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Government Affairs: Advocacy

  • Health Care Reform Implementation for the Hispanic Community

    Opening Remarks From Dr. Elena Rios

    Honorable Lucille Roybal-Allard

    Dr. Garth Graham

    Dr. Janet Heinrich

    Nora Super

    Questions Part 1

    Questions Part 2

  • National Hispanic Medical Association Partners With American Cancer Society

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    Did you know that cancer is the second leading cause of death among Hispanics, accounting for 20% of deaths nationally?

    Overall, about 1 in 2 Hispanic men and 1 in 3 Hispanic women will be diagnosed with cancer in their lifetime. NHMA is working with the American Cancer Society to promote education among Hispanic health professionals and their patients.
    Click Here for Cancer Facts & Figures for Hispanics/Latinos 2009-2011 (PDF)
    Click Here for Cancer Awareness for Hispanic Women (PDF)
    Click Here for Datos Estadisticas Hispanos Latinos 2009-2011 (PDF)

  • Video Presentations from NHMA's 13th Annual Conference

    Submitted by Elena Rios MD on Wed, 10/21/2009 - 13:32
    NHMA 13th Annual Conference
     

      NEW VIDEOS!  Building a Health Care Workforce for the Hispanic Community

      Depression & Hispanics: Epidemiological, Socioeconomic & Cultural Considerations

      March 19-22, 2009

      Click on the image to view presentations

     

     

     

     

     

  • HEALTH CARE REFORM AND HISPANICS - SPEECH TO CMS

    Submitted by Elena Rios MD on Thu, 10/15/2009 - 18:18

     

    Hispanic Heritage Month Speech
    Centers for Medicare and Medicaid
     
    Elena Rios, MD, MSPH
    President & CEO, NHMA
     
    October 14, 2009
     
    I am honored to join you today in celebrating Hispanic Heritage Month. On behalf of the Board of Directors and our Board Chairman, Dr. Ciro Sumaya, I want to thank each and everyone of you for being here today. We recognize how important CMS is to the advancement of the health of our Hispanic population and thank you for your public service.  
     
    The National Hispanic Medical Association (NHMA) is a nonprofit association representing the interests of 47, 000 Hispanic physicians in the U.S. The NHMA mission is to improve the health delivery and the health of the Hispanics and other underserved.
     
    A core group of physicians came together in collaboration with President Clinton’s White House Health Care Reform Task Force, started NHMA in 1994 with a vision to build a network of physicians who could provide a voice at the national level to advocate for Hispanic health from across the nation – I was from Los Angeles, others were from New York and Texas.
     
    NHMA developed its NHMA Leadership Fellowship that has trained 120 physicians for public service, an advocacy agenda with Congressional Briefing Series on Hispanic Health and a Foundation with the Robert F. Wagner Graduate School of Public Service that has developed a national scholarship program for health professions students interested in serving the Hispanic population. We have built our headquarters here in Washington, DC, the NHMA Council of Medical Societies with 16 regional and State medical societies; the National Hispanic Health Professional Leadership Network with all the national Hispanic health professional organizations; the NHMA Council of Residents, and we have a member of the Board of Directors from the Latino Medical Student Association.
     
    Health care spending is expected to consume 17.6 percent of Gross Domestic Product (GDP) in 2009, and it is projected to rise to 20.3 percent by 2018 if current trends continue.  Since 2000, health care premiums have grown four times faster than wages.  The U.S. spends twice as much per person for health care as any other country in the world, and yet continues to lag behind other countries in terms of coverage and quality.  There are 46.3 million uninsured people in America, and millions more have inadequate coverage. Hispanics are uninsured at 30.7 percent compared to non-Hispanic Whites at 10.8 percent and African Americans at 19.1 percent.[1] The U.S. has lower life expectancy rates than most of the other industrialized countries of the world.
     
