Affordable Care Act: Implications for Public Health and Physicians Empowering Future Physicians Conference October 27, 2012

1. Affordable Care Act:
Chicago Department of Public Health
Implications for Public Health and Physicians
Empowering Future Physicians Conference
October 27, 2012
Bechara Choucair, MD
Commissioner
Chicago Department of Public Health
@choucair on
Rahm Emanuel Bechara Choucair, MD
Mayor Commissioner

2. Presentation Outline
• Affordable Care Act Overview
• Connection with Public Health and Medical
Practice Foundations
• Effects of Health Reform on Public Health and
Physicians
• Healthy Chicago Agenda

3. Patient Protection and
Affordable Care Act (ACA)
• Signed into law on March 23, 2010
• Main Goals:
– Ensure more Americans have access to health
care
– Improve quality of healthcare
– Reduce costs of health care and budget deficit
– Increase preventive efforts

4. Patient Protection and
Affordable Care Act (ACA)
• Implemented through:
– Mandates
– Tax credits
– Required health insurance company policy
changes
– Increased funding for prevention
– Other increased funding

5. Presentation Outline
• Affordable Care Act Overview
• Connection with Public Health and Medical
Practice Foundations
• Effects of Health Reform on Public Health and
Physicians
• Healthy Chicago Agenda

6. Responsibilities of Public Health

7. Physician Competency Framework
Adopted by the
Royal College of
Physicians and
Surgeons in
Canada in 1996

8. Presentation Outline
• Affordable Care Act Overview
• Connection with Public Health and Medical
Practice Foundations
• Effects of Health Reform on Public Health
and Physicians
• Healthy Chicago Agenda

9. Effects of Health Reform on
Public Health and Physicians
• Changes in Health Insurance Coverage
• Technology and Data
• Focus on Prevention and Public Health
• Innovation

10. Increased Access to Insurance
• State Health Insurance Exchange:
– U.S. citizens and legal residents can purchase
– Small employers can purchase insurance for their workers
• Enrollment begins October 2013; Coverage in January
2014
• Administered at the State level and operated either:
– By the state
– In partnership with US Department of Health and Human
Services, or
– By the US Department of Health and Human Services

11. Increased Access to Insurance
• Navigators will be funded to inform consumers and help
them enroll
• Other provisions:
– Young adults up to age 26 can continue
on parent’s insurance
– No life-time or annual limits on coverage
– No exclusion due to pre-existing conditions
– No gender rating

12. Essential Health Benefits
• Ambulatory care • Preventive and wellness
• Emergency care services and chronic
• Hospitalization disease management
• Pediatric services,
• Maternity and newborn care including oral & vision
• Mental health & substance
use disorder services,
including behavioral health
treatment
• Prescription drugs
• Rehabilitative and habilitative
services and devices
• Laboratory services

13. Medicaid Expansion
• States can expand Medicaid to U.S. residents
living at or below 138% of federal poverty level
• Expansion will cover adults without dependent
children
• States reimbursed at 100% of costs for first 2
years
• Pregnant women and children are usually
covered at higher levels

14. Consumer Cost Savings
• Women can now obtain preventive screenings
with no cost-sharing
• Medicare recipients can receive annual physical
with no cost-sharing
• The Medicare prescription coverage gap (i.e.,
“donut hole”) will be eliminated, saving seniors
from paying all costs out-of-pocket between
their yearly coverage limit and the catastrophic
cap.

15. Implications for Insurance Coverage
For Physicians: For Public Health:
˖ Better patient outcomes: ˖
Healthier communities
• Patients seeking care sooner • Increased access to
• Coverage for preventive preventive and primary care
screenings • Improved chronic disease
˖ Improved payor mix management
• More insured patients ˗ No health insurance
˗ Insufficient workforce to options for non-US
citizens/legal residents
treat all newly insured
˗ HIE basic health plans may
not cover all needed
services

16. Effects of Health Reform on
Public Health and Physicians
• Changes in Health Insurance Coverage
• Technology and Data
• Focus on Prevention and Public Health
• Innovation

17. Technology and Data
• Improved access to data
through innovative
technology
– Electronic health records
– Electronic laboratory
reporting
• Health Reform using provider incentives (“Meaningful
Use”) to obtain public health data
— Immunization rates
— Reportable diseases
— Syndromic surveillance

18. Health Information Exchange
“Health information
exchange (HIE) refers to the
sharing of clinical and
administrative data across
the boundaries of health
care institutions, health
data repositories, and
States.”
Agency for Healthcare Research and Quality

