National Academies of Sciences, Engineering, and Medicine: Integrating Health Literacy, Cultural Competence, and Language Access Services

The Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) has published a summary of a workshop on integrating health literacy, cultural competence, and language access services. Health care organizations are searching for approaches that will enable them to provide information and services to all persons from diverse backgrounds in terms of age, race, culture, and language skills, in a manner that facilitates understanding and use of information to make appropriate health decisions and utilize health care services effectively.

The workshop included presentations and discussions about the opportunities that the implementation of the Affordable Care Act and other health care delivery system changes are creating to support the integration of health literacy, cultural competence, and language access services. There also were presentations and discussions about the issues and challenges in such integration, and some real-world approaches that health care systems are taking to address those issues and challenges. Breakout groups focused on the implications of integration of health literacy, cultural competence, and language access services for research, for policy, and for services and care. In accordance with the policies of the National Academies of Sciences, Engineering, and Medicine, the workshop did not  establish any conclusions or recommendations about needs and future directions, and the workshop summary only reports on issues identified by the speakers and workshop participants.

The October 2015 workshop was sponsored by the Roundtable on Health Literacy, which is planning followup activities.

Posted in Cultural Competency, Health Care Reform, Health Care Reform: Advancing Equity, Health Literacy, Language Access | Leave a comment

Fenway Institute: Building Patient-Centered Medical Homes for Lesbian, Gay, Bisexual, and Transgender Patients and Families

This issue brief published by the National LGBT Health Education Center of the Fenway Institute uses the framework of a patient-centered medical home (PCMH) to improve health care and health outcomes for lesbian, gay, bisexual, and transgender (LGBT) patients and families. As an underserved and vulnerable population, LGBT people experience disparities in both health care and health status.

The issue brief provides practice improvement actions for improving care for LGBT patients and families that are linked to national standards for PCMHs. If a health care provider is going through the process of achieving PCMH recognition, these practice improvement actions can be used for a parallel evaluation of effectiveness in building a PCMH for LGBT patients and families. Those providers who have already achieved PCMH recognition can use this template to assess their current effectiveness in establishing a PCMH for LGBT patients and families.

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Posted in Author, Health Care Reform, Health Care Reform: Medical Homes, Lesbian, Gay, Bisexual and Transgender Health, Patient-Centeredness | Leave a comment

Why We Will Keeping Dancing

OrlandoLivesMatter

Over 26 years ago, I went to a gay club for the first time. I had just turned 30, finally coming out as a gay man to my closest friends, my family, and at work. The first few times I went to the gay clubs, I was terrified. Back then, I didn’t drink very much (one beer would make me dizzy), and I was painfully shy.

But there was something about the diversity of faces and bodies, the freedom with which people danced, and the energy of the music, that melted away my self-consciousness… and I soon realized that I just wanted to dance…to literally move my body and physically release all the worrying, all the internal struggle to come out, all my “praying away being gay”…and just dance…

And so the Box and I-Beam, and then Club Townsend, the End Up, 1015 Folsom, 715 Harrison, Club Eight, Ruby Skye and many other spaces became my places of refuge, places of creating community, places of liberation. In that journey, I was supported by my now-husband John, and then by dozens and dozens of friends (many who might be reading this).

Many other gay clubs around the U.S. (Los Angeles, San Diego, Sacramento, Honolulu, Seattle, Las Vegas, Denver, Minneapolis, Chicago, Houston, New Orleans, Atlanta, Boston, New York, Philadelphia, Washington, DC, Miami) and, luckily for me, around the world (Canada, Mexico, Brazil, Argentina, England, France, Spain, Portugal, Italy, Hong Kong, China, Thailand, Singapore, Australia), now are vital parts of my stories of my life as a gay man. Many of these clubs have long been gone, now condominiums and office buildings and retail stores; but others continue to welcome and host thousands of gay men on their dance floors. Those gay clubs continue to be the spaces that hold those stories, those coming out experiences, those vital moments in the lives of so many gay men like me.

