PHSKC Health Dialogue: New Opportunities for Public Health, Workforce and Innovative Pilot Projects under Health Care Reform Charissa Fotinos, MD Chief Medical Officer June 16, 2010

2 Presentation Overview Public Health provisions Workforce provisions Innovative Pilot & Demonstration Projects How to maximize new provisions & innovative opportunities

3 Key Public Health & Prevention Provisions Prevention and Public Health Fund $15 Billion/10 years $500 million/FY2010, ramping up to $2 billion in FY2015 and each year thereafter Provides for expanded and sustained national investment in prevention and public health programs authorized by the Public Health Service Act for prevention, wellness, and public health activities, including prevention research and health screenings National Prevention, Health Promotion & Public Health Council (2010) Comprised of high-level federal officials led by the Surgeon General Charged with developing the National Prevention Strategy (to be released in 2011) Makes recommendations to the President on federal policy changes needed to achieve national wellness, health promotion and public health goals The President will appoint a 25-member non-federal Advisory Group on Prevention, Health Promotion, and Integrative and Public Health to advise the Council.

Selected Public Health & Prevention Con’t First dollar coverage of clinical preventive services ▫ All new health plans required to cover proven preventive services without cost-sharing (2010) ▫ Medicare coverage of proven preventive services without cost-sharing begins (2011) ▫ Medicare begins covering an annual wellness visit with personalized prevention plan services at no cost-sharing (2011) $25 million childhood obesity demonstration project funding begins (2010) $100 million appropriated for Medicaid incentive programs for prevention of chronic Diseases (2011) A five-year national, public education campaign focused on oral healthcare prevention and education is authorized (2012) School-Based Health Centers ▫ $50 million available FY10-13 for renovation/construction ▫ Grant program authorized but unfunded

5 Examples of Workforce Provisions Public Health Workforce Recruitment and Retention Programs (2010) ▫ $195 million/year for loan repayment /$30 million/year for mid-career training ▫ Establishes a public health workforce loan repayment program ▫ Allied health workforce recruitment and retention programs; Training for mid-career public health professionals. ▫ Subject to funding through Congressional appropriations Public Health Training for Mid-Career Professionals (2010) ▫ $60 million in 2010 for scholarships to support mid-career public and allied health professionals Ready Reserve Corps within Commissioned Corps (2010) ▫ For $5 million for recruitment and training and $12.5 million for the Ready Reserve Corps Health Workforce Development Grants (2010) ▫ Grantees: state workforce investment board and high ed institutions ▫ 1 and 2 year planning grants ▫ $150 million in FY 2010 Grants to Develop/Expand Primary Care Residencies (2010) ▫ Amends Title VII primary care training grants (FM, IM, Peds) ▫ Authorizes $125M for 2010; Awards for five years

Workforce Provisions Con’t National Health Care Workforce Commission (2011) ▫ Review and assess health care workforce capacity Epidemiology-laboratory Capacity Grants (2010) ▫ To state and local health departments to improve surveillance and response to infectious diseases ▫ $190 each year, Grants to Promote the Community Health Workforce (2010) ▫ Use of community health workers in underserved communities Preventive Medicine and Public Health Training Grant Program (2011) ▫ Reauthorizes grant program for preventive medicine and public health residencies ▫ Increase in authorization to $43 M in 2011 Family Nurse Practitioner Training Demonstration Program (2011) ▫ 3 year grants to FQHCs and Nurse Managed Health Centers for 1 year training program for primary care NPs ▫ Grants up to $600K per year Increased Medicaid Payments to PCPs (2013) ▫ For primary care services by PCPs at no less than 100% of Medicare rate in 2013 and 2014

7 Innovative Pilots & Programs Community Transformation Grants (2010) ▫ Competitive grants to state and local governmental agencies and community-based organizations to reduce chronic disease rates, address health disparities, and develop a stronger evidence-base of effective prevention programming; 20% of the grants are targeted to rural and frontier areas Healthy Aging, Living Well (2010) ▫ CDC will administer competitive grants to health departments and Indian tribes for 5-year pilot programs to provide public health community interventions, screenings, and clinical referrals for year olds ▫ Community based public health interventions include efforts to improve nutrition, increase physical activity, reduce tobacco use and substance abuse, improve mental health and promote healthy lifestyles Subject to funding through Congressional appropriations Home Visitation for Families (2010) ▫ $1.5 billion over 5 years (Mandatory funding; $100 M/FY10) ▫ State grant program for evidence-based early childhood home visitation ▫ Measures improvement in maternal and child health, childhood injury prevention, school readiness, juvenile delinquency, family economic factors, and coordination with community resources Diabetes Prevention Program (2010) ▫ National diabetes prevention program targeting adults at high risk for diabetes ▫ Grantees: state and local health departments, tribal organizations, CBO networks, academic institutions

8 Innovative Pilots & Programs Con’t Medicare Shared Savings Demonstration Program: ACOs (2012) ▫ A program to share savings with ACOs that take responsibility for the cost and quality of care and services for a Medicare patient population Medical Home Pilot: Medicaid (2011) ▫ State option to enroll Medicaid beneficiaries with chronic conditions into a health home ▫ Funding for planning grants not to exceed $25M; 90% FMP for two years Medical Home Pilot: Medicare (2013) ▫ Establish and fund community health teams to support development of medical homes for person with chronic conditions Access to Affordable Care 3 year Demonstration Project ▫ Grants up to $2M to 10 states for access to comprehensive care to the uninsured at a reduced rate Health Disparities/Data Collection (2011) ▫ Requires the collection and reporting of data on race and ethnicity, gender, geographic location, socioeconomic status (including education, employment or income), primary language, and, disability status

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10 Questions to think about How can our community work together to maximize new provisions & innovative opportunities What type of structural changes do we need to make to effectively use of these funds