Category Archives: Health reform
For the last several years there’s been a bit of a tradition at the annual meeting of the Association of State and Territorial Health Officials (ASTHO), with the incoming president introducing a year-long “President's Challenge” to focus the attention of state health officers on a critical national public health issue.
José Montero, MD, outgoing president of ASTHO and director of the New Hampshire Department of Health and Human Services, chose the reintegration of public health and health care. The starting point for the challenge was a report by the Institute of Medicine, Primary Care and Public Health: Exploring Integration to Improve Population Health. In his announcement, Montero emphasized the need to take a systems approach to health care transformation in order to achieve lasting improvements in population health.
Throughout the past year, both state health departments and other public health organizations have added their integration projects to a project list maintained by ASTHO. This includes the State of New Hampshire Department of Public Health, which has collaborated with a community health center network and others to use electronic health records to link providers and tobacco quitline services, with the goal of cutting smoking rates.
>>Follow our ASTHO Annual Meeting coverage throughout the week.
Just ahead of the 2013 ASTHO annual meeting, NewPublicHealth spoke with Montero about the importance of the challenge he put forward for his fellow state health officers and next steps.
NewPublicHealth: What participation have you seen by the state health departments in your President's Challenge on reintegration of public health and health care?
José Montero: The specific metric that I used was to have states and the District of Columbia send stories that illustrate levels of partnership and integration. During the past year, the visibility of the topic has grown dramatically. In addition, ASTHO has an ongoing partnership that has brought together more than 50 different organizations for the same purpose. We meet regularly, working together on how to advance the agenda of better coordination and integration, and every day we identify new people who want to participate, and I think that has been an amazing result. I don’t want to claim that all of this is because of the ASTHO initiative. There were a lot of things that were out there already. But this was a timely call, and all of those who were working on it are joining efforts to make it happen.
A recent survey by the American Institute of Certified Public Accountants (AICPA) found that more than half of about 1,000 American adults polled could not correctly define common health insurance financial terms such as premium, deductible or copay. That’s concerning considering that opening day to sign up for health insurance under the Affordable Care Act is October 1. “Half of Americans would fail health insurance 101,” said Ernie Almonte, CPA, chair of the Institute’s National CPA Financial Literacy Commission. “That’s critical insight as consumers prepare to make important decisions with implications for both their physical and fiscal well-being,” says Almonte. “Americans need to take time in the coming weeks to familiarize themselves with key terms and assess their needs so they make the best decisions for their health and financial situations.”
Knowing what the terms mean can help people make informed choices when they sign up for health insurance. For example, a copay is the out of pocket cost to a patient for a health service. Choosing a plan with lower co-pays can help individuals save money, according to the Institute.
The survey found that people with high school diplomas or less education were significantly more likely than those with a college education to be unable to define financial health terms. The survey also found that 41 percent of responders said they were not at all knowledgeable about the Affordable Care Act; just under half of responders said they thought they were somewhat knowledgeable.
A new commentary by Dr. Georges Benjamin, president of the American Public Health Association, looks at how the Affordable Care Act (ACA) is impacting public health and how it will create new opportunities for better health for more people across the nation.
The Affordable Care Act affects all 10 essential public health services, writes Dr. Benjamin in the commentary published by the Institute of Medicine. Dr. Benjamin says the ACA will influence the public health system in three major ways:
- Expanded insurance coverage will impact how public health departments offer clinical services: Governmental public health agencies currently providing clinical services may transfer cases to the private sector, such as routine childhood vaccinations.
- New care delivery models offer opportunities to integrate public health principles and enhance requirement for hospitals to define and utilize beneficial community efforts: Public health practitioners will have the opportunity to share their expertise on assessing the health of populations, implementing community and broad-based solutions, and evaluating the outcomes of these solutions.
- Public health services can reach more people: Programs and services such as, home visiting and other maternal child health programs and specialized behavioral health services will be made available to the general population, in addition to programs on prevention and protection.
“There is a lot to learn as we make this transformation to achieve better health and better value for our health investment. A transformed public health system is an essential element of that change,” Dr. Benjamin comments in the report.
>>Read the commentary.
On July 12, a standing room only crowd of local health leaders took part in a 2012 NACCHO Annual Meeting session on the implications of the recent favorable Supreme Court ruling on the Affordable Care Act (ACA). As the law faces continued uncertainty amid renewed legal challenges and the forthcoming national election, proponents were urged to continue educating stakeholders about the work of public health. Laura Hanen, who leads government and public affairs for NACCHO, advised that public health needs increasingly to have a seat at table in health policy decision making at the national, state and local level–or risk being on it.
Lillian Shirley, director of the Multnomah County (Oregon) Health Department and immediate past president of NACCHO, urged health department leaders in attendance that in addition to being more vocal about the return on investment of public health, they need be more forthright about the added value they can bring to local decision making in areas such as demonstrating evidence, measuring and evaluating, spreading best practices, and collecting data that can inform policy decisions. “We have been invited to be part of the solution,” Shirley said. “We shouldn’t be shy about the skills we bring.”
During the question and answer period, many participants voiced confusion they were feeling in the early stages of the law’s implementation. One raised the question of whether to continue to focus on clinical services, an issue that many health departments are grappling with now amidst budget cuts and increased partnership with health systems. Another participant asked whether local health departments will have to address complaints from residents of the communities they serve if some parts of the law are not upheld, such as a requirement that many companies establish dedicated break rooms and break time for nursing mothers. Hanen said that the answers to such questions will in many cases be dictated by policies set at the local level, and advised health department leaders to continue to be assertive–but cautious at the same time. “We can’t predict [everything] at this point.”
>>View a list of resources compiled by the Robert Wood Johnson Foundation regarding the Supreme Court decision on the ACA.
>>Check out other outlets to follow with analysis of the decision.