So when the news of the mass killings at the Pulse gay club in Orlando finally began to sink in for me, I was flooded with my own memories of so many hours on the dance floors of so many gay clubs.

Almost every gay man will have his own stories about the gay clubs he has been to: the friends, lovers, boyfriends, and husbands met, the DJs who spun magical mixes, the songs that made us jump high in the air and get down low, the laser lights that flashed across the dancing bodies, the go-go dancers we admired, the live performances we cheered and sang along to, the flaggers who brought the colors of the rainbow onto the dance floor, the glow sticks that lit up our faces, the icy popsicles in the middle of morning, the sunrises we greeted when we finally left the club, and so much more…

And that is why it is so horrifying and so personal to learn that a killer invaded one of our sacred spaces, and ended the lives of so many. So many who could have been my friends. So many who could have been me.

That is why this mass killing hurts so much, has wounded each of us so deeply…

What gives me some solace and hope in my grief and anger is to read about the lives of the 49 men and women who were killed, to learn how their parents, their families, their friends, their co-workers – everyone in their lives – all testify to the life, the love, the kindness, the humor, the happiness, that each of them brought into the world. It gives me hope that soon, both our families of origin and our families created on the dance floors of gay clubs will just become “our family”.

As a gay man of color, I am especially grateful to learn how so many Latino families accepted and supported their gay sons, their gay brothers. This is a coming out moment for gay Latinos in the U.S.; through this horrific tragedy, we have eroded some of the invisibility of our gay Latino sons, our gay Latino brothers, our gay Latino cousins, our gay Latino friends…

But prayers and vigils and memorials are not enough.

We need to enact comprehensive federal, state, and local legal protections against discrimination based on sexual orientation and gender identity in employment, housing, credit, and public accommodations (including public bathrooms). We need to stand up to the National Rifle Association and enact common sense legislation prohibiting ownership of assault weapons and high caliber ammunition. And we need to insist on the adoption and continuous accountability for public policies and private business practices that fully recognize and unequivocally support all lesbian, gay, bisexual, and transgender people – as your family members, neighbors, co-workers, members of your faith communities, in every occupation and profession, elected officials, and community leaders.

And we who are lesbian, gay, bisexual, and transgender people – and our families, friends, and allies – must re-commit ourselves to work harder, to speak out louder, to act up more boldly, to give more, to do everything we can to achieve the full equality and liberation of all the members of our diverse communities.

In the names of those killed in Orlando, we will keep dancing…

For reflections that inspired mine, see:

Daniel Leon-Davis, The site of the Orlando shooting wasn’t just a gay nightclub. It was my safe haven, Fusion,net, June 12, 2016

Justin Torres, In praise of Latin night at the Queer Club, Washington Post, June 13, 2016

Richard Kim, Please Don’t Stop the Music, The Nation, June 12, 2016

 

Posted in Lesbian, Gay, Bisexual and Transgender Health, The iBau Blog | 7 Comments

American Medical Association: Action Kit on MACRA Proposed Rule

The American Medical Association (AMA) has published an “Action Kit” summarizing the proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA) and highlighting its preliminary comments and recommendations for changes to the proposed rule.

Among the issues that the AMA highlights for changes are mitigating the adverse impact of the proposed rule on solo and small group physician practices, reducing the two year look-back for the performance period, tailoring the quality measures for specialists and physicians in ambulatory rather than hospital-based practices, greater incentives for using electronic reporting of quality measures, more sophisticated and appropriate resource use measures, greater flexibility on health information exchange and patient engagement measures, the full year reporting for advancing care information, refining the definition of nominal risk for Advanced Alternate Payment Models (APMs), and more definition of APMs that are not “advanced” but would provide credits under the Merit Incentive Payment System (MIPS).

Many stakeholders are continuing the analyze the nearly 1,000 page proposed rule, and conducting information sessions to educate and mobilize their constituencies to comment on the proposed rule. Comments on the proposed rule are due on June 27, 2016.