19. Implications of Technology and Data
For Physicians: For Public Health:
• Coordinated and cost- • More efficient and
efficient care comprehensive
– Duplicative tests surveillance capabilities
– Administrative costs • Improved
– Improved clinical understanding of public
management health conditions

20. Effects of Health Reform on
Public Health and Physicians
• Changes in Health Insurance Coverage
• Technology and Data
• Focus on Prevention and Public Health
• Innovation

21. Focus on Prevention
• Public health responsible for 80% of increase in US life
expectancy
• ACA established National Prevention, Health
Promotion and Public Health Council
– National Prevention Strategy priorities:
• Tobacco-free living
• Prevention of drug abuse & excessive alcohol use
• Healthy Eating
• Active Living
• Injury and violence-free living
• Reproductive and sexual health
• Mental and emotional well-being
• CDPH Healthy Chicago Agenda

22. Prevention and Public Health Fund
• Goal: To provide stable and increased investment in
prevention
• First-ever fund dedicated to prevention & public health with
total investment of $15 million
• Funded at $500 million in 2010; up to $2 billion in 2022
• Funds efforts in:
- Community prevention - Clinical Prevention
- Public health workforce - Research and Tracking
• Chicago: $14.9 million for obesity prevention, HIV
prevention, immunization, tobacco, performance
management, and surveillance capacity.

23. Premature Deaths and Related Grant
30% Funding, Chicago
25%
20%
15%
10%
5%
0%
Heart Disease Cancer Tobacco Use Violence Healthy HIV Prevention Communicable Healthy Homes
and Stroke Disparities Prevention Mothers and Disease
Babies Control and
Prevention
Deaths before 75 (2004-2008) 2012 Funding

24. Chicago’s Funding Awards to Date
Grant Amount
Prevention & Public Health $14,970,000
Community Health Centers $32,860,000
Strengthen Workforce $5,806,000
Innovation Grant $6,078,000

25. Community Transformation Grants
• Funds community-level interventions to reduce rates of
chronic, preventable diseases
• State of Illinois received $24M CTG in 2011
• Chicago Public Schools, in collaboration
with CDPH, received a $4.4 million grant
to fund Healthy CPS
– Reduce tobacco use
– Increase physical activity
– Decrease weight
– Improve nutrition
– Improve emotional well-being

26. Implications of Prevention Funding
For Physicians: For Public Health:
• Integrative models of care • New and dedicated funding
– Primary care into for key public health efforts
behavioral heath settings
• Substantial investment in
• Workforce development chronic disease prevention
– Primary care workforce • Funding for epidemiology
– National Health Service and lab capacity efforts
Corps
• Expansion safety net
• FQHC Medical Expansion to through FQHC funding
serve more patients

27. Effects of Health Reform on
Public Health and Physicians
• Changes in Health Insurance Coverage
• Technology and Data
• Focus on Prevention and Public Health
• Innovation

28. Center for Medicare and
Medicaid Innovation
• Established in 2010 to test innovative payment and
delivery models that reduce expenditures for
Medicare, Medicaid and the Children’s Health
Insurance Program, while improving or maintaining
care quality
• Provide more cost-effective health care by shifting
from “paying for volume” to “paying for value”

29. Models of Payment and Care Delivery
• Models that are mandated or have been
promoted by policy experts
• Models that demonstrate compelling
approaches
– Innovation Challenge funds grants between $1-
$30 million
• Models currently being tested include:
– Accountable Care Organizations
– Initiatives for dual-eligible beneficiaries
– Bundled payments

30. Implications of Innovation Efforts
For Physicians: For Public Health:
• Incentive payments • Cost savings could fund
more primary care and
• Funding to test system prevention
redesign • Models that monitor care
improve:
• Opportunities to expand
– Quality and outcomes
partnerships
– Coordination among
providers and systems
• Creates culture of
innovative thinking

31. Presentation Outline
• Affordable Care Act Overview
• Connection with Public Health and Medical
Practice Foundations
• Effects of Health Reform on Public Health and
Physicians
• Healthy Chicago Agenda

32. HEALTHY CHICAGO
CHICAGO DEPARTMENT OF PUBLIC HEALTH
TRANSFORMING THE
Chicago Department of Public Health
HEALTH OF OUR CITY
CHICAGO ANSWERS THE CALL
Rahm Emanuel Bechara Choucair, MD
Mayor Commissioner

