Health Care Reform Through the Cancer Lens State and Private Sector Reforms for Hispanic Healthcare Edward E. Partridge, MD National Board President American Cancer Society National Hispanic Medical Association 15 th Annual Conference March 19, 2011

Through its Body of Work, the American Cancer Society is the leader in the global effort to eliminate cancer disparities among ALL populations …Because Cancer Doesn’t Discriminate!

The Case For Equity

Population Distribution by Race/Ethnicity, U.S. (2009) Source: U.S. Census Bureau, CPS: Annual Social and Economic Supplements

Uninsured Hispanic, under age 65: US, (3 Year Annual Average) Source: National Health Interview Survey (NHIS)

Leading Causes of Death, Among Hispanics by underlying cause, ages 18+: US/State, Source: The National Vital Statistics System Death Rates

Chronic conditions, ages 18+: US, Hispanic Population Source: National Health Interview Survey (NHIS) Percent % % % % % % % % % % % %

Incidence and Death Rates for All Cancers Combined among Hispanics Source: Cancer Facts & Figures for Hispanics/Latinos, American Cancer Society, Atlanta, GA

What We Know  Suffering and death could be prevented through more systematic methods of health screening and early detection.  A disproportionate number of Hispanics and other medically underserved populations are not fully benefiting from available resources.  Underlying causes of cancer disparities are interrelated and complex

Causes of Cancer Disparities Can be linked to social determinants of health, such as but not limited to:  Inequalities in access to care,  Language barriers,  Unhealthy environments, and  Discrimination

Disparities In Outcomes Are Related With: 1.Treatment… Hispanics and other minority groups are more likely to be living in poverty and are less likely to receive recommended treatment. 2.Screening… Hispanics and other minority groups are more likely to be uninsured and are less likely to receive timely screening. 3.Incidence… Hispanics and other minority groups are more likely to be diagnosed with later-stage preventable cancers. 4.Mortality… Hispanics and other minority groups are more likely to earn a lower income and are more likely to die from preventable cancers. 5.Risk Factors… Hispanics and other minority groups are more likely to report cancer related risk factors.

Focus Areas:  Prevention and Early Detection - increasing access to cancer screening, diagnosis and treatment  Information – data collection and evaluation  Quality of Life - Serving with impact  Research Through…  Advocacy  System Policy and Practice  Cancer Information and Empowerment  Resource Navigation  Communities of Support  Research How Do We Address Disparities?

Lessons Learned Task of Eliminating Disparities – Daunting or not? 1. Technical advances to be delivered not so complex -- tobacco control -- age appropriate screening -- healthy diet, physical activity 2. Populations most at risk -- geographically focused 3. Patient Protection and Affordable Care Act -- eliminates barrier to access 4. Communities most at risk eager to engage

Easy to More Difficult Changes Easy1. age appropriate screening 2. tobacco control 3. high quality treatment for all Difficult4. healthy eating, physical activity

Community Engagement Create trust Eliminate bias Share power

Strategies to Improve Cancer screening among Hispanics  Effective communication initiatives are needed to close this knowledge gap.  Social support may improve participation in screening.  Local outreach programs and culturally targeted interventions by lay Hispanic health advisors along with physician encouragement are also effective strategies for improving cancer screening participation rates

A number of provisions in the Affordable Care Act will help reduce these disparities and increase access to culturally competent care for Hispanics

How Does the Patient Protection and Affordable Care Act Help?  Expanding Coverage  Private insurance  Medicaid  Medicare  Enhancing Prevention  Improving Quality of Life

Implementation Expanding Coverage: Medicaid  Expands coverage to all persons under 133% FPL (up to $29,327 for a family of four)  Simplifies enrollment into Medicaid  Incentive programs to encourage participation in chronic disease preventive programs  Increases access to cessation drugs

Implementation Addressing Disparities  Qualified health plans must provide materials in appropriate languages  Strategy for increased access to language translation services

Implementation: State activity  Contracting of high-risk pools  Creation of the exchanges  Creation of state-based ombudsman programs  Protecting mandates and Breast and Cervical program until at least 2014

YOUR ROLE

Implementation: To do list  Learn what’s in the bill  Identify state publications that will update you  Develop a relationship with your State and Local officials, i.e. State Insurance Commissioner and Medicaid Director

Implementation: Resources ACS CAN Web page:

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