    According to the U.S. Census, Hispanics are 15 million or 15 percent of the U.S. population and by 2042 will be one out of four Americans. Hispanics are not only the subpopulation with the highest rate of uninsured, but also the subpopulation with the highest rate of health care disparities.[2] Without changes in policy, a growing number of Hispanics will become uninsured. Hispanics face severe lack of access to health care, lack of trust and knowledge, and are low-income, poorly educated with strong cultural and family values, limited English proficiency, mainly living in urban areas. Due to immigration and media, Hispanics have a strong identity. Hispanics suffer from high rates of obesity, diabetes, infectious and chronic diseases with a strong need for cultural competence, language and education services from the health care providers. In terms of the health care system, it lacks Hispanic researchers, providers and leaders in public and private sector agencies. Finally, there are no incentives in the current health care system to contain or slow the rate of growth of spending. So, we strongly support health care reform. The NHMA vision has been to become the premier organization in the country that can improve health of Hispanics by facilitating the participation of Hispanic physicians, with their knowledge and expertise to do the following:
     
    1. Increase access to health care services to Hispanics
    2. Increase responsiveness of the health care system to reach out to our communities – medical education, hospitals, clinics and private practices, and research
    To that end, together with the US Department of Health and Human Services Office of Minority Health in 2007-2008, NHMA convened a Summit Series on “Health Disparities and Hispanics” in New York, Sacramento, and Austin. We had one day working meetings with speakers addressing the problem and recommendations on Access to Health Care, Prevention of Diabetes and Obesity and Hispanics in the Health Professions, followed by facilitated discussion with 300 stakeholders from the government, business, health insurance and pharmaceutical companies, media, unions, hospitals and clinics, physicians, nurses, and teachers. We facilitated the meeting and recorded the consensus recommendations and their ratings.
     
    The recommendations that became the priority Federal policy recommendations include many of our recommendations for health care reform ---
    We support:
     
    Access:
    1. Universal and affordable health insurance with expanded eligibility – families, immigrants, low income, and with individual mandates
    2. Outreach and education targeted to reach the Hispanic communities
    3. Enforce standards for Culturally and Linguistically Appropriate Services (Joint Commission, NCQA)
    4. Promote cultural competency for all providers (incentives, performance payments, Federal clearinghouse)
    5. Language services need to be part of the essential benefits – interpreters, pooling of resources, federal laws on access to services
    6. Race/ethnicity/language data should be mandatory
    7. Support providers, working in multidisciplinary teams, in underserved communities
      1. Strengthen DSH payment system to private practice
      2. Expand NHSC or similar program
    8. Medical Home = CHCs for all + increase referral systems to tertiary care
    9. Patient centered care
    Our added recommendations given health reform legislative efforts:
    1. Include all eligible persons, including legal immigrants from day 1 and get rid of the 5 year ban for services for Medicaid, low income subsidies, exchanges
    2. Include a Public Option
    3. Do not link premium cost with participation in prevention programs
     
    And for the Quality Initiatives, we also support
    1. Health IT subsidies to private practices and clinics serving Hispanics
    2. Quality standards and performance quality improvement needs to include cultural competence and communications standards
    3. Physicians and hospitals working together - bundling payments, reimbursement based on value, performance, transparency, education for consumers and providers
     
     
    Prevention
    1. Develop a standard curriculum on healthy lifestyle in schools
    2. Coordinate national education campaign of our parents and families – nutrition, physical exercise, cooking traditional foods in healthy ways
    3. Educate our politicians and identify our champions
    Given health reform legislation,
    1. We strongly support a National Strategy for Prevention, Public Health and Integrative Care that includes eliminating racial/ethnic health disparities that includes reauthorizing the Office of Minority Health, providing funding for the facilitation of all major health reform initiatives across the HHS agencies and across the Cabinet level agencies.
    2. We support the community transformation grants to be targeted to Hispanic communities.
    3. New lifespan approach ----school clinics, worksite wellness, aging healthy initiatives for 55-64 year olds.
     
