1. Presenters: Dennis Andrulis, PhD, MPH Senior Research Scientist, Texas Health Institute Associate Professor, Univ. of Texas School of Public Health & Nadia Siddiqui, MPH Senior Health Policy Analyst, Texas Health Institute Presentation to the National Health Plan Collaborative November 8, 2012 Advancing Racial/Ethnic Health Equity Through the Affordable Care Act: Understanding the Progress of Health Plans

2. Objective To monitor and assess implementation progress of ACA’s provisions specific to advancing racial/ethnic equity in health and health care. We are tracking 60+ provisions specific to or with relevance for racial/ethnic health disparities across the following topics: (1) Health insurance & exchanges; (2) Health care safety net; (3) Workforce support and diversity; (4) Data, research and quality; and (5) Public health and community prevention programs. Funded by Kaiser Permanente, W. K. Kellogg Foundation and The California Endowment 2

3. History We have been monitoring and analyzing health care reform from a health equity lens since shortly after the inauguration of President Obama in 2008 Select references to our work: Major Report, entitled Patient Protection and Affordable Care Act of 2010: Advancing Health Equity for Racially and Ethnically Diverse Populations (Supported by the Joint Center for Political and Economic Studies) Article in Disparities issue of Health Affairs, October 2011, entitled “Health Reform Holds Both Risks and Rewards for Safety-Net Providers and Racially and Ethnically Diverse Patients” 3

4. Intended Outcome & Value Report to be issued in March 2013, coinciding with the 8 th National Conference on Quality Health Care for Culturally Diverse Populations First-of-a-kind, practical and user-friendly report offering a snapshot on: Status and progress in addressing diversity/equity objectives through health plans and the exchanges; Models and promising practices from across the country; Early indicators of outcomes and lessons learned; and Guidance, including specific process and strategies, for effectively meeting requirements. 4

5. Health Plan & Equity Provisions 1. Culturally and linguistically appropriate summaries of benefits and uniform glossaries [sec. 1001] 2. Culturally and linguistically appropriate claims appeal processes [sec. 1011] 3. Ensuring that materials such as enrollment data, claims data, and financial disclosures are in plain language [sec. 1311(i)] 4. Providing outreach and education in a culturally and linguistically appropriate manner [sec. 1311(i)] 5. Planning for market-based incentives for reducing health care disparities [sec. 1311 as amended by sec. 10404] 6. Collecting data on race, language and ethnicity [sec. 4302] 5

6. Process for Review & Analysis Conducting a review & analysis of: Federal rules and guidance related provisions 1-6; Peer-reviewed research & policy reports; Health plan programs related to diversity & equity; Complemented by key informant interviews with: Federal and state government officials; National experts and advocates; Health plans; and Community representatives. 6

7. Questions for Health Plans 1. What progress has your health plan made to implement the cultural and linguistic requirements outlined in provisions 1-6 on slide 5? 2. Are there existing equity, diversity or cultural competence programs that may inform the implementation of the above requirements in ACA? 3. What challenges is your health plan facing in implementing these requirements? 4. Are there any early indicators of successes, failures, or lessons learned? Any models or best practices? 5. What guidance would you provide to other health plans tackling these requirements? 6. What related research, reports or initiatives would you recommend we review to further inform this assessment? 7

8. Confidentiality of Information Information collected through interviews will be kept confidential and only accessible by select Project Staff. Information you provide will be reported anonymously and/or aggregately with other plans. The only information that will be attributable to a health plan will be: Programs and findings in the public domain (e.g., in published research or literature); and Anything you give us permission to cite in our reports. We plan to list all key informants and their respective organizations at the end of the report in an Appendix. Please let us know if you do not wish to be listed here. 8

9. Next Steps Please indicate to Natalie Slaughter at AHIP your interest in participating in a key informant interview with us. Please indicate your preferred method for providing information: One-on-one phone interview; or E-mail questionnaire. We hope to complete phone/e-mail interviews by December 14, 2012. 9

10. Contact Information Should you have any questions or require additional information, please feel free to contact: Nadia Siddiqui Senior Health Policy Analyst Texas Health Institute E-mail: nsiddiqui@texashealthinstitute.orgnsiddiqui@texashealthinstitute.org Phone: 281-692-2420 (9am – 1pm CST) 10