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Posted in Health Care Reform, Health Care Reform: Accountable Care Organizations, Health Care Reform: Medical Homes, Health Care Reform: Payment Reform, Health Care Reform: Quality Improvement, Health Information Technology, Health Information Technology: Meaningful Use | Leave a comment

Office for Minority Health: Compendium of State-Level Activities and Legislation on National Standards for Culturally and Linguistically Appropriate Services

The U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) has published a compendium of state-sponsored activities and an interactive map listing state legislative activities implementing its National Standards for Culturally and Linguistically Appropriate Services (CLAS).  This is the first comprehensive listing of all these state-level activities.  The interactive map displays both enacted and pending state legislation in each state related to CLAS.

The compendium includes 172 activities from 32 states, including assessments, adoption of policies, integration into state-level planning, collaborations, dissemination of information, training, and technical assistance activities. Based on its review of these state-level activities, OMH recommends:

  1. Increase the depth, clarity, and concrete action steps in strategic planning for  National CLAS Standards implementation.

2. Make needs assessments a priority, use them to drive strategic planning and activities for National CLAS Standards implementation, and conduct them frequently enough to permit course-correction if activities are not meeting identified needs.

3. Incorporate evaluation of patient and population outcomes, in addition to evaluation of process measures, into National CLAS Standards implementation.

4. Assess the extent to which cultural and linguistic competency efforts are guided by the comprehensive framework of the National CLAS Standards.

5. Consider ways to streamline dissemination of National CLAS Standards implementation activities by using the National CLAS Standards as a framework for organizing all CLAS activities and developing a website that combines resources, reports, and strategic plans.

OMH has yet to compile and publish a similar compendium of activities by HHS’ own operating and staff divisions’ activities implementing CLAS.

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Posted in Cultural Competency, Cultural Competency: Frameworks, Cultural Competency: Training, Demographic Data, Health Care Disparities, Health Care Disparities: Stakeholders Engaged, Health Workforce Diversity, Language Access, Language Access: Standards | Leave a comment

National Health Law Program: Analysis of ACA Section 1557 Final Rule

This is the National Health Law Program’s initial analysis of the final rule implementing section 1557 of the Affordable Care Act (ACA) prohibiting discrimination in federally funded health programs and services on the basis of race, color, national origin, age, sex, and disability. The analysis highlights the broad application of the ACA’s prohibition against discrimination, and the key additions of sex and disability as protected classes under the law.

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Posted in Health Care Reform, Health Care Reform: Advancing Equity, Language Access, Language Access: Standards, Lesbian, Gay, Bisexual and Transgender Health | Leave a comment

U.S. Department of Health and Human Services Office of Civil Rights: Final Rule Prohibiting Discrimination Under Affordable Care Act

The U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) has issued its final rule implementing Section 1557 of the Affordable Care Act prohibiting discrimination on the basis of race, color, national origin, sex, age, and disability. Discrimination based on sex includes discrimination based on pregnancy, gender identity, and sex stereotyping. Discrimination based on national origin includes discrimination based on limited English proficiency.

While the final rule does not resolve whether discrimination on the basis of an individual’s sexual orientation status alone is a form of sex discrimination under Section 1557, the rule makes clear that OCR will evaluate complaints that allege sex discrimination related to an individual’s sexual orientation to determine if they involve the sorts of stereotyping that can be addressed under 1557. HHS supports prohibiting sexual orientation discrimination as a matter of policy and will continue to monitor legal developments on this issue.

The final rule also states that where application of any requirement of the rule would violate applicable federal statutes protecting religious freedom and conscience, that application will not be required.

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Posted in Health Care Reform, Health Care Reform: Advancing Equity, Language Access, Language Access: Standards, Lesbian, Gay, Bisexual and Transgender Health | Leave a comment

Centers for Medicare and Medicaid Services: MACRA Proposed Rule Fact Sheet about Small Practices

The Centers for Medicare and Medicaid Services (CMS) has published this fact sheet describing how small group physician practices (defined as practices with 15 or fewer physicians) and practices in rural or health professional shortage areas will be impacted and accommodated under CMS’ proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA).