     
    Workforce
    1. Political will – to continue the Federal recruitment programs of students and faculty to the health professions
    2. Link the medical school admissions to our alumni and diversify the leadership of the Trustees and faculty of the institutions
    We held a second summit this summer with the Josiah Macy Foundation and convened 25 African American and Hispanic experts and have these major recommendations:
     
    1. Medical education institutions need to change their mission to be able to advance excellence – and incorporate diversity. Policies with health reform were looked at including the regionalization of training – the Primary Care Extension program.
     
    Given health reform legislation
    1. Regional and leadership development - for Hispanics/minority providers of the future
    Medicare training dollars for flexibility with outpt training,
    2. Incentives for primary care through the National Workforce Strategy, reimbursement changes, and redistribution of Medicare GME funds for residency program slots
    3. Community health workers, navigators, nursing and dental workforce, allied health workforce (TANF training funding) to increase primary care in our underserved communities
    4. Public health workforce increase for the new infrastructure at the Federal, State and Local level
     
    As for NHMA, we have been involved with the Health Care Reform journey as follows:
     
    April 2008 – NHMA Recommendations presented to the Presidential Campaign Health Advisors; I spoke at both the Democrat and Republican National Conventions
    Senator Kennedy’s Committee Meetings in August 2008
    President Obama Transition Team and White House Meetings
    Mar 5th Stakeholder Health Summit with Senator Kennedy, Senate and Congressional leaders and major stakeholders who all voiced support for the journey to health care reform legislation
    Mar 25th Health Reform and Physicians Meeting
     
    May 5th - the Congressional Hispanic Caucus brought together major national Hispanic organizations and unions ---and over the past few months, the National Hispanic Leadership Agenda and our Health Committee developed its agenda for health reform
     
    Tricaucus effort - they introduced their 4th bill to Congress on a joint minority health statement ---with some parameters included in health reform, for example, the territories and health empowerment zones, the HCOP and COE diversity in medical education, community health workers.
     
    Then following the bills introduction – May –then July and in September -Advocacy and letter writing campaign and meetings with Congress and Senate staffers
     
    What are key trends for CMS that could become part of health care reform?
    1.      The costs of care delivery will be a major focus. Fischer has described key differences in patterns of care in Medicare between high and low expenditure areas without a clear correlation with higher quality of care in high expenditure areas. In a 2008 study by Fowler, spending more on care does not improve patient’s perceptions of the medical care they receive. For each group (low expenditure and high expenditure) their needs were met and so the report similar measures of satisfaction with their care. The study’s conclusion is that the limiting factor in restraining cost growth will be the extent the medical community will be able to adjust to new standards for what constitutes appropriate medical care. [3] Others have quantified the low income population’s greater use of health care services. [4] The Hablamos Juntos program has documented the business case for language services in Spanish speaking health care facilities. [5]
    2.      The health care delivery system will focus more on value and incentives for providers who deliver the best value. CMS will continue to develop its value-based purchasing for payments based on performance on quality and efficiency as it transforms Medicare to a purchaser of higher quality, more efficient health care, maximizing value and documenting outcomes measured over a continuum of care, not episodes of care. Measures need to be developed not only on disease indicators and survival, but on outcomes ---with new health indicators, descriptors of the care experience, the recovery time, compliance issues, communication issues, cultural issues ---How do we measure a provider’s quality of care in a practice setting? integrated, multidisciplinary care that links public health, medicine and mental health services? Comparative effectiveness research will help provide new knowledge on medical treatments and clinical effectiveness and this research needs to remain objective in the AHRQ. The CMS demonstration projects are key to building new information (for example, the diabetes projects with the QIOs). The National Quality Forum has recently reported a list of measures for cultural competence.
    3.      Innovation will be a focus across new networks - health plans, employers, and eventually, medical practices that provide basic care for the Hispanic populations – need to be connected through learning networks. CMS open door forums are a great model. The sharing of information requires a strategic approach to health information technology.
    4.      Racial/ethnic Health Disparities will be a continued focus of a National Strategy to understand how can CMS work for our Hispanic communities. The equation must include how to work with the Hispanic community leaders and our role must be to provide the input to meet the challenges and needs of Hispanic health. NHMA has developed its learning practices on its Hispanic Health portal and a national conference that will continue to be a focal point of Hispanic health learning. I invite you to our next 14th Annual Conference : “Health Care Transformation – to Increase Prevention and Public Health for Hispanic Communities” march 25-28, 2010 at the Marriott Wardman park, Washington, DC. Go to our website www.nhmamd.org
     
