Health Care Consortium ACA Readiness Project Presented to the Merced County Health Care Consortium October 23, 2014 Kathleen Grassi, R.D., M.P.H. Merced County Department of Public Health

In neighborhoods, in schools and ACA Readiness Project 2013 Public Health Department funded by: The California Endowment, Building Healthy Communities, Merced Blue Shield of California Foundation In neighborhoods, in schools and with prevention.  

Affordable Care Act Federal legislation signed into law in 2010 ACA Triple Aim Goals: Improve health care delivery; Improve the health of populations; and Reduce health care costs.

Why is the ACA Important? Too many people lack health coverage & care System focuses on treatment instead of prevention Inefficient delivery and payment system U.S. healthcare spending is unsustainable Low-ranking U.S. health outcomes

ACA Components

ACA Readiness Project Project Goals: Increase health care access through coordination of enrollment opportunities Assess local health care provider capacity Plan for service integration within and across health care institutions

Why Health Care Coverage? Merced County Estimated Uninsured and Projected Coverage Eligibility (prior to January 2014) Source: Pacific Health Consulting Group. Early Returns: First Year Covered California and Expanded Medi-Cal Enrollment Trends in Merced County, September 2014.

Medi-Cal Enrollment Results New Medi-Cal Enrollment in Merced County January 1 – June 30, 2014

Covered California Enrollment Covered California Enrollment Characteristics   Source: Covered California   Merced County (N=8,403) California Subsidy Eligibility Eligible for Subsidies 94% 88% Age Less than 18 4% 6% 18 to 25 13% 12% 26 to 34 16% 17% 35 to 44 18% 45 to 54 26% 24% 55 to 64 Ethnicity Latino/Hispanic 41% 28% October 2013 to April 2014

Health Care Services Sufficient primary care capacity currently Insufficient specialty care capacity historically Integration of care, especially PC/BH Development of prevention services

Project Deliverables Expanded Health Care Consortium Regular Informational Meetings Coordinated Outreach and Enrollment Efforts Development of Policy Briefs Harness the Momentum: From Care to Coverage Summit

Innovations Chronic Disease Self-Management “Now that I have coverage….” Integration across systems Health Information Exchange

Contribution to Premature Death 2002 Social circumstances 21% Environmental exposures 7% Behavioral patterns 57% Medical care 14% 2007 Adapted from: McGinnis JM, Williams‐Russo P, Knickman JR. “ The case for more active policy attention to health promotion”. Health Affairs

Health Impact Pyramid Source: Frieden, T. A Framework for Public Heath Action: The Health Impact Pyramid. Am J Public Health. 2010; April; 100(4): 590–595.

Partnerships to Improve Community Health Public Health Strategies Reduce Exposure to Tobacco and Second-hand Smoke   Increase Healthy Food Options Create Physical Activity Opportunity Expand Access to Chronic Disease Prevention resources Evaluation Measure the Impact of Public Health Strategies Communication Educate and Inform The Public, Partners and Policy–makers Partnerships Work together with residents, community and faith-based organizations, schools, agencies, and local government to create health promoting environments where we live, work, and play

ACA Readiness Project Thank you