equity, opportunities for state and federal agency collaborations to strengthen these efforts, and important lessons and considerations for advancing health equity. This report first discusses select ACA provisions and policy levers in four broad categories that can be used to advance health equity for racial and ethnic minorities: • Insurance coverage provisions, particularly the Medicaid expansion and development of insurance exchanges, to improve racial and ethnic minority populations’ access to needed health care services, as well as culturally and linguistically competent eligibility and enrollment services. • Health care delivery reform provisions related to the development and implementation of medical and health homes, federal opportunities to support delivery innovations, and support for developing a more diverse health care workforce. • Provisions related to data collection and standardization to analyze health care access and utilization by race, ethnicity and language. • Provisions
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