PPH MOD 6.1 6.2 6.3 6.4

policy 6.1

a law regulation, procedure, administrative action, incentive, or voluntary practice of gov & other institutions

policy types 6.1

1. law/statute

2. ordinance

3. regulation

4. rule

5. guidance document

   AS YOU MOVE DOWN LESS PPL REACH VICE VERSA

law statute 6.1

• federal/state

• whole pop

• civil/criminal enforcement

ordinance 6.1

• local (council legislature)

• only those in jurisdiction

• fine

regulation 6.1

• non elected bureaucratic org

• only those specified by regulation

• fine

rule 6.1

• public/private org

• only those w/in org

• no but minor consequences

guidance doc 6.1

• any org w/interest in sum

• only those specified by doc

• no enforcement

policy process

1. identify problem

2. analyze policy

3. strategy & policy development

4. policy enactment

5. policy implementation

   PROCESS IS EVALUATED AT ALL STEPS CYCLE!!!

public health policies

1. infrastructural- enabling public health statues

2. interventional- federal, state, local policy designed to modify health risks

3. intersectoral- federal, state, local policy implemented by NON-HEALTH AGENCY for primary purpose other than health (intended/unintended) health effects

take home policy 6.1

policies have consequences, both intended/unintended

policy can be important determinant of health, even when not primarily intended to affect health

rescue imperative ‘rule of rescue’ 6.1

ppl more emotional to cases of individual misfortune (PATHOS FEELINGS)

ex: troubles of a small child highlighted on the news

technological imperative 6.1

biomedical technologies have > appeal than pop based interventions, they have greater funding for technological advances

visibility imperative 6.1

THINGS ARE GOOD UNTIL THEY’RE NOT

acts that occur behind the scenes remain invisible & taken for granted until crisis arise

individualism imperative 6.1

US culture values INDIVIDUALISM

PERSONAL RIGHTS OVER PUBLIC GOODS

federal lvl barriers 6.1

legislation hampered by partisanship

strong institutional norms and the disincentives do not allow collaboration between institutions (or makes it difficult) resulting in difficulty to tackling policy reform across multiple domains

immunizations 6.1

mid 1800s: RPh distribute smallpox vaccine

late 1800s/early 1900s: RPh oversee depots for diphtheria antitoxin

WWl: education for pts & providers on vaccinations

1960s: RPh distribute oral polio vaccine

1970: national task force recommends RPh to be allowed to administer drugs (immunizations)

1993:APhA recognizes RPh have 4 roles (education/mobilization, distribution, access/administration, registries & tracking systems)

1994: washington state pharmacy association first org immunization program

1995: two RPh went to MDs for collaboration on flu vaccines

1996: APhA developed immunization program

2001: 1st RPh joins CDC ACIP

2002: physicians support RPh vaccination

present: all 50 states allow RPh to immunize

health system 6.2

org of ppl, institutions, & resources that deliver healthcare services to meet the health needs of target pops

THINK UF HEALTH

health systems influence 6.2

• increase pop access to care

• incentives for health systems to improve care quality

• incentives for health systems to control care costs

national quality strategy 6.2

• brought up by the DHHS, DHHS made the AHRQ develop a national strategy quality in healthcare

• prompted by ACA in 2010

• published in 2011

• (3-6-9)

  adopt 3-aims

  that focus on 6-priorities

  use 9-levers to point out functions/resources/actions that improve healthcare quality

3 AIMS NQS 6.2

1. better care

2. healthy ppl/communities

3. affordable care

6 PRIORITIES NQS 6.2

1. health & well being

2. prevention & treatment for leading causes of death

3. ppl/family centered

4. pt safety

5. effective communication/care coordination

6. affordable care

9 LEVERS NQS 6.2

1. measurement/feedback

2. public reporting

3. learning & tech assistance

4. certification, accreditation, regulation

5. consumer incentives

6. payment

7. health info tech

8. innovation & diffusion

9. workforce development

accountable care org ACOs 6.2

• groups of providers that all accept responsibility for improving the overall health status, care efficiency, & healthcare experience for a defined pop

• relatively large systems

• consists of PCP, specialists, & greater than or equal to 1 hospital

• ACOs save MEDICARE $, they share the savings, when ACOs exceeds $ they pay back a share of the losses

ACO v HMO 6.2

ACOs DO NOT restrict provider choices for PCP or referrals

ACOs are the preferred structure for MEDICARE REIMBURSEMENT

ACO & pop health 6.2

• pt centered medical homes (PCMH)

• community resources in care coordination

• clinical/community prevention services

• needs assessments w/community COLLABORATIVE

• > use of CHW

ACO growth 6.2

2018- slowed growth

2021- declined growth

2022- enrollment is increasing

PCMH 6.2

care delivery model w/coordination, consisting of a centralized PCP facilitating partnerships between pts, and their personal MD & other MDs, & when appropriate pts families

MEDICARE COV 6.3

A- hospitalizations (payroll taxes)

B- regular office visits cov (monthly premium)

C- medicare advantage, allows enrollment in private plans (HMO/PPO) as alt to traditional MEDICARE

D- meds Rxs (monthly premium)

MEDICAID COV 6.3

childrens health insurance program CHIP- children < 19 low income IN NEED (STATE)

social security disability insurance SSDI- approved disability (FEDERAL)

CMS budget 2025 6.3

CMS represented ~85% of HHS budget in 2025

take home MEDICAID 6.3

prior to the ACA MEDICAID eligibility was limited to specific low income groups

MEDICAID usage 6.3

most MEDICAID enrollees are children, most spenders are the elderly & PWD

MEDICAID & CHIP cover more than 1 in 3 children in US & >50% of all children in low-income families

1 out of 5 ppl in US enrolled in MEDICAID

take home MEDICAID 2 6.3

MEDICAID continues to evolve, but evolving does not = growth

take home MEDICARE 6.3

parts A&B= original MEDICARE

part C= MA MEDICARE ADVANTAGE

part C gaining popularity in enrollment!

MEDICARE D 6.3

more than half of all MEDICARE D enrollees are now in MA plans; enrollment in PDP (MEDICARE D) has declined since 2019

take home MEDICARE & MEDICAID 6.3

from 2004-2024, MEDICARE & MEDICAID comprised a greater proportion of US gov spending

take home gov spending 6.3

in 2024 US gov spending on public health insurance programs topped $1.6 trillion

take home federal budget 6.3

MEDICARE & MEDICAID comprise between 20-25% of the total US budget in recent yrs

ACA 6.4

• most comprehensive piece of healthcare legislation since 1965 medicare & medicaid

• published in 2011

take home on spending 6.4

SPENDING PRIMARILY OCCURS VIA THIRD PARTIES, NOT CONSUMERS

US= low personal expenditure on healthcare

ACA BIG CHANGES 6.4

1. bans against lifetime limits

2. insurances can no longer deny ppl w/pre-existing conditions

3. insurances can no longer drop pts when they get sick

4. preventative care & screenings must be covered by all new plans

5. adjust rates to stop charging men/women differently = SAME RATES

take home medicaid expansion 6.4

by 2022 39 states & DC adopted medicaid expansion

take home covid 6.4

COVID era brought both additional spending & enrollment & spending

take home ACA influence 6.4

policy like ACA influences pts by

1. access care

2. experience care quality

3. pay for care

take home main message 6.4

when evaluating whether or not a policy discussion has an impact on pts consider that ALL POLICIES & PROGRAMS THAT INFLUENCE HEALTH ARE “HEALTH POLICIES”