Living Well with Chronic Illness A Call for Public Health Action (2012) / Chapter Skim
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3 Policy
3 Policy
Pages 119-150
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From page 119... ...
Beginning with the base of Frieden's pyramid (Frieden, 2010) , the chapter highlights numerous public policies that have an impact on the ability of high-risk populations with chronic illnesses to live well.
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From page 120... ...
Given the numerous provisions targeted to improving health care delivery and population health, the chapter describes aspects of the ACA that are particularly relevant to the well-being of those with chronic illness. Finally, in order to promote synergistic improvements in public policies that have the potential to impact health, the chapter describes a broad Health in All Policies (HIAP)
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From page 121... ...
Barriers to Effective Health Policy As expressed in the recent IOM report (2011) , "now is a critical time to examine the role and usefulness of the law and public policy more broadly, both in and outside the health sector, in efforts to improve population health." The report noted the need for improvements in public policy as a result of several factors, including but not limited to developments in the science of public health; the current economic crisis and severe budget cuts faced by local, state, and federal government; the lack of coordination of health policies and regulations; recent passage of federal health reform (the ACA)
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From page 122... ...
, track state policies that pertain to such chronic illnesses as diabetes. NCSL provides information about diabetes minimum coverage requirements for state-regulated health insurance policies, state Medicaid diabetes coverage terms and conditions, and an overview of federal funding from the Centers for Disease Control and Prevention (CDC)
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From page 123... ...
Chapter 5 provides a detailed description and framework for chronic disease surveillance that will be required to adequately evaluate policies aimed at helping those with chronic illness to live well. American Values in Public Policy Even as new research establishes that social and environmental factors significantly influence health status, Americans often question this worldview (IOM, 2011)
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From page 124... ...
CONTEXTUALIZING HEALTH POLICY INTERVENTIONS: FRIEDEN'S PYRAMID Although most interventions aimed to help people with chronic illness live well focus on the individual, the Health Impact Pyramid (Figure 3-1) illustrates why interventions focused more on public health may be beneficial as well (Frieden, 2010)
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From page 125... ...
, to tax policies that preclude fringe benefits, such as health insurance, from being counted as taxable income, to community supports such as those provided through the Older Americans Act, such as nutrition assistance, home- and community-based services, as well as caregiver supports. The context of public law generally creates this environment.
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From page 126... ...
• 965 -- The Older Americans Act provides funding based primarily on the 1 percentage of an area's population 60 and older for nutrition and supportive home- and community-based services, disease prevention/health promo tion services, elder rights programs, the National Family Caregiver Support Program, and the Native American Caregiver Support Program. • 978 -- Title VII of the Rehabilitation Act Amendments established the first 1 federal funding for consumer-controlled independent living centers and the National Council of the Handicapped under the U.S.
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From page 127... ...
• 008 -- The Genetic Information Nondiscrimination Act was designed to 2 prohibit the improper use of genetic information in health insurance and employment. The act prohibits group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future.
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From page 128... ...
The Family and Medical Leave Act entitles eligible covered employees up to 12 weeks of job-protected, unpaid leave during any 12-month period in order to care for family members with a serious health illness or their own serious health illness; the employee maintains group health benefits during this leave. Even for those with the ability to maintain a job, recent data suggest that one of the largest causes of home foreclosures is a medical crisis.
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From page 129... ...
Examples of public policies that prevent chronic disease in the general population and reduce morbidity in those already living with a chronic illness are highlighted in Box 3-2. Chapter 4 on community-based intervention provides additional details on policies and interventions that affect lifestyle behaviors, screening and vaccination, and other inventions such as self-help and disease management.
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From page 130... ...
Policies Aimed at Clinical Interventions The burden of chronic disease is staggering. Chapter 2 summarizes the burdens experienced by those affected, which range from a number of debilitating medical illnesses to disease self-management challenges, accompanying psychological health issues, and frequent social consequences for employment, education, parenting, etc.
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From page 131... ...
Chapter 6 highlights aspects of the ACA aimed at government public health agencies, many of which currently provide health care services to the uninsured; with full implementation of the ACA anticipated in 2014, the law will provide access to health insurance for most Americans. However, the ACA does not mandate major changes in how the United States delivers and pays for most health care services but instead tests new and innovative models of reimbursement; this is described in more detail later in this chapter.
