Health Education Specialists in the Changing Healthcare System M. Elaine Auld, MPH, MCHES Chief Executive Officer, SOPHE SOPHE Advocacy Summit October 15, 2016
2016 ACHI Conference Today s Objectives: Articulate the latest developments related to the Affordable Care Act (ACA) and the health education profession. Describe opportunities for health education specialists in implementing ACA in various settings. Identify knowledge and skills needed by health education specialists in the post-health reform environment.
Quick Audience Poll Your familiarity with ACA provisions Excellent, moderate, somewhat, fair, poor Your Attitudes toward ACA
90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 38.8% 35.1% 59.6% 11.4% 56.4% Favorable Familiar Success at Increasing Insured 28.5% 30.7% 24.1% 24.3% Liberal Political View Moderate Somewhat Very Health Education Specialists Knowledge, Attitudes, and Perceptions of the Patient Protection and Affordable Care Act, Jessica Strong, Carl L. Hanson, Brianna Magnusson, and Brad Neiger. Health Promot Pract, March 2016; vol. 17, 2: pp. 226-234.
ACA signed into Law March 2010
ACA Major Provisions Triple Aim Preventative Services Healthcare Workforce
Challenges of Achieving ACA Goals Burden of chronic disease Social determinants of health Changing population demographics Lack of population health literacy and numeracy Size, composition, skills & distribution of health work force Bridging worlds of health care and community health
Health Education Specialists Demand for health educators to increase by more than 21%, almost twice as fast as all other occupations (11%). US Department of Labor AREAS OF RESPONSIBILITY 1. Assess Needs, Assets, Capacity 2. Plan Health Education 3. Implement Health Education 4. Conduct Evaluation & Research 5. Administer & Manage Health Education 6. Serve as a Resource Person 7. Communicate & Advocate
Health Education Specialists Roles in ACA Hospitals Clinics Schools Worksites Health Depts Non- Profits
Health Education Specialists at Work in ACA
Healthcare Patient & family health coaching on health issues Patient-centered on diabetes Connections to non-clinical resources, e.g. housing, food Resources for Spanish speaking patients Samantha Gonzalez, MPH, CPH Care Manager and Patient Health Educator, Salud Family Health Centers
Third Party Reimbursement CMS Ruling 2014 - Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, (CMS-2334-F) Allows state Medicaid programs to reimburse for preventive services provided by professionals that may fall outside of a state s clinical licensure system, as long as the services have been initially recommended by a physician or other licensed practitioner. CHES/MCHES linked to some disease specific testing, reimbursement (e.g. diabetes educator, asthma educator)
CDC Diabetes Prevention Program Structured program in person or online developed to prevent type 2 diabetes. Includes dietary coaching, lifestyle intervention, and moderate physical activity, behavior change strategies for weight control. After 16 core sessions, less intensive monthly follow-up Primary goal is at least 5% average weight loss among participants. A trained lifestyle coach leads the program In March 2016, HHS announced this program would be reimbursable; moving forward for implementation January 2018 Developed & tested in collaboration with YMCA; significant opportunities for health education specialists
Healthcare - Patient Navigators Martin Logo, PhDc, MPH Director of Health Promotion, The Project of the Quad Cities Emily Williams, MS Navigator and Health Educator, Access Care and Resources for Health
Healthcare: Community Benefit Expanded requirements under ACA Nonprofit hospitals must provide organized and sustainable community benefit programming to address health disparities in their communities Must demonstrate a commitment to community outreach in response to an identified need. Must conduct a community health needs assessment and program planning
Healthcare Community Benefit Oversees that hospitals target their programming towards the identified needs of their local communities through: Tri-annual community health needs assessment (CHNA), an implementation strategy based on the CHNA, Yearly report on how the hospital has addressed the identified needs. Staff training on CHNA, provide monitoring and evaluation consultation, analyze data, and represent City of Hope in the community Nancy Clifton-Hawkins, MPH, MCHES Community Benefit Manager City of Hope, Los Angeles
Worksite Determines optimal approaches for population disease management and preventive care Collaborates with the benefits department to ensure health plan partners are accountable for health improvement and cost reduction Supervises the internal Health and Wellness team in designing offerings Analyzes data for program effectiveness. Michael Staufacker, MA, MCHES Director, Health Management, Emory University
Schools Directs development of technical assistance, resources and training for school based health centers Manages staff to implement programs Directs program for annual school based health care convention Assists with fundraising, outreach to public and private partners Helps identify new payment & reimbursement models for services Andrea Shore, MPH, Director of Programs, School-Based Health Alliance
Knowledge & Skills Needed in ACA Implementation Conduct Evaluation and Research Related to Health Shared Risk/ Benefit Assess Needs, Assets & Capacity for Health Improve Quality Serve as a Health Education Resource Person Performance Reporting EHR Communicate and Advocate for Health Plan and Implement Health Education Coordinate Care Communic ation and Access Assess Needs, Assets & Capacity Integration with Community Services Care Plans Patient Registries, Tracking Administer and Manage
Knowledge/Skills Required Program planning (community assessment skills, budgeting, strategic planning Behavioral change, motivational interviewing Cultural competency skills Communication skills (presenting data to target audiences so it is accessible, meaningful and culturally relevant) Community & partner engagement Policy and systems change; advocacy Ability to work across disciplines, effective collaboration skills Evaluation, analyzing and & interpreting data
SOPHE Advocacy Resources www.sophe.org Stories from the Field White Paper on ACA Medicaid Reimbursement Toolkit Educating State Policymakers Guide Resolutions on many important topics in school & community health and health equity www.sophe.org
Summary Health education specialists are playing a vital role in ACA implementation to improve health equity Opportunities at individual, systems levels in health care, schools, worksites, & communities Application of core health education competencies across all settings; value added of HES Services are being reimbursed 1-1, but also as part of health care team Trends in reimbursement continuing to change, rapid transformation
Thank You Stay tuned post election 2017!! Elaine Auld eauld@sophe.org