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Strategic Objective
Ensure access to quality, culturally competent care, including long-term services and supports, for vulnerable populations
Strategic Objective
Overview
With the growing diversity of the U.S. population, healthcare providers are increasingly called on to address their patient's unique social and cultural experience and language needs. The Affordable Care Act highlights minority health by formally establishing minority health offices in the Department's agencies, and contains provisions to improve data collection and analysis. HHS is working to address disparities by promoting access to quality primary care and preventive services, developing a diverse, culturally-competent workforce, and preventing discriminatory practices.
Read Less...Progress Update
Please note that this section summarizes the result of the FY 2014 HHS Strategic Review process, limiting the scope of content to that available prior to spring of 2015. Due to this constraint, the following may not be the most current information available.
Conclusion: Progressing
Analysis: Important progress has been made for this objective; data from the HHS Action Plan to Reduce Racial and Ethnic Health Disparities shows that progress has been made in implementing more than 90 percent of the plan’s action steps. For example, the Department of Health and Human Services leads the dissemination and implementation of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, to date awarding more than 1 million continuing education credits to providers who have completed e-learning programs designed to improve the competency of providers to deliver culturally and linguistically appropriate care to diverse populations. Numerous studies have also shown racial and ethnic minority practitioners are more likely to practice in medically underserved areas. Currently nearly 30 percent of the 9,200 clinicians serving in the National Health Service Corps are from minority groups, while more than half of the 1,100 Corps scholars in the training pipeline are from minority groups. Grantees are building networks with community health care facilities to promote effective, culturally appropriate, trauma-informed services that improve the safety and well-being of victims of human trafficking. Another example of culturally appropriate services is the Tribal Home Visiting program which is designed to utilize home visiting approaches to strengthen tribal capacity to support and promote the health and well-being of American Indian and Alaska Native families.
Though many people served by federally funded health centers are sicker and more frequently at risk than the national average progress has been made in serving a variety of conditions. The Ryan White HIV/AIDS Program provides HIV primary medical care, treatment, and supportive services to 56 percent of the people who have been diagnosed with HIV in the United States. Data show that 75 percent of these patients are virally suppressed, while overall in the U.S. only 30 percent of people living with HIV are virally suppressed. In another example, the rate of low birth weight babies born to health center patients has declined to 7.29 percent, lower than the national average of 7.99 percent. Sixty-three percent of health center patients with hypertension had their blood pressure controlled, exceeding the national average of 48.9 percent. Rural providers and patients experiencing depression in Indian country have benefitted from using televideo services for a range of behavioral health services and training and technical assistance. More than 100 rural communities were awarded grants to support access to care including grants that improve emergency medical services, provide resources for implementing telehealth solutions, or help communities build networks of care.
Surveys and focus groups were used by Medicare and Marketplace programs to understand perceptions and behaviors of consumers and guide messaging to support outreach and enrollment efforts. Through segmented analysis, CMS knows that about 25 percent of the uninsured are active seekers of health care information but need additional support to enroll in health care. In 2014 the Medicare language line handled 63,644 calls in 193 different languages, while the Marketplace Call Center handled 279,538 calls in 246 different languages.
The review identified a challenge related to refugee health. There is the lack of institutionalized shared resources supporting domestic refugees. There are gaps in health literacy and culturally appropriate care; mainstream service providers can approach clients with messages that may not resonate with refugees due to lack of familiarity with Western medicine concepts and care. Another challenge relates to the Veterans Administration which has been using Provider Agreements to pay the Aging and Disability Network for veterans’ long term services and supports. Recently the VA has ceased using Provider Agreements until the statute is amended. Approximately 400 Veterans and their families in 13 states are at risk of losing service. Another group that is affected by limitations to high quality health care includes individuals that live in states that have not expanded Medicaid. Adults may fall into a “coverage gap” of having incomes above Medicaid eligibility but below the Marketplace premium tax credit income eligibility. Health centers in these states may provide services that may not be fully reimbursed. High quality care is based on having well-trained providers and National Health Service Corps Scholarship program was only able to fund 10 percent of applicants, indicating high demand for this program.
In the coming year, HHS plans to improve results and better manage progress by developing a Priority Goal related to improving access for those affected by serious mental illness. HHS is working to provide states an option to eliminate the assignment of court ordered medical support as a requirement of receiving Medicaid. In addition, HHS will solicit applications for a second phase of an initiative to reduce preventable inpatient hospitalizations among residents of nursing facilities while identifying the impact of a new payment model.