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From page 132... ...
In addition, the law gives new rights to those who have previously faced difficulties obtaining health insurance -- a problem often faced by those living with chronic illness. For example, the law allows young adults under 26 to maintain coverage through their parents' health insurance, ends lifetime and most annual limits on care, and gives patients access to recommended preventive services without cost sharing.
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From page 133... ...
The state insurance exchanges created through the ACA aim to create efficient and competitive health insurance markets through which individuals and small businesses can purchase health insurance coverage. All qualified health plans in the new exchanges will be required to offer the "essential health benefits package" as defined by the law and will include at least the following general categories (as well as the items and services covered within the categories)
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From page 134... ...
have a serious and persistent mental health illness. Finally, the ACA made important new investments in community health centers, which predominantly serve individuals and families with low income, many of whom have chronic illnesses.
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. CMI will test various innovative payment and service delivery models to ascertain if and how these models could reduce program expenditures while preserving or enhancing the quality of care provided to individuals enrolled in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP)
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From page 136... ...
In addition, the ACA contains multiple provisions to strengthen coverage of preventive services, both inside and outside the new health insurance exchanges. As of January 1, 2011, all new private insurance plans are required to cover a range of preventive services with no cost sharing, including any services given an A or B recommendation by the U.S.
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From page 137... ...
Not only is this investment in chronic disease prevention unprecedented; it also represents an opportunity to transform how communities and government work together to solve large complex problems, like preventing chronic disease, reducing health inequities, and (potentially) containing health care costs.
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. Europe now has an explicit policy that a health impact assessment will apply to all new key EU policies (Koivusalo, 2010)
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have been used as a primary tool for evaluating how policies and actions outside the health sector will impact population health. According to WHO, a Health Impact Assessment is a "means of assessing the health impacts of policies,
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For example, an assessment of the potential health impact of a new highway project may require involvement of health, environmental, and transportation experts. The health experts alone may need to include epidemiologists, community health experts, and physicians.
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Recommendation 7 The committee recommends that CDC routinely examine and adjust relevant policies to ensure that its public health chronic disease man agement and control programs reflect the concepts and priorities em bodied in the current health and insurance reform legislation that are aimed at improving the lives of individuals living with chronic illness. Recommendation 8 The committee recommends that the secretary of HHS and CDC ex plore and test a HIAP approach with HIAs as a promising practice on a select set of major federal legislation, regulations, and policies, and evaluate its impact on health related quality of life, functional status, and relevant efficiencies over time.
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From page 142... ...
Appeals Process Group health plans and health insurance issuers Sec. 1001 offering group or individual health insurance coverage must implement an effective internal appeals process for coverage determinations and claims, including appropriate notice of the process and the availability of any consumer assistance to help enrollees navigate their appeals.
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. State Option to Provide States have the option to amend their Medicaid benefits Health Homes for Enrollees to enroll Medicaid beneficiaries with chronic illnesses with Chronic Conditions into a health home selected by the beneficiary (including Sec.
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3021 models reduce program expenditures while preserving or enhancing the quality of care provided to individuals enrolled in Medicare, Medicaid, and the Children's Health Insurance Program. Medicare Shared Savings A program that incentivizes groups of providers and Program suppliers to work together through accountable care Sec.
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Patient navigators will also facilitate the involvement of community organizations in assisting individuals who are at risk for or who have chronic illnesses to receive better access to high-quality health care services. Title IV National Prevention Council The National Prevention, Health Promotion and Public Sec.
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5302 employed in long-term care settings and agree to work in the field of geriatrics, disability services, long-term services and supports, or chronic care management for a minimum of 2 years following completion of the assistance period. Grants to Promote the A grant program to support community health workers Community Health Workforce and to promote positive health behaviors and outcomes Sec.
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Sec. 5604 Title VI Patient Centered Outcomes A private, nonprofit institute to advance research on the Research Institute comparative clinical effectiveness of health care services Sec.
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2009. Health impact assessment.
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2011. Health in all policies: Addressing the legal and policy foundations of health impact assessment.
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2011. Income, Poverty, and Health Insurance Coverage in the United States: 2010.
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