Claudia R. Baquet, MD, MPH Professor of Medicine Associate Dean Policy and Planning University of Maryland School of Medicine Cancer Health Disparities Summit 2006 July 18, 2006
What it a Policy? Policies are activities or strategies developed to achieve anticipated outcomes; in the case of health policy, the activities are expected to impact the health care delivery system. Policy may impact access to care, target scarce resources or guide funding decisions. Policy may be implemented through legislation and/or regulation. What is the link between Health Disparities Research and Health Policy? Health Disparities Research can: 1. Document/describe the existence of health disparities; 2. Contribute to the understanding of the etiology of health disparities; 3. Inform and guide policy maker s agenda; 4. Assist in defining nature/extent of health disparities; 5. Influence the development of science-guided policy/interventions to reduce or eliminate health disparities; 6. Evaluate policies with regard to whether desired outcomes are achieved. 7. Foster sustainability and leveraging.
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'! Maryland General Assembly 188 Senators and Delegates(47 Senators and 141 Delegates from 47 districts) Meets in session for 90 days Annually considers about 2,300 bills and the state budget General Assembly can cut the State budget but cannot add to it Laws passed can affect the general welfare, create new executive agencies and impose new taxes (
)))*))+ YEAR Bill Number Title Synopsis 2000 HB 1184 / SB809 Oral Health Programs Reducing Oral Cancer Mortality Requires Secretary of DHMH to establish an Oral Health Program to prevent and detect oral cancer; targeting high risk underserved persons 2000 HB 1425 * Cigarette Restitution Fund Tobacco Use Prevention and Cessation Program - Cancer Prevention, Education, Screening, and Treatment Program Establishing a Tobacco Use Prevention and Cessation Program and a Cancer Prevention, Education, Screening, and Treatment Program in the Department of Health and Mental Hygiene; providing that the programs shall be funded as provided in the State budget with money from the Cigarette Restitution Fund; authorizing the Legislative Auditor to audit the appropriations and expenditures made for purposes of the programs; Funding UMMG including UMSHN & OTRD 2001 HB 492 / SB330 State Advisory Council on Heart Disease and Stroke Renaming an existing council on high blood pressure and cardiovascular disease to include stroke prevention, detection and treatment targeted to high risk populations and high-incidence areas 2001 HB 190 / SB100 Health Insurance - Colorectal Cancer Screening Coverage Requiring health insurances, nonprofit health service plans and HMO's to cover colorectal cancer screening in accordance with ACS guidelines 2002 HB 35 HIV / Aids In the Caribbean Urging Congress to oppose cutting the $20 million designated in fiscal year 2002 for HIV/AIDS prevention and education programs in the Caribbean 2003 HB 883 * Health Care Services Disparities Prevention Act Declaring the intent of the General Assembly; authorizing specified institutions of higher education in the State to include courses in the curriculum or offer special seminars on health care services disparities of specified minority populations; requiring the Department of Health and Mental Hygiene, in consultation with the Maryland Healthcare Foundation, UMSOM and other entities, to develop and implement a plan to reduce health care disparities; etc. * Significant Policy Developments,