For example, under the proposed rule, clinicians or groups who have less than or equal to $10,000 in Medicare charges AND less than or equal to 100 Medicare patients are excluded from any payment adjustment or penalty under the MACRA Merit Incentive Payment System (MIPS). In addition, if there are insufficient measures and activities applicable and available in any MIPS performance category, then the category would not be included in the MIPS score for that clinician or group (and the weight of other MIPS performance categories would be adjusted to make up the difference in the MIPS score). CMS also is inviting public comment on how solo and small group practices may join “virtual groups” and combine their MIPS reporting; such virtual group reporting would not be implemented until the second payment year, or fiscal year 2020.

MACRA also authorized up to $100 million over five years to provide technical assistance to small practices; on April 13, CMS quietly began the process to issue a request for proposals (RFP) for contractors to provide that technical assistance, but CMS has yet to release any details of the RFP except that the successful technical assistance contractors are expected to begin their work in November 2016.

The fact sheet also references CMS-funded technical assistance already in place through its Transforming Clinical Practice Initiative, which was launched in September 2015, and the ongoing payment reform developmental work being conducted by public and private stakeholders through the Health Care Payment Learning and Action Network.

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Posted in Health Care Reform, Health Care Reform: Payment Reform, Health Care Reform: Quality Improvement | Leave a comment

MACRA Physician-Focused Payment Model Technical Advisory Committee Issues Draft Proposal Review Process

The Physician-Focused Payment Model Technical Advisory Committee established by the Medicare Access and CHIP Reauthorization Act (MACRA) has issued a draft Proposal Review Process to review and recommend “physician-focused” Alternative Payment Models (APMs) for implementation through MACRA. The legislation established this Technical Advisory Committee of external subject matter experts to review and recommend APMs beyond what might be considered and recognized directly by the Centers for Medicare and Medicaid Services (CMS). The Committee is staffed by the Office of the Assistant Secretary for Planning and Evaluation (ASPE). With CMS’ publication of its proposed rule implementing MACRA, the role of this Technical Advisory Committee has received more attention.

Under the draft Proposal Review Process, the Technical Advisory Committee would accept ongoing submission of APM proposals (with no fixed deadlines or submission cycles). Proposals would undergo an ASPE staff review for completeness, then a preliminary review and scoring by 2-3 committee members, and finally, a review by the full committee. The full committee would make a recommendation about the proposal to the Secretary of Health and Human Services, with a minority report if needed. Pubic comment would be invited for proposals reviewed by the full committee. Technical assistance would be offered by ASPE staff for incomplete proposals and proposals with technical deficiencies. The draft Proposal Review Process does not address the criteria for defining APMs since those are included in the MACRA statute, and further described in CMS’ proposed rule.

The Technical Advisory Committee discussed the draft Proposal Review Process and heard public comments about it at its meeting on May 4, 2016. Additional public comments may be submitted to the committee until May 13, 2016; comments may be sent by email to <PTAC@hhs.gov>.

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Posted in Health Care Reform, Health Care Reform: Payment Reform | Leave a comment

Centers for Medicare and Medicaid Services: Additional Resources on MACRA Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) has made available two additional resources about its proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA).  The first resource is a set of slides describing the proposed rule.

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Then second resource is a slide deck with more specific information about the proposed Merit Incentive Payment System (MIPS) that most Medicare physicians will be using to seek additional bonus payments beginning in 2019.

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CMS also is conducting a series of webinars about the proposed rule to prepare for the public comment deadline of June 27, 2016.

Posted in Health Care Reform, Health Care Reform: Accountable Care Organizations, Health Care Reform: Medical Homes, Health Care Reform: Payment Reform, Health Care Reform: Quality Improvement, Health Information Technology, Health Information Technology: Meaningful Use | Leave a comment