    In conclusion, CMS is key for reforming the health care delivered to all our communities. Medicare, Medicaid and CHIP and the private sector programs you work with are very important  and need your continued leadership. We thank you for celebrating the importance of health reform to improve Hispanic health and all America’s health.

    [1] U.S. Bureau of the Census. Report on Health Insurance in 2008. September 2009.
    [2] National Health Disparities Report, AHRQ, US DHHS. 2007.
    [3] Fowler, J, et al. Relationship Between Regional Per Capita Medicare Expenditures and Patient Perceptions of Quality of Care. JAMA, 2008, Vol.299, No.20, pp.2406-12.
    [4] Chen A, Escarce J. Quantifying income-related inequality in health care. Health Affairs. 2009, 28(10w91-102.
    [5] Hablamos Juntos, supported by the Robert Wood Johnson Foundation.
     
     
     
     

     

  • Federal Health Policy 2008

    Federal Health Policy REDES Conference August 2008

    Presented by:
    Elena Rios, MD, MSPH
    President & CEO
    National Hispanic Medical Association

    Download an attachment of Dr. Rios's PowerPoint presentation, below:

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    Federal Health Policy REDES Conference August 2008.ppt87 KB

  • Hispanics and Depressions

    Submitted by nhma on Sat, 03/06/2004 - 11:33
    Among Hispanic Americans with a mental disorder, fewer than 1 in 11 contact mental health specialists, while fewer than 1 in 5 contact general health care providers. Among Hispanic immigrants with mental disorders, fewer than 1 in 20 use services from mental health specialists, while fewer than 1 in 10 use services from general health care providers. One national study found that only 24% of Hispanics with depression and anxiety received appropriate care. Another study found that Latinos who visited a general medical doctor were less than half as likely as whites to receive either a diagnosis of depression or antidepressant medicine.

     

    NHMA’s 12th Annual Conference Video

    Recognition & Management of Depression & Co- Morbidities in the Hispanic Population

    View Speaker PowerPoints

    Pedro Delgado
    Andres Pumariega
    Julio Lucinio

    Hispanics & Depression Risk Factors Table
    Hispanic & Depression Options for Treatment Table
    Additional Resources on Hispanics and Depression/Mental Health
    Click Here For References

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    Andres_J_Pumariega.ppt876.5 KB
    Julio_Lucinio.ppt3.81 MB
    RiskFactorsTable.JPG234.78 KB
    Treatment_Update.xls48 KB
    Hispanic_Mental_Health_Resources.xls27.5 KB
    References.doc49.5 KB

  • Latinos in the United States in 2000 | Office of Minority Health, USDHHS

    Submitted by nhma on Sat, 02/01/2003 - 02:00

    he United States is currently experiencing unprecedented changes in its population (U.S. Committee for Refugees, 2001). A growing need to understand both similarities and differences among and within ethnic minority groups and, especially, linguistically diverse people rises along with increasing pluralism. Latinos constitute the fastest growing ethnic minority group in the United States, with varying estimates by demographers as to the year in which Latinos will become the largest minority group in terms of number of individuals in the U.S census...

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  • NHMA POLICY REPORT: “National Hispanic Health Leadership Summit

    Submitted by nhma on Sat, 08/17/2002 - 01:00

    “National Hispanic Health Leadership Summit”, August 15-17, 2002

    The National Hispanic Medical Association (NHMA) and the honorary co-chair, the United States Congressional Hispanic Caucus (CHC) convened the “National Hispanic Health Leadership Summit”, August 15-17, 2002 at the downtown campus of the University of Texas at San Antonio. Key sponsors of the event were the U.S. Department of Health and Human Services, the Robert Wood Johnson Foundation, Amgen, Aventis, GlaxoSmithKline, PhRMA, and numerous other partners.