)))*))+ 2004 HB 86 / SB177 * Maryland Office of Minority Health and Health Disparities Establishing the Maryland Office of Minority Health and Health Disparities in the Department of Health and Mental Hygiene; requiring the Director of the Office to report to the Secretary of Health and Mental Hygiene; establishing the duties and responsibilities of the Office; requiring the Director to promote health and prevention of disease among African Americans, Hispanics and American Indians 2004 HB 1000 Maryland Cancer Fund-Income Tax Check Off Establishing the Maryland Cancer Fund in DHMH to be used to provide grants for cancer research, prevention and treatment; requiring funds to only be expended through an appropriation in the State budget 2004 SB 499 State Council on Cancer Control Cervical Cancer Committee of the Maryland Comprehensive Cancer Control Plan Establishing a Cervical Cancer Committee on the Maryland Comprehensive Cancer Control Plan; requires DHMH to staff 2005 HB 303 Health Insurance Mandated Benefits Smoking Cessation Treatment Requiring specified insurers, nonprofit health service plans, and health maintenance organizations to provide coverage for specified drugs and nicotine replacement therapy to assist an insured or enrollee to cease the use of tobacco products; prohibiting the insurers, nonprofit health service plans, and health maintenance organizations from imposing specified co-payments or coinsurance requirements for specified drugs and nicotine replacement therapy; etc. 2005 HB 627 / SB775 Community Health Care Access and Safety Net Act of 2005 Establishing the Maryland Community Health Resources Commission; requiring the Commission to work with clinical education and training programs, area health education centers and telemedicine centers to enhance access to quality primary and specialty care for persons in rural and underserved areas referred by community health resources * S ignificant Policy Developments +
)))*))+ 2006 HB 58 Department of Health and Mental Hygiene Racial and Ethnic Variations Health Care Disparities Policy Report Card * requires DHMH in collaboration with MHCC to annually prepare a health disparities existing consumer performance report cards for HMO's, nursing homes and hospitals; policy report card that includes: 1. An analysis of racial and ethnic variations in health insurance coverage for low income persons 2. Racial and ethnic composition of physician population in Maryland as compared to state's population; and 3. Racial and ethnic disparities in mortality and morbidity for cardiovascular diseases, cancer, diabetes, HIV/AIDS, infant mortality, asthma and other diseases 2006 SB 61 Maryland Medbank Program -Sunset Repeal Repeals sunset terminating Program so the Program will be continuing 2006 SB 728 Telemedicine-Use and Reimbursement Study Requires the University of Maryland School of Medicine, in consultation with the School of Nursing and other stakeholders to study; 1. Current use of telemedicine in the State; 2. Use of and reimbursement for telemedicine in other states; 3. How any reimbursements for telemedicine in other states have increased access to health care in those states; 4. Any current barriers to reimbursement for telemedicine; and 5. Potential for telemedicine to improve access to health care in underserved areas of the state 2006 HB 1455 Cultural Competency and Health Outcomes - Pilot Program Requires the Family Health Administration in DHMH, in consultation with the Office of Minority Health and Health Disparities, to provide assistance to a state-based community teaching hospital system for a pilot program that addresses: 1. Cultural competency for health care providers, 2. Health outcomes and Community - based models for targeting health outcomes, 3. At least two of the following indicators shall be tracked: a Improvement in BMI and hemoglobin A/C levels, persons with diabetes, b. Increases screening breast cancer, c. Increased screening cervical cancer, d. Increase screening prostate cancer, e. Improvement blood pressure, cholesterol, hypertension/persons with cardiovascular disease. Program must be implemented in system serving underserved areas and entity may not be academic health center * S ignificant Policy Developments -
)))*))+ 2006 SB 824/HB 681 Maryland Commission for Men's Health Creates Maryland Commission for Men s Health, requires Commission to develop strategies and reduce or eliminate disparities in morbidity and mortality for specific diseases among racial and ethnic minorities and underserved and consider population diversity in its activities/ recommendations..