33. Healthy Chicago Overview
• Released in August 2011 as the first
comprehensive city-wide public heath agenda
• Provides a blueprint for public health action
in Chicago
• 12 priorities; 192 strategies
• Strategies cover areas of:
– Policy
– Programs
– Education and Awareness

34. HEALTHY CHICAGO
Chicago Department of Public Health
Infrastructure

35. Alignment of ACA and Healthy Chicago
Prevention Efforts
Healthy
ACA
Chicago
National Healthy
Prevention Chicago
Strategy Agenda
National
Inter-agency
Prevention
Council
Council
Guiding Guiding
Principles Principles

36. Alignment of Guiding Principles
• Focus on issues and strategies with measurable
outcomes
• Strategies informed by evidenced-based and
promising practices
• Commitment to health equity and the elimination
of disparities
• Diverse partnerships
• Focus on policy, systems, and environmental
change

37. Priority: Access to Care
ACA, including Medicaid Expansion will help Healthy
Chicago to reach its targets and conduct its strategies
Targets: Strategies
• Increase the number of • Advocate for FQHC
Chicagoans receiving sustainability and
Medicaid integration of behavioral
• Increase FQHC patients and primary care
• Improve mental health • Collect and analyze data
collaborations and reflective of heath care
service capacity system changes

38. Accomplishment:
School-based Oral Health Services
CDPH’s School-Based Oral Health Program provided
over 113,000 Chicago Public School students with
oral health care, and placed over 300,000 dental
sealants on 65,000 students.

39. Priority: Healthy Mothers and Babies
ACA improved insurance coverage for women’s preventive
care and breastfeeding support
Targets: Strategies
• Reduce infant mortality • Pass a City ordinance
rate, especially among prohibiting discrimination
Black infants of breastfeeding in public
• Reduce percentage of • Conducting 16,000 home
low birthweight babies visits annually to pregnant
• Increase percentage of women and new mothers
WIC infants still breast • Implement campaign on
fed at 6 months nutrition during pregnancy

40. Accomplishment:
Baby-Friendly Hospitals
14 Chicago hospitals are participating in the Baby-
Friendly Hospital Initiative to support breastfeeding
and increase breastfeeding rates

41. Priority: Tobacco Use
Tobacco-free living is one of the National Prevention
Strategy’s priorities
Targets: Strategies
• Reduce smoking • Passed City ordinance to
prevalence among adults prohibit tobacco vending
• Reduce smoking machines
prevalence among youth • Support 750 undercover stings
to tobacco vendors to prevent
sales to minors
• Create smoke-free parks
through adoption of Park
District’s smoke-free policy

42. Accomplishments:
Smoke-free & Tobacco-free Policies
Smoke-free
• Over 3,250 units of private
housing
• Over 1,600 units of public
housing
Tobacco-free
• 5 hospital campuses
• 3 higher education campuses
• 6 substance abuse & mental
health service agencies

43. Priority: Obesity Prevention
The National Prevention Strategy identifies healthy eating
and active living as prevention priorities
Targets: Strategies:
• Reduce adult and • Implement healthy vending
childhood obesity machine policy for City of
• Decrease proportion of Chicago
youth and adults • Develop toolkit for faith-based
consuming <5 servings of and community groups to
fruits and vegetables promote healthy food and
• Reduce food desserts physical activity
• Develop Integrated Food Space
Plan

44. Accomplishments:
Obesity Prevention
• Healthy Produce Carts
• Healthy Corner Stores
• PlayStreets

45. Priority: Public Health Infrastructure
Supported by the focus on Technology and Data and
increased funding through the Prevention and Public
Health Fund
Targets: Strategies
• Prepare residents and • Strengthen epidemiology
providers for emergencies capacity by growing
• Use technology for disease program
tracking, data dissemination, • Participate on Health
and implementation of Information Exchange
interventions advisory committees
• Improve effectiveness • Strengthen performance
through Performance management
Management

46. Accomplishments:
Public Health Infrastructure
• First large city health department to submit
documents for Public Health Accreditation
• Maintain 18 public health data files on
City of Chicago’s open data portal

47. Cross-cutting Accomplishments:
Engaging Diverse Partners
• City of Chicago Departments
• LISC-Chicago community leaders
• LGBT Partners
• Chicago Public Schools: “Healthy CPS”

48. facebook.com/ChicagoPublicHealth
Gplus.to/ChiPublicHealth
@ChiPublicHealth
312.747.9884
CityofChicago.org/Health
HealthyChicago@CityofChicago.org