    The purpose of the National Hispanic Health Leadership Summit was threefold:

     

    • To share the strengths and weaknesses of current health care programs that impact Hispanics,
    • To discuss strategies needed for future health care programs, and
    • To build consensus on the programs and policies that can be developed or enhanced to improve the quality of health care delivery to the Hispanic population in the United States over the next five years.

    Participants addressed issues and worked to reach consensus on one of eight workgroups in the following areas:

     

    1. Access to Health Care
    2. Emerging Public Health Issues (Behavioral Health, Violence, Injuries, Immunizations, Infectious Diseases and HIV/AIDS)
    3. Cultural Competence and Limited English Proficiency Services
    4. Health Professions Training
    5. Building Community-Based Hispanic Research (Biomedical and Health Services Research)
    6. Prevention, Management and Treatment of Chronic Diseases (Heart Disease, Diabetes, Hypertension, Cancer and Related Complications)
    7. Special Populations (Women’s and Children’s Health)
    8. U.S.-Mexico Border Health, Bio-Terrorism, Environmental Health, Occupational Health, Asthma)

    The U.S. Department of Health and Human Services (DHHS) contributed its agencies to produce a powerful partnership to ensure the success of the National Hispanic Health Leadership Summit. These agencies included Office of the Secretary (The Intergovernmental Affairs Office and The Office of Communications), The Office of the Deputy Secretary, Health Resource and Services Administration, Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry, Substance Abuse and Mental Health Services Administration, Food and Drug Administration, Office of Women’s Health, Office of Minority Health, and the Center for Medicare and Medicaid Services. Each agency nominated two government health experts and two civilian health experts to participate in the Summit. Congressional members with over 20 percent Latino constituencies nominated two health experts from their Congressional districts. Congressional legislative staff and leaders from San Antonio also attended the Leadership Summit. All present worked to produce a set of strategies to enhance national health promotion and treatment programs and to increase the number of health professionals and research programs that target Hispanic populations in the United States.

    A total of 170 experts in the health care of Hispanic populations attended the National Hispanic Health Leadership Summit. The summit brought together Hispanic Congressional leaders, physicians, nurses, and other health care professionals, and a core group of experts from multiple disciplines: health care providers and administrators from civilian and military hospitals and health plans representatives of national Hispanic organizations, insurance and pharmaceutical companies, community based organizations, and local, state and Federal government agencies.

    The report includes major strategies to improve Hispanic health, a Congressional Roundtable with presentations and questions and answers from several Congressmembers, the first public speech outside of Washington, DC of U.S. Surgeon General Richard Carmona, MD, and the list of participants.

    For more information, call the NHMA at (202) 628-5895.

  • Centers for Disease Control and Prevention Hispanic Health Factbook

    Submitted by nhma on Thu, 08/01/2002 - 01:00

    See the Centers for Disease Control and Prevention Hispanic Health Factbook published for the National Hispanic Medical Association and Congressional Hispanic Caucus' National Hispanic Health Leadership Summit in August 2002 in San Antonio.

  • Culturally and Linguistically Appropriate Services Standards Final Report

    Submitted by nhma on Thu, 03/01/2001 - 02:00

    As the U.S. population becomes more diverse, medical providers and other people involved in health care delivery are interacting with patients/consumers from many different cultural and linguistic backgrounds. Because culture and language are vital factors in how health care services are delivered and received, it is important that health care organizations and their staff understand and respond with sensitivity to the needs and preferences that culturally and linguistically diverse patients/consumers bring to the health encounter. Providing culturally and linguistically appropriate services (CLAS) to these patients has the potential to improve access to care, quality of care, and, ultimately, health outcomes...

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