/ 0 2001 HB 1425 Cigarette Restitution Fund CRF money fostered: Leveraging additional funding for sustainability Establishment of University of Maryland Statewide Health Network (UMSHN) Development of Other Tobacco Related Diseases Research Grant (OTRD) Community-based Clinical Trials (National Best Practice Award) Telemedicine initiatives Free cancer screening in Baltimore City University of Maryland Marlene and Stewart Greenebaum Cancer Center Research Grant 1
UMSHN Community and Telemedicine/Videoconference Linkages Unique Infrastructure Garrett Allegany Allegany Washington Carroll Harford Harford Cecil Frederick Baltimore Baltimore City Regional Office Area Served Baltimore City Western Maryland Regional Office Area served Garrett County, Allegany County, Washington, and Frederick Counties UMSHN Offices Eastern Shore Regional Office Area Served Caroline, Cecil, Dorchester, Kent, Queen Anne s,. Talbot, Somerset, Wicomico and Worcester Counties Southern Maryland Regional Office Area Served Calvert, Charles and St. Mary s Counties Covered for community & professional health education through NIH P-60 funding UMSHN Offices 1. Central Office/Baltimore City Office 2. Eastern Shore Regional Office - Salisbury 3. Western Maryland Regional Office - Hagerstown 4. Southern Maryland Regional Office - Waldorf Montgomery Howard Howard Charles Charles Prince George s Balt. City Anne Arundel St. Mary s Cal - Calvert vert St. Mary s Kent Queen Anne s Talbot Talbot Dorchester Car - oline Dorchester Caroline Somerset Wicomico Somerset Telemedicine/Videoconference Linkages (31) (#) reflect number of TM/VC linkages Worcester
2003 HB 883 Health Care Disparities Prevention Act declared the intent of the General Assembly that institutions of higher education include courses on health disparities and cultural sensitivity and DHMH develop a plan to address disparities 2004 HB 86 Office of Minority Health and Health Disparities established the Office of Minority Health and Health Disparities in the Department of Health and Mental Hygiene; required the Office to report directly to the Secretary, required Director to promote health and prevention of disease in specified groups 2
2006 HB58 DHMH Racial and Ethnic Variations Health Care Disparities Policy Report Card Requires health disparity measures to be added to current quality report cards for nursing homes, hospitals, and HMO s. The Health Department is required to develop annually a report on disparities in insurance coverage, health and participation in health professions. Significance: Sets up ongoing objective data-driven process to assess where we were and where we are in achieving health disparities goal. All three (3) bills had same key sponsor - Delegate Shirley Nathan - Pulliam 2&
! " Mandated Benefits are required health insurance benefits or services that insured health plans must include (developed in response to cost cutting initiatives by HMOs etc.). Maryland has 40 mandates Mandates do not apply to small group market, Medicaid or the self insured (about 75% of the population under 65 years are not covered by mandates; mandates influence what is covered and the extent of coverage in other markets) Mandates cover a number of cancer related services 2(
! Mandates for prevention, screening and treatment in Insurance Article 15-804-coverage for off label use of drugs 15-809 Hospice Care 15-814 Mammography coverage 15-815 Reconstructive Breast Surgery coverage 15-825 Prostate Cancer screening coverage 15-827 Clinical trials coverage 15-832 Length of stay mastectomies and prostate surgeries 15-834 Prosthesis after mastectomy 15-836 Wigs after chemotherapy 150837 Colorectal cancer screening 2,
# $ % & Research/Data identified appropriate treatment or procedure Legislative Policy was developed around research to assure access to treatment or procedure through passing laws i.e. mandated benefits Medicaid and State employee benefit policies adapted mandates in general through Regulatory changes in their benefit plans UMSOM focus group research (2004) indicates lack of awareness about coverage in mandates especially in minority and rural underserved populations Interventions are needed to increase awareness so that benefits are accessed to help reduce disparities in morbidity and mortality Policies to increase awareness of mandates need to be evaluated as part of the assessment of the effect of mandates in reducing disparities NCMHD/P60 developed educational tool to explain mandated benefits to minority and underserved population June 2006 focus group tested educational tool in Baltimore City Results of focus group research will guide revision of the educational tool and inform legislators about minority and underserved s understanding of legislated benefits which could lead to future policy changes. 2+
Beyond Maryland Southern Legislative Conference Rural and Agricultural Committee 16 rural states Chair-former Maryland Tobacco Farmer (research TA led to crop conversion funding and money) Invitation to present to all states in Mobile, Alabama Toolkit for state legislators was developed
0!! Health Disparities Research is a powerful tool for: Providing evidence for policy formulation Ongoing technical assistance to elected officials Assuring policies which are responsive to actual data research results Fostering new policy research 2-